Lloyd A J, Abd Elwahab S M, Boland M R, Elfadul A, Hill A D K, Power C
Department of Surgery, Beaumont Hospital, Dublin, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Surgery, Beaumont Hospital, Dublin, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Int J Surg Case Rep. 2022 Mar;92:106872. doi: 10.1016/j.ijscr.2022.106872. Epub 2022 Feb 25.
Acute appendicitis is one of the most common presentations to the emergency department, particularly in young adults. A combination of clinical suspicion, inflammatory blood markers and imaging modalities such as ultrasound and CT are used for its definitive diagnosis. Early detection and intervention are paramount to reduce morbidity and mortality. Laparoscopic appendicectomy is the current gold standard in the management of appendicitis, especially if complicated according to EAES guidelines. There are few documented cases in the literature of acute appendicitis secondary to foreign body ingestion. On account of this, there are currently no guidelines for its management. Our literature review highlights the importance of surgical management of foreign body acute appendicitis.
This case report describes the rare presentation of acute complicated appendicitis caused by an ingested toothpick in a 64 year old woman. The patient was admitted with a 3 day history of lower abdominal pain, localizing to the right iliac fossa with raised inflammatory markers. CT imaging reported acute complicated appendicitis. Laparoscopic appendicectomy was performed during which a toothpick was seen protruding through the appendiceal wall. Post operatively the patient was treated with IV antibiotics for 5 days prior to discharge.
Due to the rare nature of foreign body appendicitis there are no specific guidelines on the respective surgical approach. A literature review showed that in the setting of foreign body appendicitis, surgical intervention is paramount with no scope for conservative management.
Surgical approach is based on the clinical judgement and skillset of the operating surgeon.
急性阑尾炎是急诊科最常见的病症之一，尤其在年轻成年人中。临床怀疑、炎症血液标志物以及超声和CT等影像学检查手段相结合用于其明确诊断。早期发现和干预对于降低发病率和死亡率至关重要。腹腔镜阑尾切除术是目前阑尾炎治疗的金标准，特别是根据欧洲内镜外科学会（EAES）指南判定为复杂情况时。文献中记录的异物吞食继发急性阑尾炎的病例很少。因此，目前尚无针对其治疗的指南。我们的文献综述强调了异物性急性阑尾炎手术治疗的重要性。
本病例报告描述了一名64岁女性因吞食牙签导致罕见的急性复杂性阑尾炎。患者因下腹部疼痛3天入院，疼痛定位于右下腹，炎症标志物升高。CT成像显示为急性复杂性阑尾炎。进行了腹腔镜阑尾切除术，术中可见一根牙签从阑尾壁穿出。术后患者在出院前接受了5天的静脉抗生素治疗。
由于异物性阑尾炎的罕见性，对于各自的手术方法没有具体指南。文献综述表明，在异物性阑尾炎的情况下，手术干预至关重要，没有保守治疗的余地。
手术方法基于主刀医生的临床判断和技能水平。
