図１１の１〜図７の5は虫垂であるが，全体的に虚脱している．周囲脂肪組織の濃度上昇は強く，図８のガス（↑）は虫垂外の可能性が高い．腹膜は，図１〜図７の△に認められるように虫垂からかなり距離のある部位まで広範囲に肥厚し，穿孔性虫垂炎が強く疑われる． A：上行結腸，C：盲腸，TI：回腸末端．抗生物質（CEZとCLDM）投与で保存的に治癒した．

文献考察：穿孔性虫垂炎で汎発性腹膜炎症状を呈するのは手術の適応である．局所性に腫瘤を形成するものは保存的治療によく反応することはよく知られていることである．腫瘤を形成しない，局所性穿孔も保存的に治療し95％に成功する．
Am J Surg. 2000 Mar;179(3):177-81.
Nonoperative management of perforated appendicitis without periappendiceal mass.
Oliak D, Yamini D, Udani VM, Lewis RJ, Vargas H, Arnell T, Stamos MJ.
BACKGROUND: Initial nonoperative treatment for patients with periappendiceal mass has been shown to be safe and effective. Our goal was to evaluate the safety and efficacy of initial nonoperative management for perforated appendicitis not accompanied by a palpable mass. METHODS: The study population consisted of 77 patients with appendicitis treated initially nonoperatively between 1992 and 1998. All had localized abdominal tenderness and computed tomography findings of abscess or phlegmon. None had a palpable abdominal mass. Outcome parameters evaluated were rate of failure, complication, and recurrence. RESULTS: There were 49 males and 28 females with a mean age of 35 years (range 16 to 75). Initial nonoperative management was successful in 95% of patients. Complications occurred in 12% of patients. Recurrent appendicitis developed in 6.5% of patients after an average follow-up of 30 weeks. CONCLUSIONS: Perforated appendicitis patients with localized abdominal tenderness and abscess or phlegmon can safely and effectively be treated in an initial nonoperative fashion.PMID: 10827313