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2013, vol. 10, br. 3, str. 119-122
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Apendikularna endometrioza - prezentacija pacijenta i pregled literature
Appendicular endometriosis: Case presentation and review of the literature
aUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Srbija bKlinički centar Kragujevac, Služba za patološku-anatomsku dijagnostiku, Srbija
e-adresa: lena.ilic@gmail.com
Sažetak
Endometrioza je estrogen-zavisna inflamatorna bolest koja se javlja kod 5-50% žena u reproduktivnom periodu. Može biti asimptomatska ili je uzrok brojnih ginekoloških poremećaja, od pelvičnog bola do steriliteta, kod čak 45% obolelih. Pacijentkinja, stara 23 godine primljena je u Urgentni centar Hirurške klinike, zbog bolova u donjem desnom delu trbuha, sa visokom temperaturom od 39 stepeni, mukom i gađenjem, bez povraćanja. Bol je prisutan 4 poslednja dana, a ostala simptomatologija se javila u poslednjih 24 sata. Kliničkim pregledom, nađena je bolna osetljivost uz zategnutost trbuha, posebno izraženi u donjem desnom kvadrantu trbuha. Nalazi rektalnog i vaginalnog pregleda bili su uredni. Laboratorijske analize bile su referentnim granicama, izuzev C-reaktivnog proteina uz prisutnu leukocitozu. Kompjuterizovanom tomografijom abdomena uočeno je, retrocekalno, uvećano slepo crevo prečnika 20mm. Laparatomijom, u opštoj endotrahealnoj anesteziji identifikovano je, retrocekalno, edematoznouvećano slepo srevo, tamno mrke boje, bez znakova peritonitisa. Desni jajnik i terminalni deo tankog creva su bili bez makroskopski vidljivih patomorfoloških promena. Urađena je apendektomija, i operativni materijal je poslat na patohistološku analizu. Standardnim mikroskopskim pregledom uz imunohistohemijsku analizu postavljena je dijagnoza akutnog apendicitisa sa endometriozom. Postoperativni tok je prošao uredno i pacijentkinja je otpuštena iz bolnice petog dana u dobrom opštem stanju. Endometrioza slepog creva je vrlo retka pojava i može biti uzrok akutnog apendicitisa. Preoperativno postavljanje dijagnoze je skoro nemoguće, a značaj precizne patohistološke analize je veliki naročito kod žena koje se leče od steriliteta.
Abstract
Endometriosisis an estrogen-dependent inflammatory disease which occurs in 5-50% of women in the reproductive period. May be asymptomatic or can cause extensive gynecological disorders, from pelvic pain to infertility in 45% of patients. The patient, aged 23, was admitted to hospital Surgery Clinic, because of pain in the lower right part of the abdomen, with a high temperature of 39 degrees, pain and disgust, without vomiting. Pain was present last 4 days, and the other symptoms have occurred in the last 24 hours. Clinical examination, painful sensitivity was found with abdominal tightness, particularly pronounced in the lower right quadrant of the abdomen. Findings of rectal and vaginal examination were normal. Laboratory findings were in normal range, except for C-reactive protein in the presence of leukocytosis. Computed tomography of the abdomen it was noticed, retrocecal, enlarged appendix diameter 20 mm. Laparotomy, under general endotracheal anesthesia were identified, retrocecal, oedematous- enlarged appendix, dark brown in color, with no signs of peritonitis. Right ovary and the terminal portion of the small intestine were macroscopically visible without macroscopic changes. Appendectomy was performed, and the operative material was sent for histopathological analysis. Standard microscopic examination with immunohistochemical analysis confirmed the diagnosis of acute appendicitis with endometriosis. The postoperative course was regular and the patient was discharged from hospital on the fifth day in a good general condition. Endometriosis of the appendix is very rare and can be a cause of acute appendicitis. Preoperative diagnosis is almost impossible, and the importance of the precise histological analysis is particularly high among women treated for infertility.
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