右下腹部痛(Right Lower Quadrant Pain)シリーズ14 RESIDENT COURSE 解答 【症例 RR 66】

急性虫垂炎.Acute appendicitis.


盲腸(C)は図6で盲端になり,図3のTIが回腸末端と思われるがその先は追跡困難である.図5と図6に虫垂根部と思われる部位に糞石(△)があり,その糞石と連続して図7に均一なlow densityの液状内容物を含む管状構造物がある(▲).外径は2cmを超えるので膿瘍であろうと判断したが,手術所見では3×12cm大の巨大虫垂であった(図A:粘膜面).病理:gangrenous appendicitis.







文献考察:complicated (gangrenous or perforated) appendicitisの最大の原因は患者の受診が遅いこと.創感染は10倍に,治療費は3倍に増大する
Am Surg. 2000 Jun;66(6):548-54.
Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies.
Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA, Pruitt BA Jr, Root HD.
A perceived high rate of complicated (gangrenous or perforated) appendicitis, despite advances in laboratory and radiographic diagnostic modalities, prompted a review of our experience with appendicitis followed by a prospective analysis that examined the time course from presentation to definitive treatment in 218 consecutive patients. In 5755 appendectomies, our overall rate of complicated appendicitis was 32 per cent; higher in males, in the young, and in the elderly; and relatively stable over each year reviewed. Prospectively, we determined that of the various time intervals, the time from the onset of symptoms to first seeking medical attention is the only significant predictor of complicated appendicitis (39.8 vs 16.5 hours for acute appendicitis). On the other hand, the time from surgical evaluation to operative intervention was significantly shorter for complicated appendicitis (3.8 vs 4.7 hours for acute appendicitis). The high rate of complicated appendicitis with its subsequent sequelae of increased morbidity and resource expenditure is primarily the direct result of patient delay in seeking medical attention and not the result of diagnostic dilemma or surgical delay. Public education, specifically targeting those groups at risk, may provide a substantial and significant solution to the complicated appendix.PMID: 10888130

 【 次の問題→ 】  【 このシリーズの問題一覧に戻る 】 【 演習問題一覧に戻る 】