모호한 복부 통증의 환자에서 대장내시경으로 진단된 충수돌기염 3예
Three Cases of Appendicitis Diagnosed by Colonoscopy in Patients with Atypical Presentations
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초록
전형적인 충수돌기염의 증상을 호소하는 경우 자세한 문진과 신체 검사만으로도 충수돌기염의 진단이 가능하다. 그러나, 모호한 복부 통증을 호소하는 비전형적인 충수돌기염에서는 임상적으로 다른 질환과 감별하기가 쉽지 않다. 따라서, 진단의 정확도를 높이기 위해서 다양한 검사를 이용하게 되는데, 특히 비전형적인 임상 양상이 있거나 영상 검사 소견이 불명확한 경우에는 대장내시경이 다른 원인에 의한 복부 통증을 감별하고 충수돌기염을 진단하는데 도움이 된다. 저자들은 비전형적인 충수돌기염의 복부 통증을 호소하는 환자들에서 대장내시경검사로 진단된 충수돌기염 3예를 경험하여서 문헌고찰과 함께 보고한다.
Abstract
The diagnostic considerations are broad for patients who clinically present with obscure abdominal pain. Acute appendicitis can be diagnosed according to the clinical signs and symptoms, yet this can often be extremely challenging. Difficulties particularly arise when the presentation is atypical. Investigations that may help include laboratory tests, non-invasive imaging and laparoscopy. We experienced 3 cases of acute appendicitis that were diagnosed by colonoscopy. The colonoscopy revealed a bulging of the appendix into the cecal lumen. The mucosa was erythematous and edematous with pus draining from the appendiceal orifice. These findings were suggestive of appendicitis, which was confirmed after surgical appendectomy. In our experience, making the colonoscopic diagnosis of appendicitis might be helpful for patients with atypical symptoms, but colonoscopy should not be used for the diagnosis in the beginning if appendicitis is initially suspected.
참고문헌 (10)
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