Suer Muhammed Salih
General Surgery, Ankara Etlik City Hospital, Ankara, TUR.
Cureus. 2024 Nov 21;16(11):e74138. doi: 10.7759/cureus.74138. eCollection 2024 Nov.
Acute appendicitis typically causes right lower quadrant pain, but in elderly patients with comorbidities, it can present atypically, complicating diagnosis. This case highlights a rare presentation, mimicking sigmoid diverticulitis. A 70-year-old man with chronic heart failure, arrhythmia, and renal failure presented with two days of left lower quadrant pain. Examination showed tenderness, rebound, and guarding. Laboratory tests revealed a white blood cell count of 12,000/µL and creatinine of 2.5 mg/dL. C-reactive protein was elevated at 25 mg/L. Computed tomography revealed an inflamed appendix with an appendicolith and localized inflammation near the sigmoid colon, but no diverticulitis. An appendectomy confirmed a perforated appendix in contact with the sigmoid colon. In elderly patients, acute appendicitis may present atypically with left-sided pain, risking misdiagnosis. Careful evaluation and imaging are essential for accurate diagnosis and management in those with comorbidities.
急性阑尾炎通常会引起右下腹疼痛，但在患有合并症的老年患者中，其表现可能不典型，从而使诊断变得复杂。本病例突出了一种罕见的表现，类似乙状结肠憩室炎。一名患有慢性心力衰竭、心律失常和肾衰竭的70岁男性，出现了两天的左下腹疼痛。检查发现有压痛、反跳痛和肌紧张。实验室检查显示白细胞计数为12,000/µL，肌酐为2.5 mg/dL。C反应蛋白升高至25 mg/L。计算机断层扫描显示阑尾发炎并伴有阑尾结石，以及乙状结肠附近的局部炎症，但未发现憩室炎。阑尾切除术证实阑尾穿孔并与乙状结肠接触。在老年患者中，急性阑尾炎可能以左侧疼痛的非典型表现出现，有误诊的风险。对于患有合并症的患者，仔细评估和影像学检查对于准确诊断和管理至关重要。
