|
文献考察:虫垂憩室炎Appendiceal diverticulitis
South Med J. 2000 Jan;93(1):76-9.
Appendiceal diverticulitis.
Place RJ, Simmang CL, Huber PJ Jr.
We report the case of a 56-year-old man with episodic right lower quadrant abdominal pain. Preoperative evaluation included computed tomography (CT) showing a right lower quadrant phlegmon consistent with cecal diverticulitis or appendicitis. The patient was treated with a short course of bowel rest and antibiotics. Four weeks later, he had an appendectomy. The patient was found to have chronic appendiceal diverticulitis and recovered uneventfully. Histopathologic studies revealed herniated mucosa through the muscular layer associated with chronic inflammation and marked fibrosis. These findings represent appendiceal diverticulitis. Diverticulosis of the appendix is believed to be uncommon and roentgenologic diagnosis of appendiceal diverticular disease is rarely made. We discuss the diagnosis and CT findings of appendiceal diverticulitis and present a thorough review of the literature.PMID: 10653074
追記：虫垂憩室の頻度は虫垂切除例の0.004〜2.1％，autopsy例で0.2〜0.66％．腸管壁の全層を有する先天性憩室はまれで，ほとんどが後天性の漿膜，粘膜下組織と粘膜からなる仮性憩室である．発生機序は結腸憩室と同様で，虫垂の閉塞があり収縮により内圧が上昇して，脆弱部（血管貫通部）で粘膜がヘルニアを起こし発生すると推測される．憩室炎の発生機序は粘膜下浮腫，炎症，糞石や線維性狭窄などによる閉塞や狭窄があり，粘液貯留が感染を起こすといわれる．1974年以後294例が報告されている．60％は末梢側1/3に認める．穿孔率は急性虫垂炎の4倍で，穿孔から腹膜偽粘液腫pseudomyxoma peritoneiを続発した報告もある．CT診断は困難だが，外科的か保存的かの治療法を選択するのに有用である．
|
