Очень интересная полнотекстовая статья по аппендициту. Очень хорошие примеры УЗИ и КТ, есть информация по лечению. Говорится о необходимости опер лечения.
http://radiology.rsnajnls.org/cgi/content/full/215/2/337
Abstract
Acute appendicitis is a common clinical problem. Accurate and prompt diagnosis is essential to minimize morbidity. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Helical computed tomography (CT) and graded compression color Doppler ultrasonography (US) are highly accurate means of establishing the diagnosis. These imaging modalities have now assumed critical roles in the treatment of patients suspected to have appendicitis. The purpose of this article is threefold: to provide an update on new information regarding the pathophysiology, clinical diagnosis, and laparoscopic treatment of acute appendicitis; to describe the state-of-the art use of CT and US in diagnosing this disease entity; and to address the role of medical imaging in this patient population.
Index terms: Appendicitis, 751.291 • Appendix, CT, 751.12112, 751.12115 • Appendix, US, 751.12983 • State of the Art
Appendicitis is the most common cause of acute abdominal pain that requires surgical intervention in the Western world (1). Patients with the disease may present with a wide variety of clinical manifestations, and the diagnosis may elude even the most experienced clinicians (2). Prompt diagnosis is essential to minimize morbidity, which remains substantial if perforation occurs. The advent of antibiotics and effective surgical management have substantially reduced appendicitis-related mortality; however, deaths from appendicitis still occur, particularly in the elderly.
Appendicitis was rare in the past and remains so in underdeveloped countries (3). There appears to be no record of early physicians, from Hippocrates to Moses Maimonides, recognizing this disease entity (3). Although the anatomy of the appendix was well known by the 18th century, it was not until this time that it was recognized that the appendix could become inflamed, with possibly fatal consequences (4). Early reports of perityphlitis and typhlitis in the 19th century appeared to describe a new clinical phenomenon (3,4). Confusion over this right-lower-quadrant entity existed until Reginald H. Fitz presented his landmark article in 1886, in which he coined the term "appendicitis" and correctly classified this disease by describing the appendix as the primary source of inflammation in acute typhlitis (5). Fitz described the signs and symptoms of acute and perforated appendicitis, outlined the progression from acute right-lower-quadrant inflammation through peritonitis and iliac fossa abscess formation, and recommended early appendectomy if there were signs of spreading peritonitis or of clinical deterioration. Shortly thereafter, Charles McBurney and other pioneering surgeons began to intervene early in acute appendicitis (6,7). These clinicians advocated prompt clinical diagnosis and surgical intervention. Their surgical aim was to operate in a timely fashion before appendiceal perforation and peritonitis developed.
The goal of modern surgical management essentially is the same and focuses on a balance between the rate of false-negative laparotomy and the rate of perforation at the time of surgical exploration (8–10). It is tradition that surgeons have diagnosed appendicitis on the basis of patient history and physical examination results. The relatively recent introduction of new imaging technology—in particular, graded compression color Doppler US and helical computed tomography (CT)—potentially has changed "the rules of the game." The purpose of this article is to document recent advances in our understanding of appendicitis and to define the role of medical imaging in patients with this condition.
