右下腹部痛(Right Lower Quadrant Pain)シリーズ18 RESIDENT COURSE 解答 【症例 RR 89】

急性虫垂炎.Acute appendicitis



回腸末端(TI)は図2から始まり下行する.図5の1が虫垂根部で,図6の2で糞石が嵌頓し,図7の3から拡張し始め,トグロを巻くようにUターンし図7の9で盲端になる.周囲脂肪組織の濃度上昇は認めないが,図5の5で最大径1cm程度に腫大し,壁は良好な造影効果を受け,急性虫垂炎である.手術および病理所見:phlegmonous appendicitis.






文献考察:CTを活用してnegative appendectomyが25%→6%に減った
Am J Surg. 2002 Dec;184(6):587-9; discussion 589-90.
The use of abdominal computed tomography scan decreases the frequency of misdiagnosis in cases of suspected appendicitis.
Naoum JJ, Mileski WJ, Daller JA, Gomez GA, Gore DC, Kimbrough TD, Ko TC, Sanford AP, Wolf SE.
BACKGROUND: Despite considerable experience the reported frequency of misdiagnosis in patients undergoing appendectomy continues in the range of 20% to 40% in some populations. METHODS: We developed a clinical guideline that recommended abdominal computed tomography (CT) for all nonpregnant adults in whom the diagnosis of appendicitis was suspected unless the diagnosis could be ruled out clinically. The records of adult patients that underwent appendectomy from July 1998 through October 2001 were reviewed. The clinical guideline was developed in July 2000. RESULTS: There were 194 appendectomies performed, 114 prior to the guideline and 80 after the development of the guideline. The rate of misdiagnosis decreased from 25% to 6% (P
  【参照症例】   1. 右下腹部痛シリーズ1 【症例 RR 1〜5】

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