Computed Tomography Detection of Schistosomal Appendicitis
DCW Tang, THT Sung, MW Lam, SCS Cheng
Hong Kong J Radiol 2014;17:277-80
DOI: 10.12809/hkjr1414249
Schistosomiasis is the second most prevalent parasitic disease worldwide, which is rarely reported in developed countries like Hong Kong. We report a case of schistosomal appendicitis in a 79-year-old male presenting with right lower abdominal pain. Computed tomography of the abdomen and pelvis showed dilated appendix with adjacent stranding, suggestive of acute appendicitis. Long-segment circumferential interrupted mural calcification was also seen along the large bowel and appendix, together with capsular calcification extending towards the centre of liver with turtleback appearance, highly suspicious of prior schistosomiasis infection. Subsequent histological study of the appendicectomy specimen revealed transmural suppurative inflammation of the appendix with numerous calcified Schistosoma ova in the appendiceal wall, compatible with schistosomal appendicitis. Having discussed the incidence and pathogenesis of schistosomal appendicitis, we stress the importance of considering prior schistosomal infestation as a cause of acute appendicitis, especially in patients who have emigrated or are travelling from endemic areas.
中文摘要
利用電腦斷層掃描檢測血吸蟲闌尾炎
鄧峻樺、宋咸東、林聞華、鄭志成
血吸蟲病是全球第二種最常見的寄生蟲病，發達國家如香港很少有類似的病例報導。本文報告一名症狀為右下腹痛的79歲男性血吸蟲性闌尾炎病例。病人的腹部和盆腔電腦斷層掃描顯示闌尾擴張伴周圍脂肪條紋徵，提示有急性闌尾炎。沿大腸和闌尾可見長段環狀非連續性壁鈣化，伴囊狀鈣化延伸至呈龜甲外觀的肝臟的中心位置，高度懷疑原發性血吸蟲感染。闌尾切除術的病理標本證實為透壁性化膿性闌尾炎伴闌尾壁上多個鈣化的血吸蟲卵，符合血吸蟲闌尾炎的診斷。本文討論血吸蟲性闌尾炎的發病率和發病機制，強調考慮原發性血吸蟲感染為急性闌尾炎的病因的重要性，特別是對於曾移民或到血吸蟲病流行地區旅行的病人。