맹장 및 맹장주위 염증에 관한 새로운 인식 - 1980년에서 1987년까지 증례를 통한 임상적 고찰

Typhlitis and perityphitis is a rare disease manifested by cecal inflammation, distinguished from appendicitis or periappendiceal abscess requiring immediate operative intervention. The pathogenesis of thyphlitis and perityphlitis may be different from that of acute appendicitis, arised from circulatory impairment due to the obstruction of the base of appendix. Conservative management is expected to ameliorate typhlitis and perityphlitis. Among the patients operated due to severe right lower quadrant pain at Department of Surgery, SNUH between May, 1980 and July, 1987, 20 Cases were confirmed as typhlitis and perityphlitis. Several important results were found from them by the clinical review. 1) 2 cases of primary typhlitis and perityphlitis were idiopathic. The other 18 cases were secondary, associated with previous inflammation of appendix or adjacent structures, preceded by inadequate appendectomy or incomplete management of appendicitis. 2) The most common symptom was intermittent right lower quadrant pain. The duration of symptom were more than 1 month in 15 cases and more than 2 weeks in 5 cases. Otherwise anorexia, conspitation, abdominal distension, diarrhea, nausea and vomiting, were also noticed. 3) Preoperative diagnosis was made by physical findings, ultrasonography, and colon study. 4) Open biopsy was performed in 7 cases, wheras right hemicolectomy in 6 cases. Adhesiolysis and cecectomy was done in 5 cases and 1 cases, respectively. 5) The histopathologic findings of specimen showed that cecal inflammation was characterized by infiltration of small round cells and plasma cells, proliferation of fibroblasts and endothelial cells through the whole layer of cecum, in other words, chronic inflarnmation predominated in their whole depth. In conclusion, for the adequate managenivnt of typhlitis and perityphlitis it is of importance to treat appendicitis adequately in order to prevent. The development of typhlitis and perityphlitis. Furthermore the precise research for the pathogenesis of typhlitis and perityphlitis as well as the understanding of the physiologic characteristics of cecum is essential to the management of typhlitis and perityphlitis.