■急性阑尾炎是世界上最常见的腹部外科急症,通常需要手术干预。阑尾炎的并发症之一是脓肿形成。在极少数情况下,局部脓肿可以发生在相邻的器官中,如髂肌和腰大肌。继发于,或者伴随着,急性阑尾炎极为罕见。然而,漏诊其中一种或两种情况都可能导致严重的并发症,包括死亡率。
方法:一名27岁男性患者就诊于急诊科,有急性严重右髋部疼痛病史,该疼痛因运动而加重,并伴有恶心和呕吐。CT提示急性单纯性阑尾炎,无局部污染。他接受了紧急腹腔镜检查,显示阑尾轻度炎症,并进行了阑尾切除术。手术后几小时他就出现了败血症,导致入院高度依赖护理单位进行密切观察。在第二天的审查中,他报告了持续的右髋部疼痛和下背部疼痛,新发作不能负重。进行了MRI扫描,显示右骶髂关节周围有感染特征,金黄色葡萄球菌在他的血液培养物中生长。然后诊断为急性化脓性骶髂关节炎。患者接受静脉抗生素治疗共四周,随后口服抗生素两周。
■急性化脓性骶髂关节炎是可以模拟急腹症的罕见病症之一,在这种情况下,急性阑尾炎。MRI是骶髂关节炎的最佳诊断方式,与阑尾炎的CT相比。在大多数急性阑尾炎病例中,血液培养中可见混合细菌,包括需氧菌和厌氧菌,而金黄色葡萄球菌主要见于急性化脓性骶髂关节炎。据报道,金黄色葡萄球菌引起的阑尾炎的病例不到3.7%。早期诊断其中一种或两种情况可以显着减少并发症,更重要的是,加快实施适当的治疗。
结论:在我们的案例中,我们提出了一种联合急性阑尾炎,急性骶髂关节炎和金黄色葡萄球菌败血症,并证明急性化脓性骶髂关节炎可能是急性阑尾炎的罕见并发症。因此,在适当的临床方案中,应考虑高临床怀疑指数.
UNASSIGNED: Acute appendicitis is the most common abdominal surgical emergency in the world and often requires surgical intervention. One of the complications of appendicitis is abscess formation. In rare cases, a localised abscess can occur in the adjacent organs, such as the iliac and psoas muscles.
Sacroiliitis occurring secondary to, or concomitant with, acute appendicitis is extremely rare. However, a missed diagnosis of either or both conditions can lead to serious complications, including mortality.
METHODS: A 27-year-old male patient presented to the emergency department with a history of acute severe right hip pain that was aggravated by movement and associated with nausea and vomiting. CT suggested acute uncomplicated appendicitis with no localised contamination. He underwent an emergent laparoscopy which showed mild appendiceal inflammation and appendicectomy was performed. He became septic a few hours after the operation, resulting in admission to the high dependency care unit for close observation. On review the following day, he reported ongoing right hip pain and lower back pain with a new onset inability to weight-bear. An MRI scan was performed which showed features of infection around the right sacroiliac joint and Staphylococcus aureus grew in his blood culture. A diagnosis of acute pyogenic
sacroiliitis was then made. The patient was treated with IV antibiotics for a total of four weeks, followed by two weeks of oral antibiotics.
UNASSIGNED: Acute pyogenic sacroiliitis is one of the rarer conditions seen that can mimic the acute abdomen, in this
case acute appendicitis. MRI is the best diagnostic modality in
sacroiliitis, in comparison to CT for appendicitis. In most cases of acute appendicitis, mixed bacteria including aerobes and anaerobes are seen in the blood culture while staphylococcus aureus is seen mostly in acute pyogenic sacroiliitis. Staphylococcus aureus-induced appendicitis is reported in less than 3.7 % of cases. An early diagnosis of either or both conditions can significantly reduce complications and, more importantly, expedite implementation of appropriate treatment.
CONCLUSIONS: In our
case we present a combination acute appendicitis, acute
sacroiliitis and staphylococcus aureus septicaemia and provide proof that acute pyogenic sacroiliitis can be a rare complication of acute appendicitis. Thus, a high clinical index of suspicion should be considered in the appropriate clinical scenario.