Perforated Appendicitis in a 4-Month-Old Infant

四個月大嬰兒之穿孔性闌尾炎

柯毓熙(Yue-Sci Ko) ； 林隆煌(Lung-Huang Lin) ； 黃清水(Ching-Shui Huang)

《Acta Paediatrica Sinica》 37卷4期 (1996/08) Pp. 283-285

https://doi.org/10.7097/APS.199608.0283

摘要

本文報告一例四個月大的男嬰，在住院前四天發生水瀉合併高燒，兩天後緩解。住院當天食慾變差且有輕微腹脹。更深檢查發現輕微腹脹但仍柔軟，腸音減少無明顯腹部壓痛。實驗室檢查中白血球及分類計數正常，C反應蛋白明顯上昇。住院後腹脹迴避且有含膽汁之嘔吐，系列腹部X光攝影顯示有阻塞的現象，腹部超音波檢查發現有流體積留於腹腔內。在腸穿孔的診斷下接受緊急手術，手術發現爲空孔性闌尾炎併膿性腹水及腹膜炎。腹水培養爲綠膿杆菌並且只有Ceftazidime有效。抗生素包含Prostaphlin, Metronidazole及Ceftazidime共使用兩週。也給予短期靜脈營養，並於術後第五天開始喟食。病人於入院三週後出院，無其它合併症。嬰兒其闌尾炎十分少見且有高比例的穿孔及腹膜炎，因爲臨床表現常不典型故診斷不易，所以特提出報告。

關鍵字

闌尾炎 ； 嬰兒期

並列摘要

A 4-month-old male infant was admitted to our hospital because of poor intake and mild abdominal distention for 1 day. Fever and watery diarrhea had occurred 4 days prior to admission, but subsided 2 days later after taking oral medications. A physical examination showed an acute ill-looking baby with a soft and mildly distended abdomen. The bowel sound was hypoactive and no obvious abdominal tenderness was found. Normal leukocyte and differential counts were noted in initial laboratory examinations; however, the serum level of C reactive protein was extremely high (31.4 mg/dL). Progressive abdominal distention and bilious vomiting occurred. Serial plain films of abdomen showed ileus with a fixed gas pattern and an abdominal echo revealed intraperitoneal fluid accumulation. Under the impression of intestinal perforation, an emergency laparotomy was performed. A perforated appendicitis with turbid fluid in the peritoneal cavity was noted during surgery. A pus culture grew Pseudomonas aeruginosa which was sensitive to Ceftazidime only. Triple antibiotics consisting of Prostaphlin, Metronidazole, and Ceftazidime were administered for 2 weeks. The patient was discharged 3 weeks later without any complications. Appendicitis in infancy is a rare condition and associated with a high frequency of perforation and peritonitis. Diagnosis is often difficult because of variable and nonspecific clinical manifestations.

並列關鍵字

appendicitis ； infancy