Ultrasonography-triggered diagnosis of putrid,ulcero-phlegmonous,hemorrhagic appendicitis and periappendicitis with an atypical symptom pattern:a case report

摘要

Background:Asymptomatic and oligosymptomatic appendicitis are rare and challenging diagnoses that should not be missed.Case presentation:A young female patient presented with mild to moderate pain in the middle and lower abdomen,and the results of physical examination,including digital rectal examination,were otherwise non-contributory.Ultrasonography demonstrated a marked increase of the outer appendiceal diameter up to 12.0mm and a trace of free liquid around the terminal ileum.Subsequent surgical exploration and histological examination allowed for a final diagnosis of putrid,ulcero-phlegmonous,hemorrhagic appendicitis and periappendicitis.Conclusion:Ultrasonography is increasingly used for the diagnosis of appendiceal inflammation,particularly in military medical settings.Increases in the outer appendiceal diameter up to>6.0mm under compression have recently been demonstrated to be indicative of acute appendicitis.At a minimum,in cases with doubtful physical examination results,ultrasonography should be considered as an element in the diagnosis of acute appendicitis.