Datasheet1_Colonoscopic titanium clipping to address appendiceal stump leakage: a case report.pdf

The incidence of appendiceal stump leakage (ASL) is extremely low and heterogeneous, which has been reported to be approximately 0.5%–1.0%. It is a catastrophic complication with high mortality rate despite its low morbidity. Once it occurs, it will put the doctor in a passive position because dealing with the leakage is much more cumbersome than appendectomy. We extensively reviewed the literature on ASL, focusing on the management and prognosis. Unsurprisingly, all of the physicians advocated extended resection, which apparently gave them sufficient confidence. However, partial cecum resection, cecostomy, or terminal ileectomy is extremely invasive and destructive. So, the patients had to experience great mental and physical trauma, longer hospital stays, higher rates of wound infection, more costs, and even a third surgery. Therefore, are there any better approaches for ASL? In this article, we report a case of ASL who successfully underwent endoscopic treatment. A 70-year-old male was admitted with gangrenous perforated appendicitis with a large iliopsoas abscess. Appendectomy, iliopsoas abscess debridement and sufficient drainage, appendicular stump repair and closure, and terminal ileostomy were performed. Three months later, the patient was readmitted and the stoma reversal was performed as scheduled. Seven days later, ASL was found when a liquid diet was applied routinely due to right lower quadrant pain and low fever. Finally, with the periappendiceal abscess completely drained, we clamped the appendiceal orifice with five titanium clips under an electronic colonoscope, which eventually sealed the leakage and avoided extended resection.

阑尾残端漏（appendiceal stump leakage, ASL）的发病率极低且存在异质性，既往报道其发生率约为0.5%~1.0%。作为一种灾难性并发症，尽管其发病率较低，但病死率颇高。一旦发生，常令临床医师陷入被动境地，因为处理该漏口的操作远比阑尾切除术更为繁杂棘手。我们全面检索并复习了ASL相关文献，重点聚焦于其治疗策略与预后转归。不出所料，所有纳入研究的医师均主张采取扩大切除术，这似乎为其提供了充足的治疗信心。然而，盲肠部分切除术、盲肠造口术或末端回肠切除术均属于极具侵袭性与破坏性的手术方式，患者因此需承受巨大的身心创伤，住院时间延长，伤口感染率升高，医疗成本增加，甚至需接受第三次手术。那么，针对ASL是否存在更优的治疗方案？本文报告1例经内镜治疗成功的ASL病例。患者为70岁男性，因坏疽穿孔性阑尾炎伴巨大腰大肌脓肿入院。术中依次行阑尾切除术、腰大肌脓肿清创引流术、阑尾残端修补闭合术以及末端回肠造口术。术后3个月，患者再次入院，按计划行造口还纳术。术后7日，患者因出现右下腹疼痛伴低热，常规试行流质饮食后确诊为ASL。最终，在彻底引流阑尾周围脓肿后，我们于电子结肠镜（electronic colonoscope）下使用5枚钛夹（titanium clips）夹闭阑尾残端开口，成功封堵漏口，避免了扩大切除术。