Almansouri Omar, Algethmi Abdulrahman M, Qutub Majed, Khan Muhammad A, Mazraani Nadia
Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Medical Student, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU.
Cureus. 2022 Dec 2;14(12):e32130. doi: 10.7759/cureus.32130. eCollection 2022 Dec.
The objective of this report is to present a rare case of chronic appendicitis with an atypical presentation. The patient presented with intermittent periumbilical pain without any other symptom, relieved by an anti-inflammatory, and later incidentally diagnosed on computed tomography (CT) scan. The patient was managed with an appendectomy during laparoscopic exploration. A 61-year-old male, with a history of renal calculi, managed type 2 diabetes mellitus, managed hypertension, and ischemic heart disease who underwent percutaneous coronary intervention 10 years ago, presented to the clinic for a CT scan to follow up a non-obstructing renal calculus diagnosed previously. The imaging showed incidental appendiceal findings, and the patient informed the medical team that he had been experiencing intermittent periumbilical pain once every 4-12 weeks for the past year, which was not associated with fever, nausea, or vomiting. At that time, oral non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed, following which his symptoms subsided. A few days later, he presented to the clinic with the same complaint. The patient underwent laparoscopic exploration after numerous clinic visits and was diagnosed with chronic appendicitis. Chronic appendicitis should be explored in afebrile patients with periumbilical pain lasting for several days without other symptoms or predisposing factors. It should also be suspected in patients with recurrent or intermittent vague abdominal pain that subsides with NSAIDs. A CT scan of the abdomen should be conducted, and if the results confirm or imply chronic appendicitis, appendectomy is the preferred therapy.
本报告的目的是呈现一例表现不典型的慢性阑尾炎罕见病例。患者表现为间歇性脐周疼痛，无其他症状，服用抗炎药后缓解，后来经计算机断层扫描（CT）偶然确诊。患者在腹腔镜探查期间接受了阑尾切除术。一名61岁男性，有肾结石病史，2型糖尿病、高血压及缺血性心脏病经治疗，10年前接受过经皮冠状动脉介入治疗，因之前诊断的非梗阻性肾结石前来诊所进行CT扫描随访。影像学检查显示阑尾有偶然发现，患者告知医疗团队，在过去一年里他每4 - 12周就会出现一次间歇性脐周疼痛，与发热、恶心或呕吐无关。当时给他开了口服非甾体抗炎药（NSAIDs），之后他的症状缓解。几天后，他因同样的症状再次就诊。在多次门诊就诊后，患者接受了腹腔镜探查，被诊断为慢性阑尾炎。对于无发热、脐周疼痛持续数天且无其他症状或易感因素的患者，应考虑慢性阑尾炎。对于复发性或间歇性模糊腹痛且服用NSAIDs后缓解的患者也应怀疑。应进行腹部CT扫描，如果结果证实或提示慢性阑尾炎，阑尾切除术是首选治疗方法。
