Duan Xing-Xing, Peng Ya, Yang Liu, Chen Wen-Juan, Tang Xiang-Lian
Department of Ultrasound.
Department of paediatric surgery, Hunan Children's Hospital, Changsha, Hunan Province, China.
Medicine (Baltimore). 2020 Dec 4;99(49):e23452. doi: 10.1097/MD.0000000000023452.
Appendiceal intussusception is a rare disease. The definite preoperative diagnosis of appendiceal intussusception is rare and challenging. Here, we present a case of McSwain type V appendiceal intussusception in a 10-year-old boy. To our best knowledge, this is the first case report of a type V appendiceal intussusception that was preoperatively confirmed with sonography. Here, we have described in detail the ultrasound features and differential diagnosis of this rare disease.
A 10-year-old boy presented with 3 days of recurrent intermittent mild abdominal pain. The result of ultrasonography suggested an ileocolic intussusception and a therapeutic air-contrast enema was requested to reduce the intussusception but failed at a local hospital.
Physical exam revealed mild tenderness in the lower right quadrant of the abdomen. However, ultrasonography showed a target-sign in cross section and a finger-like appearance in the longitudinal view. A diagnosis of McSwain type V appendiceal intussusception was made.
The patient underwent an appendectomy after successful manual reduction on laparotomy. The appendix was successfully resected.
Intraoperatively, the appendix was completely inverted in the cecum, and the preoperative sonographic findings were confirmed. During follow-up, there were no signs of recurrence.
Pre-operatively, on ultrasound a type V appendiceal intussusception is usually misdiagnosed as an ileocolic intussusception. Radiologists must execute caution to avoid over reliance on the sonographic findings of intussusception, especially when there is a mismatch with clinical symptoms. It is especially important to accurately understand the surgical-anatomic configuration of type V appendiceal intussusception that creates a "target-sign" and a "finger-like" layout on ultrasonography.
阑尾套叠是一种罕见疾病。术前明确诊断阑尾套叠很罕见且具有挑战性。在此，我们报告一例10岁男孩的麦克斯文V型阑尾套叠病例。据我们所知，这是首例术前经超声确诊的V型阑尾套叠病例报告。在此，我们详细描述了这种罕见疾病的超声特征及鉴别诊断。
一名10岁男孩出现反复间歇性轻度腹痛3天。超声检查结果提示回结肠套叠，当地医院要求进行治疗性气钡灌肠以复位套叠，但未成功。
体格检查发现腹部右下腹轻度压痛。然而，超声检查显示横断面呈靶征，纵断面呈指状外观。诊断为麦克斯文V型阑尾套叠。
患者在剖腹手术中成功手法复位后接受了阑尾切除术。阑尾被成功切除。
术中，阑尾完全倒位于盲肠内，术前超声检查结果得到证实。随访期间，无复发迹象。
术前，超声检查时V型阑尾套叠通常会被误诊为回结肠套叠。放射科医生必须谨慎，避免过度依赖套叠的超声检查结果，尤其是当与临床症状不相符时。准确理解V型阑尾套叠的手术解剖结构尤为重要，这种结构在超声检查时会形成“靶征”和“指状”布局。
