通常の解剖ではC１が盲腸だが，C２となり反転して上行するので移動盲腸である．回腸末端は同定できない．異常虫垂が正常の部位に存在しないので診断は容易ではないが，図６と図７の異常結石（糞石△）に気がつけば移動盲腸末端の図６のC２から始まるのが腫大した虫垂であり，図９で盲端になるので虫垂炎の診断がつく．虫垂周囲脂肪組織の炎症範囲（▲）の広さを考慮すれば穿孔の可能性はかなり高い．抗生物質投与にもかかわらず5日間で症状や炎症所見が改善せず，再度の腹部エコー検査とCTにて腹腔内膿瘍を認め（図１３：↑）手術となった．膿瘍形成した壊死性，穿孔性虫垂炎を認めた．病理： perforated，gangrenous appendicitis．

文献考察：CTを活用することによりnegative appendectomy rateを13.6%→6.3%に減少。
Fuchs JR, Schlamberg JS, Shortsleeve MJ, Schuler JG.
Impact of abdominal CT imaging on the management of appendicitis: an update.
J Surg Res. 2002 Jul;106(1):131-6.

BACKGROUND: Abdominal computed tomographic scanning (ACTS) has recently been shown to be an accurate diagnostic tool for appendicitis and may improve the negative exploration rate in our patient population. MATERIALS AND METHODS: We reviewed 224 patients evaluated for appendicitis during 1998. Forty-two patients underwent appendectomy on clinical grounds alone (Group I), 182 patients underwent ACTS (Group II), and 79 patients in Group II were explored for appendicitis. Diagnostic errors, alternative diagnoses, and perforation rates were noted. RESULTS: There were five negative explorations in Group I (11.9%) and five in Group II (6.3%), resulting in a combined negative rate of 8.3%. The negative exploration rate in women was 23.5% in Group I and 5.3% in Group II (P = 0.07), producing a combined negative rate of 10.9%. Fifty-eight alternative diagnoses were made by ACTS. The ACTS made a critical difference in the management of 67% of patients over 50 years of age and in 79% of Group II patients. CONCLUSIONS: The negative exploration rate for appendicitis at our institution fell from 13.6 to 8.3% with selective use of ACTS. The most striking benefit occurred in women and in patients over 50 years of age. PMID: 12127818 [PubMed - indexed for MEDLINE]