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巨大阑尾结石引起的阑尾炎

Appendicitis Caused by a Giant Appendicolith.

作者信息

Tepelidis Christos, Permekerlis Athanasios, Fotiadis Panagiotis, Kouridakis Petros

机构信息

2nd Surgical Department, 424 General Military Hospital, Thessaloniki, GRC.

出版信息

Cureus. 2023 Sep 22;15(9):e45780. doi: 10.7759/cureus.45780. eCollection 2023 Sep.

Abstract

The coproliths of the appendix are accumulations of fecal remnants within its lumen. They are categorized based on their size into coproliths < 1cm, which are the most common, and giant coproliths, with a diameter > 2cm. It's important to note that the pathophysiology of acute appendicitis is characterized by the obstruction of the appendix lumen. This leads to distension due to the inability to expel secretions, ischemia, and ultimately rupture of its wall. This presentation discusses an interesting case of acute appendicitis caused by a giant coprolith. It also covers the clinical approach and information according to international literature. A 38-year-old man presented with sudden-onset right lower quadrant pain. Clinical examination revealed tenderness, a positive McBurney's point, elevated inflammation markers, and a radiopaque finding on an X-ray. A CT scan revealed a 2.5cm coprolith in the appendix. An exploratory laparoscopy revealed appendix wall rupture, followed by subumbilical incision appendicectomy and cleansing of purulent collection. The patient was discharged from the hospital on the fourth postoperative day without any complications, demonstrating a smooth recovery process. The presence of a coprolith predisposes the development of acute appendicitis. This condition is associated with a worse prognosis, as it increases the likelihood of perforation and the formation of intraperitoneal abscesses. This case underscores the clinical significance of giant coproliths as a potential etiology for acute appendicitis. Early recognition and timely surgical intervention are pivotal in achieving favorable patient outcomes.

摘要

阑尾粪石是阑尾管腔内粪便残渣的积聚。它们根据大小分为最常见的直径<1cm的粪石和直径>2cm的巨大粪石。需要注意的是,急性阑尾炎的病理生理学特征是阑尾管腔梗阻。这会导致由于无法排出分泌物而扩张、缺血,最终阑尾壁破裂。本报告讨论了一例由巨大粪石引起的急性阑尾炎的有趣病例。它还根据国际文献介绍了临床处理方法和相关信息。一名38岁男性突发右下腹疼痛。临床检查发现压痛、麦氏点阳性、炎症标志物升高以及X线检查有不透光表现。CT扫描显示阑尾内有一个2.5cm的粪石。探查性腹腔镜检查发现阑尾壁破裂,随后经脐下切口进行阑尾切除术并清除脓性积液。患者术后第四天出院,无任何并发症,恢复过程顺利。粪石的存在易引发急性阑尾炎。这种情况预后较差,因为它增加了穿孔和形成腹腔内脓肿的可能性。该病例强调了巨大粪石作为急性阑尾炎潜在病因的临床意义。早期识别和及时手术干预对于取得良好的患者预后至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db08/10590621/9909fdaa7b8b/cureus-0015-00000045780-i01.jpg

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