盲肠化脓性炎并穿孔误诊为急性阑尾炎临床分析  

Clinical Analysis of Cecum Purulent Inflammation and Perforation Misdiagnosed as Acute Appendicitis

作　　者：莫琳 刘保荣[1] MO Lin;LIU Bao-rong(Department of General Surgery,Xi'an Central Hospital,Xi'an 710007,China)

机构地区：[1]西安市中心医院普通外科,西安710007

出　　处：《临床误诊误治》2018年第8期13-15,共3页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省科技攻关项目(2014k11-01-02-15)

摘　　要：目的探讨盲肠化脓性炎并穿孔误诊为急性阑尾炎的原因及防范措施。方法对误诊为急性阑尾炎的盲肠化脓性炎并穿孔4例的临床资料进行回顾性分析。结果 4例中2例因右下腹疼痛、恶心伴腹泻1和3 d入院;2例因恶心、呕吐伴右下腹疼痛3和5 d入院。4例发病初期均误诊为急性阑尾炎,误诊时间(5.67±3.28)d。2例行急性阑尾炎手术发现盲肠化脓性炎并穿孔,行盲肠及阑尾切除手术,术后病理检查证实为盲肠化脓性炎并穿孔。2例先采取保守治疗,治疗无效后行腹部CT检查示盲肠化脓性炎并穿孔,行盲肠穿孔修补术或切除术治疗,术后病理检查证实为盲肠化脓性炎并穿孔。4例住院治疗21~40 d均病情好转出院;出院后随访1~3个月,皆预后良好。结论盲肠化脓性炎并穿孔缺乏特异性临床表现,易误诊。临床医生应加强对盲肠化脓性炎并穿孔的警惕性和该病相关知识的认识和了解,以尽早明确诊断并及时治疗。Objective To investigate the causes and prevention countermeasures of cecum purulent inflammation and perforation misdiagnosed as acute appendicitis.Methods The clinical data of 4 patients with cecum purulent inflammation and perforation misdiagnosed as acute appendicitis were retrospectively analyzed.Results Of the 4 cases,2 were admitted to the hospital due to pain in the right lower quadrant and nausea with diarrhea for 1 and 3 d respectively;2 were admitted to the hospital because of nausea and vomiting with pain in the right lower quadrant of the abdomen after 3 and 5 d respectively.All cases were misdiagnosed as acute appendicitis in the early stage of the disease,and the duration of misdiagnosis was(5.67±3.28)d.Two cases undergoing appendectomy were found to have cecum purulent inflammation and perforation,therefore,cecectomy and appendectomy were performed.The postoperative pathological examination confirmed cecum purulent inflammation and perforation.Two cases were first given conservative treatment,which failed afterwards.Thus,an abdominal CT scan was performed to show cecum purulent inflammation and perforation.All patients underwent cecal perforation repair or resection.The postoperative pathological examination confirmed cecum purulent inflammation and perforation.All the 4 cases were discharged from hospital when the condition was markedly improved 21-40 d after treatment.And after follow-up for 1-3 months,all cases had good prognosis.Conclusion Given atypical clinical manifestations,cecum purulent inflammation and perforation are likely to be misdiagnosed.Clinicians should strengthen the vigilance of cecum purulent inflammation and perforation,and enhance the understanding of the disease,which helps a clear diagnosis and prompt treatment.

关 键 词：盲肠炎 肠穿孔 误诊 阑尾炎 

分 类 号：R574.61[医药卫生—消化系统]