早产儿阑尾炎一例误诊分析

Misdiagnosis Analysis of One Case of Preterm Infant with Acute Appendicitis

目的探讨早产儿急性阑尾炎的临床特点,避免早产儿阑尾炎的误诊。方法回顾性分析2015年12月—2016年1月温州医科大学附属第二医院收治的1例早产儿急性阑尾炎患儿的临床特点、实验室检查、影像学检查、误诊情况及治疗转归。结果患儿病情进展,出现腹胀,反应变差,C反应蛋白水平升高,腹部X线检查提示肠胀气明显、肠管扩张、腹部穿刺液提示白细胞阳性(+++),3次儿外会诊;收治后第6天行剖腹探查术,术中证实为阑尾根部坏疽穿孔,行阑尾切除术+肠粘连松懈术+腹腔冲洗引流术,痊愈出院。病理报告提示急性化脓性阑尾炎伴周围炎。结论早产儿阑尾炎发病率极低,无典型临床表现及体征,误诊率高,术前诊断困难,疑及本病时应及早行超声、腹部穿刺、影像学检查,症状无改善必要时行手术探查。

Objective To explore the clinical characteristics of preterm infant with acuteappendicitis, avoid premature appendicitis misdiagnois. Methods The clinical characteristics, laboratory and imaging findings, misdiagnosis, treatment outcome and prognosis of preterm with the acuteappendieitis were analyzed retrospectively. The case was hospitalized in the 2nd Affiliated Hospital of Wenzhou Medical University from December 2015 to January 2016. Results The premature disease progressed. The abdomen distended. The premature reaction became poor with high CRP. Abdominal X - ray showed that the accumulation of gas obvious in the intestinal segment and bowel dilatation. Abdominal puncture fluid leucocyte tested positive （ ＋ ＋ ＋ ） . Three times pediatric surgery consultation were done. The laparotomy exploration operation had been done after the sixth day. The gangrenous and perforated was confirmed in the operation. The appendectomy, ankylenteron operation, peritoneal lavage and drainage were done. The illness was cured. Pathology report showed the acute suppurative appendicitis with peripheral inflammation. Conclusion The pathogenesis of premature appendicitis rate was extremely low with no typical clinical symptoms and signs. The misdiagnosis rate was high. The preoperative diagnosis was difficult. When the disease was suspected, it should be checked by the ultrasound, abdominal puncture and radiography early. Surgical exploration should be done if the symptoms were not improved.