Suthar Pokhraj P, Chaparala Pravalya, Virmani Sumeet
Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, USA.
Cureus. 2025 May 16;17(5):e84244. doi: 10.7759/cureus.84244. eCollection 2025 May.
Acute appendicitis is a common cause of abdominal pain and a leading indication for surgery, especially in younger patients. While its diagnosis is often straightforward, rarer forms like acute tip appendicitis can be more difficult to detect. The growing use of CT imaging has made it easier to identify these unusual cases. A 32-year-old female patient presented with sharp, constant abdominal pain localized to the right lower quadrant and suprapubic region, with an intensity of 7/10 that worsened with oral intake. Physical examination revealed minimal tenderness in the lower quadrants, along with right adnexal tenderness, and lab results, including a negative urine pregnancy test, were unremarkable. CT imaging showed mild dilation of the appendiceal tip and subtle periappendiceal fat stranding, suggesting early tip appendicitis, while the rest of the appendix appeared normal. The patient underwent laparoscopic appendectomy, which confirmed inflammatory changes at the appendiceal tip, thus diagnosing acute tip appendicitis. This case underscores the importance of considering tip appendicitis in the differential diagnosis of right lower quadrant pain, particularly with the increasing use of CT imaging. Despite its rarity, tip appendicitis should be recognized as a potential cause with similar clinical risks as more common forms of appendicitis, including significant morbidity if not treated promptly.
急性阑尾炎是腹痛的常见原因,也是手术的主要指征,尤其是在年轻患者中。虽然其诊断通常较为直接,但像急性阑尾尖端炎这种较罕见的类型可能更难检测。CT成像的日益普及使得识别这些不寻常病例变得更加容易。一名32岁女性患者出现右下象限和耻骨上区域尖锐、持续性腹痛,疼痛强度为7/10,进食后加重。体格检查发现下象限压痛轻微,右侧附件区压痛,实验室检查结果,包括尿妊娠试验阴性,均无异常。CT成像显示阑尾尖端轻度扩张,阑尾周围脂肪有轻微条索状改变,提示早期阑尾尖端炎,而阑尾其余部分外观正常。患者接受了腹腔镜阑尾切除术,术中证实阑尾尖端有炎症改变,从而诊断为急性阑尾尖端炎。该病例强调了在右下象限疼痛的鉴别诊断中考虑阑尾尖端炎的重要性,特别是随着CT成像的使用增加。尽管阑尾尖端炎罕见,但应将其视为与更常见的阑尾炎形式具有相似临床风险的潜在病因,如果不及时治疗,包括显著的发病率。