Evola Giuseppe, Ferrara Francesco, Di Fede Giovanni Francesco, Patanè Marco, Sarvà Salvatore, Piazza Luigi
General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy.
General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100 Catania, Italy.
Int J Surg Case Rep. 2022 Jan;90:106658. doi: 10.1016/j.ijscr.2021.106658. Epub 2021 Dec 4.
Left-sided acute appendicitis (LSAA) is a very rare cause of acute abdomen, developing in association with two types of congenital anomalies like as situs viscerum inversus (SVI) and midgut malrotation (MM). Preoperative diagnosis of LSAA is a challenge because of its rarity and atypical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents the standard treatment of LSAA.
A 67-year-old Caucasian male with presented to the Emergency Department with a two-day history of left lower quadrant (LLQ) abdominal pain, nausea, vomiting, diarrhea and fever. Physical examination revealed LLQ abdominal rebound tenderness with guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal contrast-enhanced computed tomography showed a LSAA with intraluminal appendicoliths, fat infiltration and pericecal fluid collection in a patient with SVI. The patient underwent laparoscopic appendectomy: a gangrenous and perforated appendicitis was sectioned and removed with drainage of pericecal abscess. The postoperative course of the patient was uneventful.
LSAA is characterized by anatomical variation of appendix and atypical presentation. Preoperative clinical diagnosis of LSAA is very difficult and imaging may be helpful for determining the correct diagnosis, as well as confirming SVIT or MM. Laparoscopic appendectomy represents the correct treatment of LSAA.
LSAA is a rare surgical emergency that should be considered in the differential diagnosis of patients with LLQ abdominal pain. Preoperative diagnosis of LSAA needs a high index of suspicion and is facilitated by imaging. Surgery represents the appropriate treatment of LSAA.
左侧急性阑尾炎（LSAA）是急性腹痛的一种非常罕见的病因，其发生与两种先天性异常有关，如内脏反位（SVI）和中肠旋转不良（MM）。由于其罕见性和非典型表现，LSAA的术前诊断具有挑战性。影像学检查可能有助于做出正确诊断。手术是LSAA的标准治疗方法。
一名67岁的白种男性因左下腹（LLQ）腹痛、恶心、呕吐、腹泻和发热两天而就诊于急诊科。体格检查发现左下腹有反跳痛并伴有肌紧张。实验室检查报告显示C反应蛋白水平升高和中性粒细胞增多。腹部增强计算机断层扫描显示一名患有SVI的患者存在伴有腔内阑尾结石、脂肪浸润和盲肠周围积液的LSAA。患者接受了腹腔镜阑尾切除术：切除了坏疽穿孔性阑尾炎，并引流了盲肠周围脓肿。患者术后恢复顺利。
LSAA的特点是阑尾解剖变异和非典型表现。LSAA的术前临床诊断非常困难，影像学检查可能有助于做出正确诊断，以及确认SVI或MM。腹腔镜阑尾切除术是LSAA的正确治疗方法。
LSAA是一种罕见的外科急症，在左下腹腹痛患者的鉴别诊断中应予以考虑。LSAA的术前诊断需要高度怀疑，并借助影像学检查。手术是LSAA的合适治疗方法。
