摘要
背景：妊娠中合併闌尾炎，其罹病率約介於0.06~0.1%。雖不多見，但由於在妊娠愈晚期，其診斷愈不易，且又因為容易導致流產之併發症。故若在術前未和病患及家屬詳盡溝通，取得良好共識，極易引起不必要的醫療糾紛。個案報告：這是一位26歲女性病患，於九十三年六月十八日來本院急診，主訴一週前曾因腹痛而接受開業醫安胎2天並返家休養4天，當時為妊娠第二十一週（預產期：九十三年十月二十二日）。六月十八日早上因急性腹痛合併上腹疼痛而來急診室求診。經內科醫師會診外科、婦產科及泌尿科醫師後，除發出病危通知單外，並在「妊娠第二十二週合併腹膜炎」之急性腹症條件下，轉送開刀房。於全身麻醉下，接受剖腹探查並切除闌尾及網膜。病患於六月二十一日被發現“胎死腹中”。於六月二十三日經陰道娩出壹死胎女嬰。吾人報告此案例，是希望提醒同儕醫師注意其併發症及術前溝通，並對診斷及預後方面作一回顧。
並列摘要
The incidence of acute appendicitis during pregnancy has been reported as between 0.06% and 0.1% of all pregnancies. Although the disease is rare, it is still the most common condition requiring surgery that occurs during pregnancy, and is therefore particularly important. A 26-year-old woman, who was 22 weeks pregnant, consulted our emergency department complaining of persistent epigastralgia and diffuse abdominal pain. She had suffered from the above symptoms for 6 days but the pain had worsened in spite of being treated by a local doctor. Surgery was arranged to remove the appendix and partial omentum following diagnosis of 22 week pregnancy combined with acute peritonitis. This case report aims to remind doctors, when treating pregnant patients with acute appendicitis, not only to discuss the situation thoroughly with the patient and family before the surgery but also to pay attention to complications. A literature review on the diagnosis and prognosis of this disease is also presented.
延伸閱讀
- Liao, J. J., Wu, C. C., & Jan, Y. J. (2010). 懷孕婦女的急性闌尾炎之闌尾切除. Formosan Journal of Surgery, 43(6), 294-299. https://doi.org/10.29833/FJS.201012.0004
- 李耀泰、陳福民、郭宗正（2010）。懷孕期間的闌尾炎。當代醫學，(442)，619-622。https://doi.org/10.29941/MT.201008.0016
- Deng, Y. W., Kao, Y. C., Chang, C. M., & Chiang, K. H. (2012). 殘端闌尾炎：病例報告. 台灣急診專科醫師期刊, 4(1), 22-25. https://doi.org/10.29749/JTCEP.201203.0004
- 陳政忠、李宏昌（2009）。急性胃腸炎併發闌尾炎。當代醫學，(430)，605-608。https://doi.org/10.29941/MT.200908.0009
- Safar, A., Aqeeli, A. A., Mass, A. A., & Shaban, B. A. (2017). Post-appendectomy appendicitis: A case report. International Journal of Case Reports and Images (IJCRI), 8(9), 597-600. https://doi.org/10.5348/ijcri-201790-CR-10829