Klinik Atölye

Çocuk: karın ve iskelet · Patoloji · Kritik

Çocukta komplike/perfore apandisit

Complicated and perforated appendicitis in children

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Çocukta komplike/perfore apandisit: yayımlanmış olgu görüntüsü, aksiyel+koronal kesit
Görüntü konuyu kısmen gösteriyor; bulgunun bir bölümü seçilebilir.

4 adım

Görüntü: Kono J, Yoshimaru K, Matsuura T ve ark., “COVID19 detection in appendix of acute appendicitis in a child: a case report and review of literature.” 2023, Fig. 1. PMC10012291 · doi:10.1186/s40792-023-01618-7 · CC BY 4.0. Değişiklik: yeniden boyutlandırıldı.

Özet

Perfore apandisitte BT’de ekstraluminal gaz, bağırsak duvarı kesintisi, lokalize yağlı doku inflamasyonu, serbest sıvı veya sınırlı flegmon ve apse görülebilir. Kontrastlı BT, perforasyon yerini lokalize etmeye ve ekstraluminal gaz, duvar defekti, yağlı doku çizgilenmesi, serbest sıvı, flegmon veya apse gibi bulguları göstermeye yardımcı olur. Perforasyon şüphesinde BT’de ekstraluminal gaz, duvar kesintisi, lokalize yağlı doku inflamasyonu, serbest sıvı, flegmon veya apse bulguları aranabilir. Perfore apandisitte BT bulguları tanıyı destekler ve perforasyon yerinin belirlenmesine yardımcı olur.

Faz ve pencere

Portal tanısal
Perforasyon şüphesinde BT’de ekstraluminal gaz, duvar kesintisi, lokalize yağlı doku inflamasyonu, serbest sıvı ve sınırlı flegmon veya apse bulguları birlikte değerlendirilir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

  • Periappendiküler apse — sınırlı perforasyonlarda BT’de lokalize bir apse görülebilir.
  • Fokal duvar defekti — kontrastlanan apendiks duvarında kısa bir kesinti, lümenle çevre koleksiyon arasındaki bağlantıyı düşündürür.
  • Ekstraluminal gaz — apendiks lümeni dışında, inflamasyon odağı komşuluğunda küçük gaz kabarcıkları görülebilir.
  • Appendikolit varlığı, akut apandisitte perforasyon ve apse gibi komplikasyonlarla ilişkili olabilir.
  • Flegmon — sınırlı perforasyonlarda BT’de lokalize flegmon görülebilir.
  • Peritoneal yayılım — perforasyon değerlendirmesinde BT’de peritoneal kalınlaşma ve kontrastlanma önemli bulgulardandır.
  • Çekum ve komşu ileum reaksiyonu — apseye bitişik bağırsak duvarında kalınlaşma ve çevre yağda sekonder çizgilenme gelişebilir.

Normalde

Perforasyon değerlendirmesinde serbest sıvı, çevre yağ dokuda çizgilenme ve sınırlı flegmon veya apse bulguları aranabilir.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0119; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Perfore Meckel divertikülü apandisiti taklit edebilir; görüntülemede karın ve pelviste serbest sıvı ve hava ile inflamatuvar değişiklikler görülebilir.
Pelvik apse
pelviste yerleşimli bir apse koleksiyonu olarak görülebilir.

Tuzaklar

  • Perforasyon tanısı için serbest havayı şart koşma; apse, flegmon, fokal duvar defekti veya dışarı taşmış appendikolit gaz olmadan da görülebilir.
  • Apendikolit değerlendirmesinde BT’de taşın yeri, boyutu ve sayısı dikkate alınır.
  • Küçük miktarda basit sıvıyı apse diye adlandırma; apse lehine çevresel kontrastlanan duvar, kompleks içerik ve çevre inflamasyonu ara.

Kendini dene

  1. Çekum komşuluğundaki koleksiyonun çevresi kontrastlanıyor ve içinde apendiks dışına taşmış kalsifiye odak var. En olası durum nedir?

    Cevabı göster

    Perfore apandisit. Apendiks dışındaki appendikolit ve çevresel duvarlanan koleksiyon perforasyonla komplike apandisiti güçlü biçimde destekler. Meckel odağı ince bağırsak kaynaklıdır; terminal ileit segmental ileum duvarını, omental infarkt ise yağ yoğunluklu bir odağı merkez alır.

  2. Gastrointestinal perforasyonda doğrudan MDCT bulguları ne işe yarar?

    Cevabı göster

    Tanıyı destekler ve perforasyon yerini lokalize eder. MDCT bulguları perforasyon tanısını destekler ve perforasyon yerini lokalize eder; eşlik eden bulgular altta yatan nedeni düşündürebilir.

Kaynaklar

Bu sayfadaki 29 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 18 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.