Diagnosis and Treatment of Secondary Appendicitis (Report of 66 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Long ^1,2 , ZHU Anlong ¹ , PIAO Daxun ¹ , JIANG Tao ¹ , ZHAO Xianqi ¹

1.Department of Colorectal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China;;
2.Department of General Surgery, Subei People’s Hospital of Jiangsu Province, Yangzhou 225001, Jiangsu Province, China;

Corresponding author：

Keywords：

Secondary appendicitis; Surgery; Diagnosis; Treatment

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Objective To present the concept and explore the diagnosis and treatment strategies of secondary appendicitis. To summarize the clinical features of secondary appendicitis caused by different related factors. Methods The clinical data of 660 patients with a presumptive diagnosis of acute appendicitis between November 2003 and November 2008 in The First Affiliated Hospital of Harbin Medical University were collected and analyzed retrospectively. Five hundred and ninetyfour patients with primary appendicitis (primary appendicitis group), and 66 patients with secondary appendicitis (secondary appendicitis group). Clinical parameters such as fever， nausea or vomit, abdominal pain, abdominal distension, change of defecation habits or characters, tenderness in the right lower abdominal quadrant, acute abdomen, abdominal mass, and WBC were compared between two groups.
Results Biopsies of appendectomy were taken in all and the results showed inflammation. The pathogenic factors and cases of primary appendicitis: bacterial infection in 171 cases (25.91%), appendix cavity blocked by fecalith in 386 cases (58.48%), appendix cavity stricture in 33 cases (5.00%), and appendix deformity in 4 cases (0.61%). Sixty-six patients resulted from secondary appendicitis: colon carcinoma in 7 cases (1.06%) receiving laparocolectomy including 5 ascending colon and 2 transverse colon; gynecological disease in 20 cases (3.03%), 7 cases of right ovarian cyst accompanying adnexal torsion receiving oophorocystectomy combining with appendectomy, 5 right rupture of corpus luteum of ovary receiving right ovariectomy combining with appendectomy, 4 acute pelvic inflammation and pelvic abscess receiving transvaginal drainage of pelvic abscess combining with appendectomy, 4 extra-uterine pregnancy receiving right ovariectomy and salpingectomy combining with appendectomy; 9 cases (1.36%) of hernia, all to be right oblique hernia, receiving herniorrhaphy combining with appendectomy; Intestinal tuberculosis in 6 cases (0.91%), 4 cases receiving appendectomy, 1 case for resection of ileocecum, and 1 case for right hemicolectomy; parasitic disease in 24 cases (3.64%), all to receive appendectomy. There were significant differences in nausea or vomit, abdominal pain, abdominal distension, changes of defecation habit or character, tenderness in the right lower abdominal quadrant, abdominal mass, and WBC between two groups (P lt;0.05). There was no significant difference in fever or acute abdomen between two groups (P gt;0.05). InclusionsAppendicitis could be secondary to many diseases. We must attach importance to the diagnosis of secondary appendicitis so that to decrease or avoid the appearance of missed diagnosis and misdiagnosed in the clinical.

Citation： ZHAO Long ,ZHU Anlong,PIAO Daxun,JIANG Tao,ZHAO Xianqi. Diagnosis and Treatment of Secondary Appendicitis (Report of 66 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 932-935. doi: Copy

1.	周庆国, 宋学谦. 127例阑尾炎误诊误治分析 [J]. 中国普外基础与临床杂志, 2006; 13(5)： 505.
2.	夏君. 阑尾炎误诊误治原因分析 [J]. 临床医学, 2009; 29(2): 118.
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10.	Armstrong CP, Ahsan Z, Hinchley G, et al. Appendicectomy and carcinoma of the caecum [J]. Br J Surg, 1989; 76(10): 10491053.
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13.	Agarwal P, Sharma D, Agarwal A, et al. Tuberculous appendicitis in India [J]. Trop Doct, 2004; 34(1): 3638.
14.	沈兴华, 吴健乾. 结核性阑尾炎13例临床分析 [J]. 中国防痨杂志, 2001; 23(2): 114116.
15.	Askari A, Coventry P, Perks WH. Primary tuberculous appendicitis [J]. Postgrad Med J, 1993; 69(811): 411412.
16.	晁忠, 邱晓燕. 结核性阑尾炎六例误诊讨论 [J]. 临床误诊误治, 2007; 20(11): 35.
17.	唐廷勇, 罗伯诚. 结核性阑尾炎的诊断和治疗 [J]. 中华结核和呼吸杂志, 1998; 21(11): 651653.
18.	Bartholdy J, Kjaergrd H, Pedersen VM, et al. Hernia appendicitis [J]. Ugeskr Laeger, 1987; 149(13): 852853.
19.	孙建中, 王琪. 新生儿腹股沟疝内阑尾炎5例 [J]. 临床小儿外科杂志, 2002; 1(3): 236, 232.
20.	张号绒, 何静波. 彩色多普勒超声在诊断小儿腹股沟嵌顿性斜疝中的价值 [J]. 中华现代儿科学杂志, 2004; 1(2): 158160.
21.	肖立俊, 顾建平, 黄桂余. 误诊为急性阑尾炎42例分析 [J]. 中国普通外科杂志, 2000; 9(6): 573574.
22.	胡虞乾. CT在急性阑尾炎中的作用 [J]. 中国普通外科杂志, 2004; 13(7): 556557.
23.	张雄畴, 周素娟. 阑尾少见病34例误诊分析 [J]. 医学理论与实践, 2000; 13(11): 651653.
24.	Dorfman S, Cardozo J, Dorfman D, et al. The role of parasites in acute appendicitis of pediatric patients [J]. Invest Clin, 2003; 44(4): 337340.
25.	冷楠, 徐以浩. 寄生虫引起外科急腹症的临床特点 [J]. 腹部外科, 1997; 10(3): 105106.

1. 周庆国, 宋学谦. 127例阑尾炎误诊误治分析 [J]. 中国普外基础与临床杂志, 2006; 13(5)： 505.
2. 夏君. 阑尾炎误诊误治原因分析 [J]. 临床医学, 2009; 29(2): 118.
3. Adelstein P, Baldwin JA, Fedrich J. Cancers of the large bowel: associated disorders in individuals [J]. Cancer, 1979; 43(6): 25532557.
4. 丁家明, 佘永华, 冉茂成, 等. 盲肠和阑尾的解剖学观测及其临床意义 [J]. 四川解剖学杂志, 2006; 14(2): 1920.
5. Lai HW, Loong CC, Tai LC, et al. Incidence and odds ratio of appendicitis as first manifestation of colon cancer: a retrospective analysis of 1 873 patients [J]. J Gastroenterol Hepatol, 2006; 21(11): 16931696.
6. 周宏建, 王琳, 朱彦凯. 右半结肠癌误诊为急性阑尾炎18例分析 [J]. 腹部外科, 2007; 20(2): 111112.
7. 曹金成, 张检美. 结肠癌误诊阑尾炎10例分析 [J]. 医学信息， 2008; 21(3): 359360.
8. 胡运洲, 胡建琴. 右半结肠癌56例误诊分析 [J]. 临床误诊误治, 2006; 19(10): 53.
9. 刘良彬. 结肠癌误诊为阑尾炎12例报告 [J]. 中国普外基础与临床杂志, 1999; 6(1): 47.
10. Armstrong CP, Ahsan Z, Hinchley G, et al. Appendicectomy and carcinoma of the caecum [J]. Br J Surg, 1989; 76(10): 10491053.
11. 马玙, 朱莉贞, 潘毓萱. 结核病 [M]. 北京: 人民卫生出版社, 2006: 271274.
12. 吴在德, 郑树. 外科学 [M]. 第5版. 北京: 人民卫生出版社, 2000: 510512.
13. Agarwal P, Sharma D, Agarwal A, et al. Tuberculous appendicitis in India [J]. Trop Doct, 2004; 34(1): 3638.
14. 沈兴华, 吴健乾. 结核性阑尾炎13例临床分析 [J]. 中国防痨杂志, 2001; 23(2): 114116.
15. Askari A, Coventry P, Perks WH. Primary tuberculous appendicitis [J]. Postgrad Med J, 1993; 69(811): 411412.
16. 晁忠, 邱晓燕. 结核性阑尾炎六例误诊讨论 [J]. 临床误诊误治, 2007; 20(11): 35.
17. 唐廷勇, 罗伯诚. 结核性阑尾炎的诊断和治疗 [J]. 中华结核和呼吸杂志, 1998; 21(11): 651653.
18. Bartholdy J, Kjaergrd H, Pedersen VM, et al. Hernia appendicitis [J]. Ugeskr Laeger, 1987; 149(13): 852853.
19. 孙建中, 王琪. 新生儿腹股沟疝内阑尾炎5例 [J]. 临床小儿外科杂志, 2002; 1(3): 236, 232.
20. 张号绒, 何静波. 彩色多普勒超声在诊断小儿腹股沟嵌顿性斜疝中的价值 [J]. 中华现代儿科学杂志, 2004; 1(2): 158160.
21. 肖立俊, 顾建平, 黄桂余. 误诊为急性阑尾炎42例分析 [J]. 中国普通外科杂志, 2000; 9(6): 573574.
22. 胡虞乾. CT在急性阑尾炎中的作用 [J]. 中国普通外科杂志, 2004; 13(7): 556557.
23. 张雄畴, 周素娟. 阑尾少见病34例误诊分析 [J]. 医学理论与实践, 2000; 13(11): 651653.
24. Dorfman S, Cardozo J, Dorfman D, et al. The role of parasites in acute appendicitis of pediatric patients [J]. Invest Clin, 2003; 44(4): 337340.
25. 冷楠, 徐以浩. 寄生虫引起外科急腹症的临床特点 [J]. 腹部外科, 1997; 10(3): 105106.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment of Secondary Appendicitis (Report of 66 Cases)

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