Mizuta Noritoshi, Nakanishi Takashi, Tsunemi Kozo
Department of Surgery, Akashi Medical Center, Akashi, Hyogo 674-0063, Japan.
Int J Surg Case Rep. 2020;67:146-149. doi: 10.1016/j.ijscr.2020.01.033. Epub 2020 Feb 6.
The management of appendiceal abscess or phlegmon is a clinical important issue. Immediate appendectomy in these cases may be technically demanding because of the distorted anatomy and difficult to close the appendiceal stump because of the inflammation.
A 32-year-old female was referred to our hospital with abdominal pain. Enlarged appendix and abscess were recognized on CT scan. Preoperative diagnosis was perforated appendicitis with abscess and laparoscopic surgery was performed. The appendix was perforated and cut by stapler, but complete resection was impossible. Endoscopic transrectal drainage was performed for a pelvic abscess on the 10th POD and the patient's condition improved. Thirty months after the surgery, however, the patient was again referred to our hospital for abdominal pain. CT scan revealed an enlarged remnant appendix. Preoperative diagnosis was stump appendicitis after the incomplete first appendectomy. Emergent second appendectomy and partial resection of the cecum were performed. The postoperative course was uneventful.
In the first operation, we mistakenly thought that the base of the appendix was cut. It was not cut, however and it remained, which was lead to stump appendicitis. Furthermore, postoperative abdominal abscess was also occurred. Immediate appendectomy for perforated appendicitis with abscess is associated with a higher morbidity. Nonsurgical treatment with drainage and/or antibiotics should be selected. Laparoscopic drainage is the useful options when CT-guided drainage is impossible.
It is crucial to understand the correct management of perforated appendicitis with abscess to avoid serious complications.
阑尾脓肿或阑尾周围炎的处理是一个临床重要问题。在这些病例中，立即进行阑尾切除术在技术上可能具有挑战性，因为解剖结构扭曲，且由于炎症难以闭合阑尾残端。
一名32岁女性因腹痛被转诊至我院。CT扫描显示阑尾肿大并伴有脓肿。术前诊断为穿孔性阑尾炎伴脓肿，遂行腹腔镜手术。阑尾已穿孔并使用吻合器切断，但无法完全切除。术后第10天对盆腔脓肿进行了内镜经直肠引流，患者病情好转。然而，术后30个月，患者因腹痛再次被转诊至我院。CT扫描显示残余阑尾肿大。术前诊断为首次阑尾切除不完全后的阑尾残株炎。急诊行二次阑尾切除术及部分盲肠切除术。术后过程顺利。
在首次手术中，我们错误地认为阑尾根部已被切断。然而，它并未被切断，而是残留了下来，这导致了阑尾残株炎。此外，术后还发生了腹腔脓肿。对于穿孔性阑尾炎伴脓肿立即进行阑尾切除术的发病率较高。应选择引流和/或抗生素的非手术治疗。当无法进行CT引导下引流时，腹腔镜引流是一种有用的选择。
了解穿孔性阑尾炎伴脓肿的正确处理方法对于避免严重并发症至关重要。
