Validating the efficacy of interval appendectomy for acute appendicitis: representative three cases with different etiologies
Validating the efficacy of interval appendectomy for acute appendicitis: representative three cases with different etiologies
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DOI：
10.1186/s40792-020-00971-1
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发表时间：
2020-08-12
影响因子：
0.8
通讯作者：
Uchiyama, Hideaki
中科院分区：
文献类型：
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作者：
Kasagi, Yuta;Natsugoe, Keita;Uchiyama, Hideaki
背景急性阑尾炎的阑尾切除术被认为是最常见的急诊手术之一。然而，在大多数情况下，不推荐急诊阑尾切除术伴广泛脓肿形成等复杂病变。因此，对于再生障碍性贫血，尝试非手术治疗后行间隔阑尾切除术(IA)。在此，我们报告三例因特殊原因行间歇性阑尾切除术的再障病例。病例1：68岁男性被诊断为再生障碍性贫血合并肠旋转不良和腹内脓肿。他最初接受保守治疗，在详细的术前检查后接受了腹腔镜下的IA。病例2：一名22岁的男性因患有泛结肠炎型溃疡性结肠炎(UC)而接受治疗，该疾病每年也会出现数次右下腹痛。每次出现症状时，每次CT检查都会发现阑尾肿胀。他接受了腹腔镜术，病理结果显示切除的阑尾有典型的UC组织学特征。手术后，他从未遭受过严重的右下腹痛。例3：69岁女性，主诉右下腹痛，经CT检查发现再生障碍性贫血合并阑尾肿块，盲肠壁不规则增厚，纵隔及腹主动脉旁淋巴结肿大。手术均在保守治疗后进行。病理诊断为BRAF基因突变的结直肠癌。手术后她接受了系统的化疗，所有的转移灶都完全消失了。结论间歇性阑尾切除术提供了更清晰的解剖信息和准确的治疗策略，避免了技术性和全面性的手术并发症，恢复快，住院时间短。间歇性阑尾切除术是一种合理的手术方式，可推荐用于不同病因的再障。
Background Appendectomy for acute appendicitis (AA) is considered one of the most common emergency surgeries. However, emergency appendectomy accompanied with complex lesions such as extensive abscess formation is not recommended in most cases. Therefore, non-operative management followed by interval appendectomy (IA) for AA has been tried. Herein, we present three AA cases with specific etiology that underwent interval appendectomy. Case presentation Case 1: A 68-year-old man was diagnosed AA with intestinal malrotation and intra-abdominal abscesses. He initially treated with conservative therapy and underwent laparoscopic IA after detailed preoperative examination. Case 2: A 22-year-old man had been under treatment for pancolitis-type ulcerative colitis (UC), also bothered by right-lower abdominal pain several times a year. The appendix always appeared swollen on every CT taken during symptoms. He underwent laparoscopic IA; pathological finding revealed typical UC histological features in the resected appendix. After the surgery, he never suffered from terrible right lower abdominal pain. Case 3: A 69-year-old woman complaining a right lower abdominal pain had undergone CT examination, which revealed AA with appendiceal mass, irregular wall thickness of the cecum, and mediastinal and para-aortic lymph node swelling. The operation was carried out after conservative therapy. The pathological diagnosis revealedBRAFmutated colorectal carcinoma. She had received systematic chemotherapy after the surgery, and all metastatic lesions have completely disappeared. Conclusion Interval appendectomy provided us with much clearer anatomical information and precise therapeutic strategies, avoiding technical and general operative complications, and also induced fast recovery and short length of hospital stay. Interval appendectomy is a reasonable procedure and could be recommended in case of AA with some different etiology.