回盲部恶性肿瘤误诊为阑尾炎临床报告

Clinical Report of Malignant Tumors of Ileocecal Region Misdiagnosed as Appendicitis

目的探讨回盲部恶性肿瘤误诊为阑尾炎的原因及防范措施。方法对2014年1月—2019年12月收治曾误诊为阑尾炎的回盲部恶性肿瘤16例的临床资料进行回顾性分析。结果16例均以右下腹痛为主诉就诊,伴大便次数改变3例,大便性状改变4例,便秘或腹泻5例,排黏血便6例;伴低热11例,消瘦、乏力7例,恶心、呕吐4例。16例均右下腹腹肌稍紧张,压痛及反跳痛阳性,其中右下腹饱满、未触及明显肿块11例,右下腹触及肿块5例,肠鸣音正常或减弱。入院后初步诊断为急性阑尾炎11例,急性阑尾炎阑尾周围脓肿5例。误诊时间3 d~2个月。16例皆行阑尾切除术,术中及术后病理检查均诊断为回盲部恶性肿瘤,其中高分化腺癌7例,低分化腺癌5例,黏液腺癌和印戒细胞癌各2例。16例确诊后皆行一期根治性右半结肠切除术治疗,手术均顺利,切口愈合后出院。结论回盲部恶性肿瘤术前常易误诊。临床上对以右下腹痛和腹部肿块为主诉就诊患者,尤其是伴低热、不明原因贫血、乏力、消瘦和排便习惯改变者,应警惕回盲部恶性肿瘤,及时行相关检查,以减少或避免误诊误治。

Objective To investigate causes and preventive measures of patients with malignant tumors of ileocecal region misdiagnosed as having appendicitis.Methods Clinical data of 16 patients with malignant tumor of ileocecal region misdiagnosed as having appendicitis during January 2014 and December 2019 was retrospectively analyzed.Results All 16 patients complained of right hypogastralgia,of whom there were 3 patients associated by changes in stool frequency,4 patients by changes in stool characteristics,5 patients by constipation or diarrhea and 6 patients by glutinous bloody stool;there were 11 patients associated by low fever,7 patients by weight loss and fatigue and 4 patients by nausea and vomiting.All the 16 patients had slight tension in right lower abdominal muscles,and tenderness and rebound tenderness were positive.Among them,there were 11 patients with full right lower abdomen without palpable mass,and 5 patients with palpable mass.The bowel sounds of the patients were normal or weakened.After admission,11 patients were initially diagnosed as having acute appendicitis,and 5 patients were initially diagnosed as having appendiceal abscess appendicitis.Misdiagnosed duration ranged from 3 d to 2 months.All the 16 patients underwent appendectomy.Malignant tumors of ileocecal region was diagnosed by intraoperative and postoperative pathological examination,which included 7 cases of well-differentiated adenocarcinoma,5 cases of poorly-differentiated adenocarcinoma,2 cases of mucinous adenocarcinoma and 2 cases of signet-ring cell carcinoma.After confirmation,all patients underwent one-stage radical right hemicolectomy.All operations were successful,and the patients were discharged after incision healing.Conclusion Malignant tumor of ileocecal region is prone to be misdiagnosed before surgery.Malignant tumor of ileocecal region should be alerted for patients with right lower abdominal pain and abdominal mass as the main complaint,especially those with low fever,unexplained anemia,fatigue,weight loss and change of defecation habits,and relevant examinations should be performed in time to reduce or avoid misdiagnosis and mistreatment in clinic.