- 期刊
The Benefit of Routine Abdominal Echo for Acute Abdominal Pain of the Right Lower Quadrant with Suggested Appendicitis
急性右下腹痛且懷疑闌尾炎患者使用例行性腹部超音波檢查之研究
摘要
急診醫師常會遇到右下腹痛患者，這些患者有些會表現出典型之急性闌尾炎症候（上腹至右下腹之轉移痛，顆粒球性白血球上昇，及腹膜炎徵候），有些則不明顯。本研究之目的為例行性使用腹部超音波檢查，於急性右下腹痛患者且懷疑闌尾炎患者，並篩選不具有典型症候之急性闌尾炎患者，做鑑別診斷：共有55位患者因急性右下腹痛至急診就醫，於第一線急診醫師及會診醫師，懷疑是急性闌尾炎的情況下，安排例行性腹部超音波檢查，有35位患者有典型之急性闌尾炎症候，其中有31病患，其腹部超音波有闌尾炎影像；另外20位患者有非典型之急性闌尾炎症候，其腹部超音波例檢查，有特別發現的案例有9件（佔45%:3例是泌尿科疾病，3例是婦產科疾病，1例是盲腸腫瘤，2例有明顯闌尾炎變化），這20個案例中，最後有6例經手術後，證實為急性闌尾炎，故例行性使用腹部超音波來診斷不具有典型症候之急性闌尾炎，其診斷價值有限，但做為鑑別診斷時，則有其必要性。
並列摘要
Background: Acute abdominal pain with equivocal clinical examination is still a great challenge for emergency physicians. The aim of this study was to determine whether routine abdominal echo is helpful in the differential diagnosis for acute abdominal pain of the right lower quadrant (RLQ) with or without typical symptoms and signs of appendicitis in the emergency department. Methods: A total of 55 adult patients with suggested appendicitis underwent ultrasonography of the RLQ. Patients with symptoms and signs of appendicitis (migratory pain, localized and rebounding tenderness over McBurney's point, and leukocytosis with left shift, and plain abdominal radiography showing ileus located in the RLQ or appendiceal fecalith) were defined as typical; the other patients admitted had equivocal signs and symptoms of acute appendicitis which were atypical. Pediatric patients (age was less than 15 years old) and pregnant patients were not included in this study. Patients without complete examination results were excluded from our study. Thirty-five patients had typical symptoms and signs of appendicitis; 20 patients presented with equivocal symptoms and signs of appendicitis. The SPSS statistical programs packages were used for the statistical analysis. Differences were regarded as statistically significant when p＜0.05. Results: Thirty-five patients had typical symptoms and signs of appendicitis. Thirty-one of the 35 patients had positive signs on ultrasonography. Twenty patients did not have typical symptoms and signs of appendicitis and they were individually analyzed: three patients had right side hydronephrosis, three had gynecological problems (endometriosis, ovarian cyst rupture, and ovarian cyst torsion), two had dilated blind-end loop with target images, as well as appendicitis proven by appendectomy, and one had a cecal tumor. The ultrasonographic findings of the remaining patients (11 patients) showed normal images or much bowel gas, and four of them underwent surgery for appendicitis. The use of abdominal echo alone was of limited benefit in detecting true appendicitis in patients with atypical symptoms and signs of appendicitis (p＞0.05). However, it was a valuable tool in performing differential diagnosis. Conclusion: Routine abdominal echo performed by gastroenterologists or trained physicians is a useful tool in the differential diagnosis of patients with acute pain of the RLQ and without typical symptoms and signs of appendicitis.