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4个月婴儿重度阑尾炎伴可能微小穿孔的放射学诊断:1例罕见病例报告

Radiological diagnosis of severe appendicitis in 4 months infant with possible microperforation: A rare case report.

作者信息

Ibdah Mohammad G, Abu-Qare'e Omar, Abdallah Firas, Masalmeh Leen Ibrahim Ahamd, Joma Nataly, Al-Karaja Layth, Awaysa Asala M, Smerat Mohammad I

机构信息

Al-Quds University, College of Medicine, Palestine.

Misr University For Science And Technology, Giza, Egypt.

出版信息

Radiol Case Rep. 2024 Jun 17;19(9):3715-3718. doi: 10.1016/j.radcr.2024.05.008. eCollection 2024 Sep.

Abstract

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention; however, it is extremely rare in infants. Its diagnosis and treatment are challenging due to nonspecific clinical signs and symptoms. As a result, delayed or missed diagnosis is common in young children and is associated with an increased risk of perforation and peritonitis. We reported a case of a 4-month-old healthy male child. The patient presented with abdominal distention and fever. After ruling out other possible causes, he was diagnosed with acute appendicitis, which was confirmed by a CT scan. A gangrenous appendix, dilated bowel loops, and free fluid in the abdomen were discovered during surgery. An appendectomy was performed. The appendix in infants has an average length of 4.5 cm compared with 9.5 cm in adults. Infantile appendicitis is considered rare but cases have been documented also in neonates, misdiagnosis rates are high due to rarity in this age group in addition to nonspecific signs and symptoms, which led to a high perforation rate. Ultrasonography can diagnose appendicitis in children with a sensitivity and specificity of 90%-95% without subjecting the child to radiation. A physician should always keep the diagnosis of appendicitis in mind in the infant age group, even though it is rare, as a delay in diagnosis and treatment has been associated with an increased risk of complications including appendicular perforation and peritonitis.

摘要

阑尾炎是需要手术干预的急性腹痛最常见的病因;然而,在婴儿中极为罕见。由于临床体征和症状不具特异性,其诊断和治疗颇具挑战性。因此,幼儿中延迟诊断或漏诊很常见,且与穿孔及腹膜炎风险增加相关。我们报告了一例4个月大的健康男童病例。该患者出现腹胀和发热。排除其他可能病因后,他被诊断为急性阑尾炎,CT扫描证实了这一诊断。手术中发现阑尾坏疽、肠袢扩张及腹腔内游离液体。遂行阑尾切除术。婴儿阑尾平均长度为4.5厘米,而成人阑尾平均长度为9.5厘米。婴儿阑尾炎虽被认为罕见,但新生儿中也有病例记载,由于该年龄组病例罕见且体征和症状不具特异性,误诊率很高,这导致穿孔率很高。超声检查可诊断儿童阑尾炎,敏感性和特异性为90%-95%,且不会让儿童受到辐射。即使阑尾炎在婴儿年龄组中罕见,医生也应始终将其诊断铭记于心,因为诊断和治疗延迟与包括阑尾穿孔和腹膜炎在内的并发症风险增加相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/abfd/11231498/bb0fc3464446/gr1.jpg

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