乳幼児急性虫垂炎の2例 TWO CASES OF ACUTE APPENDICITIS IN YOUNGER CHILDREN : REPORT OF TWO CASES
診断に苦慮した乳幼児の急性虫垂炎例2例を経験した.症例1:生後46日,男児.発熱,腹部膨満,不機嫌となり近医受診.抗生剤投与にて症状改善せず入院となった.腹部所見,腹部エコーにて異常所見なく,抗生剤の投与にて症状の改善をみたが,炎症所見が持続するため, 5日目に再精査を行い,エコー, CTにて虫垂炎と診断し手術を施行した.蜂窩織炎性虫垂炎であった.症例2: 1歳,男児.下痢,食欲低下,発熱に対し近医にて加療を受けるも症状増悪し入院となった.腹部は膨満し,全体に筋性防御を認め,腹部エコー, CTにて穿孔性腹膜炎と診断し緊急手術を施行した.壊疽性虫垂炎であり,後腹膜膿瘍および便汁の貯留をみた.一期的な腸管切除吻合術は行わず回腸瘻を造設した.術後,人工呼吸器下の管理を行ったが,敗血症性ショック, DICを発症し術後19日目に死亡した.<br> 本症の年長児とは異なる特徴および診断の困難性に関し文献的考察を加え報告する.
We experienced two infant cases of acute appendicitis which presented difficulty in diagnosis. Case 1: An forty days old by visited another hospital because of fever and abdominal fullness. He did not respond to administration if antibiotics and was admitted to the hospital. No abnormality was shown by abdominal findings and abdominal echography. Symptomatic remission was observed by conservative treatment, but five days later, close examination was conducted because of sustained inflammatory markers. Ecogram and abdominal CT indicated appendicitis, and so the patient was operated on. The pathological diagnosis was phlegmonous appendicitis. Case 2: An one year old boy was admitted to the hospitals because of diarrhea, poor feedings and fever. Although he was managed with conservative therapy, no symptomatic remission was attained. On physical examination the abdomen was distended, and there was rigidity to palpation in the entire abdomen. Emergency operation was performed under a diagnosis of perforating peritonitis. Upon laporatomy, retroperitoneal abscess and tyoryuu stools were seen. Iliostomy was performed. After the operation, he was treated under artificial respiration. Septic chock and DIC appeared. The patient expired nineteen days after the operation. In this paper we present these two cases as well as some notes on characteristics of the disease differing from those of elder children and the difficulty in diagnosis of appendicitis in younger children.
- 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society
日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 58(6), 1284-1288, 1997-06-25