Invaginated Appendiceal Stump Mimicking a Cecal Tumor

反塞之闌尾殘端彷若盲腸腫瘤

楊東和(Ton-Ho Young) ； 曹為霖(Wei-Lin Tsao) ； 季大為(Da-Wei Chi) ； 唐鴻舜(Hung-Shung Tang) ； 許重得(Chung-Te Hsu) ； 趙有誠(You-Chen Chao)

《中華民國消化系醫學會雜誌》 11卷3期 (1994/09) Pp. 181-186

https://doi.org/10.6557/GJTa.199409_11(3).0001

摘要

闌尾切除術後被反塞入盲腸的闌尾殘端有時極似盲腸息肉樣腫塊。在本院近3年來396例完整的全大腸鏡檢查中，共發現4個這樣的病例。這4位病人都是女性，且過去都曾因婦科問題如：子宮肌瘤，子宮頸癌等接受剖腹術，同時也施行闌尾切除合併殘餘部份反塞入盲腸。因為反塞入盲腸的殘餘闌尾並未如預期的完全壞死脫落，因此造成了日後診斷上的困擾。其實仔細觀察這4位病人在大腸鋇劑攝影及全大腸鏡檢查之發現，皆有其特徵。全大腸鏡檢查可在闌尾出口處發現長橢圓形及表面平滑的息肉樣腫塊，而大腸鋇劑攝影，除了在盲腸有一長條形填充缺陷外，其餘皆正常。本文主要提醒臨床醫師，極少數的病例在接受闌尾切除術後，其被反塞入盲腸的闌尾殘餘部份可能未完全壞死，而極似盲腸息肉樣腫塊。藉由詳細的病史詢問，大腸鋇劑攝影或全大腸鏡檢查應能確定診斷。對於這些病人，除非具有症狀，否則我們不建議作活體切片檢查，或任何治療。

關鍵字

反塞的闌尾 ； 盲腸息肉樣腫塊 ； 大腸鏡檢查

並列摘要

An invaginated appendiceal stump mimicking a cecal polypoid tumor was found by colonoscopy in four out of 396 patients in the period from October 1990 to October 1993. These 4 patients had undergone a gynecological laparotomy and an incidental appendectomy with ligation and invagination of the appendiceal stump. The appendiceal stump failed to undergo total necrosis, thereby causing a diagnostic dilemma; perplexity; quandary in colonoscopy. Characteristic and uniform pictures of colonoscopy and double contrast barium enema studies were found in all4 patients. The colonoscopy showed an oblong smooth cecal tumor in the appendiceal area, and the double contrast barium enema studies revealed a normal colon except for a longitudinal filling defect in the cecum. This report stresses that some of the invaginated appendiceal stump mimicking cecal polypoid tumors could be diagnosed by a history of appendectomy, and typical findings in double contrast barium enema study and colonoscopy. Colonoscopic biopsy or polypectomy is not recommended for asymptomatic patients.

並列關鍵字

invaginated appendix ； cecal polypoid tumor ； colonoscopy