小肠肿瘤误诊为急性阑尾炎的临床分析

Clinical Analysis of Small Bowel Adenocarcinoma Misdiagnosed as Acute Appendicitis

摘要: 目的：分析小肠肿瘤的临床特征及诊断要点，提高术前诊断率，以减少临床工作中的误诊误治。方法：回顾性分析2023年1例小肠肿瘤误诊为急性阑尾炎患者的临床资料，并复习相关文献资料。结果：患者因间断右下腹痛1月余就诊于当地医院，考虑急性阑尾炎，给予行腹腔镜下阑尾切除术，术中发现阑尾与小肠黏连致密，完整切除困难，给予行阑尾部分切除，术后病理示因组织碎，无法明确浸润存次，少量游离组织考虑癌变。为进一步治疗转入我科，给予完善增强CT等检查，行多学科会诊，考虑患者为阑尾肿瘤合并小肠肿瘤可能性大，给予再次行手术治疗，术后病理证实患者原发肿瘤来自小肠。结论：小肠肿瘤发生率低，临床无特异性表现，诊断困难，对可疑患者应及时完善相关检查，联系多学科会诊，术中仔细探查，必要时术中送冰冻病理检查，以避免发生误诊。

Abstract: Objective: To analyze the clinical characteristics and diagnostic points of small bowel adenocarcinoma, improve the preoperative diagnosis rate, and reduce the misdiagnosis and mistreatment in clinical work. Methods: The clinical data of a case of small bowel adenocarcinoma misdiagnosed as acute appendicitis in 2023 were retrospectively analyzed, and the relevant literature was reviewed. Results: The patient was treated in a local hospital for intermittent right lower abdominal pain for more than a month. Considering acute appendicitis, laparoscopic appendectomy was performed. During the operation, it was found that the appendix was densely attached to the small intestine, making complete resection difficult, and partial appendectomy was performed. For further treatment, she was transferred to our department and given enhanced CT and other examinations and multi-disciplinary consultation. Considering that the patient had a high probability of appendiceal tumor complicated with small bowel adenocarcinoma, she was given another surgical treatment, and the postoperative pathology confirmed that the primary tumor of the patient came from the small bowel. Conclusion: The incidence of small bowel adenocarcinoma is low, there is no specific clinical manifestation, and diagnosis is difficult. For suspicious patients, relevant examinations should be improved in time, multi-disciplinary consultation should be contacted, intraoperative careful exploration should be conducted, and intraoperative frozen pathological examination should be sent when necessary to avoid misdiagnosis.