Du Zhi-Qiang, Ding Wen-Juan, Wang Fei, Zhou Xiang-Rong, Chen Tian-Ming
Department of Gastroenterology, Jianyang People's Hospital of Sichuan Province, Jianyang 641400, Sichuan Province, China.
World J Clin Cases. 2021 Jan 6;9(1):245-251. doi: 10.12998/wjcc.v9.i1.245.
Appendectomy is the procedure of choice for the treatment of acute appendicitis. However, surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis (AP). Endoscopic retrograde appendicitis treatment (ERAT) may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.
We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy. One patient had moderately severe AP due to hyperlipidemia, while the other patient had a gallstone induced by moderately severe AP. Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP. Therefore, the alternative and minimally invasive ERAT was considered. After written informed consent was collected from the patients, the ERAT procedure was performed. Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.
ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.
阑尾切除术是治疗急性阑尾炎的首选术式。然而，对于合并严重疾病或存在诸如急性胰腺炎（AP）等合并症的患者，手术可能并不适宜。内镜逆行阑尾炎治疗术（ERAT）对于现有内科治疗失败的此类患者而言，可能是一种替代手术的新方法。
我们报告2例中度重症AP患者，他们在住院期间并发急性单纯性阑尾炎且对传统内科治疗无反应。1例患者因高脂血症导致中度重症AP，另1例患者因中度重症AP诱发胆结石。由于同时存在AP，2例患者均不适合接受阑尾切除手术。因此，考虑采用替代性的微创ERAT。在获得患者书面知情同意后，实施了ERAT手术。2例患者在ERAT术后均恢复迅速，手术创伤极小。
ERAT对于合并AP的急性阑尾炎患者而言，是一种安全有效的微创内镜手术。
