克罗恩病合并急性阑尾炎患者首例经内镜逆行阑尾炎治疗的病例报告
First human case report of Crohn's disease with coexistent acute appendicitis treated by endoscopic retrograde appendicitis therapy.
作者信息
Cui Guang-Xing, Zulqarnain Muhammad, Lou Qi-Feng, Shen Hong-Zhang, Lyu Wen, Wang Xia, Huang Haitao, Mohamoud Abdi Hamse, Gu Lingfei, Fang Shijie, Liu Fangzhou, Ling Liqian, Huang Yu, Chu Linglin, Saeed Saboor
机构信息
Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China.
出版信息
Front Med (Lausanne). 2023 Jun 9;10:1171463. doi: 10.3389/fmed.2023.1171463. eCollection 2023.
BACKGROUND
The coexistence of Crohn's disease (CD) and acute appendicitis (AA) is rare. In this situation, therapeutic experience is lacking and the strategy is paradoxical and intractable. Appendectomy is the gold standard for the treatment of AA whereas a nonsurgical approach is recommended for CD.
CASE SUMMARY
A 17-year-old boy was hospitalized for right lower abdominal pain with fever of 3 days. He had the CD for 8 years. Two years ago, he underwent surgery for anal fistula with the complication of CD. His temperature was elevated at 38.3°C at admission. On physical examination, there was McBurney tenderness with mild rebound tenderness. Abdominal ultrasonography showed that the appendix was notably enlarged and dilated at 6.34 cm long and 2.76 cm wide. These findings were suggestive of uncomplicated AA in this patient with active CD. Endoscopic retrograde appendicitis therapy (ERAT) was performed. The patient had complete pain relief immediately after the procedure without tenderness in the right lower abdomen. During 18 mo follow-up, he had no more attacks in his right lower abdomen.
CONCLUSION
ERAT was effective and safe in a CD patient with coexisting AA. Such cases can avoid surgery and its-related complications.
背景
克罗恩病（CD）与急性阑尾炎（AA）并存的情况较为罕见。在此种情况下，缺乏治疗经验，治疗策略矛盾且棘手。阑尾切除术是治疗AA的金标准，而对于CD则推荐非手术治疗方法。
病例摘要
一名17岁男孩因右下腹痛伴发热3天入院。他患CD已有8年。两年前，他因肛瘘接受手术，术后出现CD并发症。入院时体温升至38.3°C。体格检查发现麦氏点压痛，伴有轻度反跳痛。腹部超声显示阑尾明显肿大、扩张，长6.34 cm，宽2.76 cm。这些表现提示该患有活动性CD的患者为非复杂性AA。遂行内镜逆行阑尾炎治疗（ERAT）。术后患者疼痛立即完全缓解，右下腹部无压痛。在18个月的随访期间，他右下腹部未再发作。
结论
ERAT对于并存AA的CD患者有效且安全。此类病例可避免手术及其相关并发症。
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