婴儿阑尾盲肠多重套叠并急性阑尾炎一例并文献复习

Multiple intussusceptions of appendix and cecum with acute appendicitis in infants： a case report and a literature review

目的探讨婴儿期阑尾盲肠多重套叠并急性阑尾炎的临床病理和诊治方法。方法回顾性分析1例阑尾盲肠多重套叠并急性阑尾炎8月龄婴儿的临床资料，并通过PubMed、ProQuest、中国知网（CNKI）、万方和维普数据库中检索2016年5月前的报道并复习相关文献资料，对各类儿童阑尾套叠进行系统性综述。结果本例阑尾盲肠多重套叠并急性阑尾炎经手术诊断，整复套叠后切除阑尾并经病理证实，术后顺利康复。共检索到215例阑尾套叠中儿童52例，阑尾盲肠套叠136例，仅3例阑尾自身套叠中有2例为儿童；检索到肠套叠并阑尾炎66例，儿童59例，其中小于1岁的患儿27例，回结型肠套叠43例，此外，检索到回肠盲肠型套叠7例和盲肠盲肠型套叠并阑尾炎1例均为成人患者，所有病例均行手术治疗而痊愈。儿童阑尾盲肠多重套叠并急性阑尾炎者未见报道。结论婴儿阑尾盲肠多重套叠并急性阑尾炎罕见，如套叠未导致回盲瓣排空完全梗阻则无典型症状体征，诊断困难，易误、漏诊。因此，对经保守治疗不能解除肠梗阻且不能解释其原因时，只要B型超声提示“同心圆征”或“套筒征”就应果断行手术探查以明确诊断并及时治疗。

Objective To review the clinicopathological features, diagnosis and treatment of an 8-month-old infant of multiple intussusceptions of appendix and cecum with acute appendicitis along with a literature review. Methods Based on the clinical profiles of this case, the databases of PubMed, ProQuest, CNKI, Wanfang and VIP were searched with regards to appendiceal-cecum intussusception prior to May 2016 from and a literature review was performed. Results The primary diagnosis of multiple intussuseeptions of appendix and cecum with acute appendicitis was made intraoperatively and confirmed by pathological examination after intussusception reduction and appendectomy. Recovery was uneventful. A total of 215 cases of appendiceal intussusception were retrieved from 52 children. Among 136 cases of appendix and cecum, only 3 cases of appendiceal intussusception itself in 2 children; among 66 cases of intussusception with acute appendicitis, there were 59 children, including 27 children aged 〈1 year and colonic intussusception in 43 cases. For adults, there were 7 cases of cecum intussusception and 1 case of appendicitis. All patients underwent surgery and recovered. There were no reports of intussusception and acute appendicitis in children. Conclusions Multiple intussuseeptions of appendix and cecum with acute appendicitis is quite rare during infancy. Its diagnosis is difficult when ileoceeal valve is obstructed incompletely due to atypical symptoms and signs especially in infants. Therefore decisive laparotomy is vital for diagnosis and treatment when intestinal obstruction fails to be relieved after conservative measures. Unexplained obstruction or abdominal ＂concentric circles＂ on ultrasound should raise a high alert.