Department of Gastroenterology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang, Wuhan, 430060, Hubei, China.
Department of Surgery, Infectious Disease Hospital Affiliated to Nanchang University (Nanchang Ninth Hospital), 167 Hongdu Middle Avenue, Qingshanhu District, Nanchang, 330002, Jiangxi, China.
Sci Rep. 2022 Jul 21;12(1):12464. doi: 10.1038/s41598-022-16682-6.
Differential diagnosis and management for perforated appendicitis and non-perforated appendicitis are current hot topics. The aim of this study is to demonstrate a new entity of non-perforated appendicitis, "acute hemorrhagic appendicitis" through studying cluster of acute appendicitis among Tibetan students at a high school in central China. Over the 11-year period, there were 120 patients with more female patients (102 of 499, 20.4%) than male patients (18 of 474, 3.8%) among 973 Tibetan students. 117 patients' clinical data were available. Clinical manifestations were identical to classic appendicitis. However, axilla temperature, white blood cell counts and neutrophil level were elevated mildly in 12 (10.3%), 19 (16.2%) and 12 (10.3%) patients respectively. Pathologically, the resected appendices exhibited focal or diffuse hemorrhages in mucosa and/or submucosa, and infiltration by eosinophil and by lymphocytes. No patients had perforated appendicitis. The median time from the onset to surgery was 3 days (IQR, 2-4). All patients were discharged with full recovery. In conclusion, "acute hemorrhagic appendicitis" represented a new entity of non-perforated appendicitis with unique cause and pathogenesis, which might be treated with antibiotics alone or self-limited. Studying the cluster is a reliable method to find new entity of appendicitis.
穿孔性阑尾炎和非穿孔性阑尾炎的鉴别诊断和处理是当前的热门话题。本研究旨在通过研究中国中部一所高中藏族学生急性阑尾炎的聚集情况，证明一种新的非穿孔性阑尾炎实体，即“急性出血性阑尾炎”。在 11 年期间，973 名藏族学生中有 120 名患者（102 名女性患者/499 名，20.4%）多于男性患者（18 名男性患者/474 名，3.8%）。117 名患者的临床数据可用。临床表现与经典阑尾炎相同。然而，12 名（10.3%）、19 名（16.2%）和 12 名（10.3%）患者的腋窝温度、白细胞计数和中性粒细胞水平分别轻度升高。病理上，切除的阑尾在黏膜和/或黏膜下层显示局灶性或弥漫性出血，以及嗜酸性粒细胞和淋巴细胞浸润。无患者发生穿孔性阑尾炎。从发病到手术的中位数时间为 3 天（IQR，2-4）。所有患者均完全恢复出院。总之，“急性出血性阑尾炎”代表了一种新的非穿孔性阑尾炎实体，具有独特的病因和发病机制，可能单独用抗生素或自行缓解治疗。研究聚集性是发现阑尾炎新实体的可靠方法。
