Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
Department of Radiology, University of Palermo, Palermo, Italy.
Eur J Med Res. 2023 Feb 20;28(1):85. doi: 10.1186/s40001-023-01059-w.
Acute appendicitis is one of the most frequent intra-abdominal diseases requiring emergency surgical consult and treatment. The diagnosis of this condition is based on clinical features and radiologic findings. One-third of patients with acute appendicitis present unusual symptoms. There are several circumstances that may cause misdiagnosis and unclear prognostic prediction. Among these, situs viscerum inversus totalis and midgut malrotation can be challenging scenarios, leading to a delay in treatment, especially when these conditions are unknown. We decided to carry on a systematic review of published cases of acute appendicitis in the context of anatomical anomalies.
We used the MESH terms "appendicitis" AND "situs inversus" AND/OR "gut malrotation" to search for titles and abstracts. Inclusion criteria were patients with clinical and/or radiological diagnosis of acute appendicitis, with conservative or surgical management and with preoperative/intraoperative findings of situs viscerum inversus or gut malrotation. Additionally, previous reviews were examined. Exclusion criteria of the studies were insufficient patient clinical and demographic data.
We included in this review 70 articles concerning 73 cases of acute appendicitis with anatomical anomaly. Patients were aged from 8 to 86 years (median: 27.0 years). 50 were male and 23 were female. 46 patients (63%) had situs viscerum inversus, 24 (33%) had midgut malrotation, 2 (2.7%) had Kartagener's syndrome, one of them (1.4%) had an undetermined anomaly In 61 patients the anatomical anomaly was unknown previously (83.6%), while 16,4% already were aware of their condition.
Acute appendicitis can occur in association of rare anatomical anomalies and in these cases diagnosis can be challenging. Situs viscerum inversus and midgut malrotation should always be considered in the differential diagnosis of a patient with left lower quadrant pain, especially in younger population. Besides clinical features, it is fundamental to implement the diagnostic progress with radiological examination. Laparoscopic approach is useful to identify and treat acute surgical emergency and it is also a diagnostic tool and can be tailored in order to offer the best exposition of the operatory field for each single case.
急性阑尾炎是最常见的需要紧急外科咨询和治疗的腹部疾病之一。这种疾病的诊断基于临床特征和影像学发现。三分之一的急性阑尾炎患者表现出不寻常的症状。有几种情况可能导致误诊和预后预测不明确。其中，内脏转位和中肠旋转不良可能是具有挑战性的情况，导致治疗延迟，尤其是在这些情况未知的情况下。我们决定对解剖异常背景下的急性阑尾炎发表病例进行系统回顾。
我们使用 MESH 术语“阑尾炎”和“内脏转位”和/或“肠旋转不良”来搜索标题和摘要。纳入标准为有临床和/或影像学诊断为急性阑尾炎、接受保守或手术治疗、术前/术中发现内脏转位或肠旋转不良的患者。此外，还检查了以前的综述。研究的排除标准为患者的临床和人口统计学数据不足。
我们共纳入 70 篇文章，共 73 例解剖异常的急性阑尾炎患者。患者年龄 8 至 86 岁（中位数：27.0 岁）。50 名男性，23 名女性。46 名患者（63%）有内脏转位，24 名（33%）有中肠旋转不良，2 名（2.7%）有 Kartagener 综合征，其中 1 名（1.4%）有未确定的异常。61 名患者以前未知有解剖异常（83.6%），而 16.4%的患者已经知道自己的情况。
急性阑尾炎可发生于罕见的解剖异常，在这些情况下，诊断可能具有挑战性。对于左下腹疼痛的患者，尤其是年轻患者，应始终考虑内脏转位和中肠旋转不良的鉴别诊断。除了临床特征外，影像学检查对于诊断进展至关重要。腹腔镜方法有助于识别和治疗急性外科急症，它也是一种诊断工具，可以根据每个病例的具体情况进行调整，以提供最佳的手术视野暴露。
