Democritus University of Thrace, Alexandroupolis, Greece.
University General Hospital of Alexandroupolis, Greece.
Ann R Coll Surg Engl. 2022 Mar;104(3):e81-e83. doi: 10.1308/rcsann.2021.0122. Epub 2021 Nov 23.
Acute appendicitis is common in patients with right lower quadrant pain and affects all gender and age groups. Because clinical diagnosis of patients with right lower quadrant pain remains a challenge to emergency physicians and surgeons, imaging is of major importance. Ultrasound has well-established direct and indirect signs for diagnosing acute appendicitis and revealing the presence of an appendicolith. Appendectomy, which can be either open or laparoscopic, constitutes the basic treatment. However, the need for an appendectomy is debatable, particularly in high-risk patients. We report the case of a 42-year-old woman with no relevant medical history who was sent to the emergency department by her family physician with right lower quadrant pain of 18 hours' duration. Using ultrasound, the emergency physicians identified, inside the appendix, a 0.6cm appendiceal faecolith, migration of which was eventuated by manipulation of the ultrasound probe. The patient was then successfully treated non-operatively without any antibiotic prescription. Despite its rarity, migration of an appendiceal faecolith is possible. When migration of an appendicolith is perhaps actualised spontaneously or by ultrasound probe manipulation, the likelihood of an appendectomy decreases dramatically. This hypothesis provides patients who present an appendiceal faecolith with an alternative treatment approach that will lead to the avoidance of surgery, minimise morbidity and reduce hospitalisation costs.
急性阑尾炎是右下腹痛患者的常见病症，影响所有性别和年龄组。由于对急诊医生和外科医生来说，对右下腹痛患者的临床诊断仍然具有挑战性，因此影像学具有重要意义。超声检查具有明确的直接和间接征象，可用于诊断急性阑尾炎并显示阑尾结石的存在。阑尾切除术，可采用开腹或腹腔镜，构成基本治疗。然而，阑尾切除术的必要性存在争议，特别是在高危患者中。我们报告了一位 42 岁的女性病例，她没有相关的病史，由家庭医生转送至急诊部，右下腹痛持续了 18 小时。急诊医生使用超声检查在阑尾内发现了一个 0.6 厘米的阑尾粪石，通过超声探头的操作导致了粪石的迁移。然后，患者成功地接受了非手术治疗，没有开具任何抗生素处方。尽管这种情况很少见，但阑尾粪石确实有可能发生迁移。当阑尾结石的迁移可能是自发发生的，或者是通过超声探头操作引起的时，阑尾切除术的可能性会显著降低。这一假设为出现阑尾粪石的患者提供了一种替代治疗方法，可以避免手术，将发病率降至最低，并降低住院费用。
