右半结肠癌95例误诊与漏诊分析

目的：总结右半结肠癌误诊和漏诊的原因，探讨对策。方法：回顾性分析95例被误诊和漏诊的右半结肠癌患者的临床资料。结果和结论：95例中主要表现为右腹痛和包块者48例，解黑便和潜血试验阳性者11例，腹痛、烂便或腹泻者27例，只有大便性状改变者2例，首发贫血者7例。误诊为慢性阑尾炎和阑尾脓肿18例，消化性溃疡15例，十二指肠球部溃疡出血4例，慢性胃炎6例，慢性胆囊炎15例，慢性结肠炎12例，缺铁性贫血7例，结肠克罗恩病2例，肠结核4例，肠易激综合征2例，钩虫病1例，阿米巴痢疾1例，中医漏诊右半结肠癌8例。误诊和漏诊原因：主诊医生对黑便、粪潜血试验阳性、我国青年大肠癌的特点和缺铁性贫血的病因认识不足，片面强调了X线钡剂灌肠造影的结果；部分专科医生结肠镜的操作技术较差。只要采取反复多次行粪潜血试验和全结肠镜检查等措施，则可以减少或避免右半结肠癌的误诊和漏诊。     

老年性右半结肠癌漏诊为阑尾炎6例分析

目的减少老年性阑尾炎诊治中右半结肠癌的误诊及漏诊。方法收集内蒙古乌海市人民医院2008-09-2009-04右半结肠癌住院的60岁以上老年病例资料。结果有6例患者术前仅被诊为阑尾炎,漏诊结肠癌。结论对老年性阑尾炎患者诊治要提高警惕,可疑者可行钡灌肠、纤维结肠镜检查,可疑时最好取剖腹探查切口,常规探查右半结肠。     

右半结肠癌并发急性阑尾炎23例临床分析

目的探讨右半结肠癌并发急性阑尾炎的诊断要点,以避免结肠癌的漏诊、漏治。方法回顾性分析2000年1月-2008年10月23例右半结肠癌并发急性阑尾炎的临床资料。结果本组人院时均诊断为急性阑尾炎或阑尾周围脓肿,20例术中探查发现结肠肿瘤与阑尾炎并存,行一期右半结肠切除。3例行阑尾切除后,症状未缓解,经相关检查发现肿瘤,再次手术治疗。患者术后均恢复良好。结论右半结肠癌与急性阑尾炎并存易误诊、漏诊,遇有急性阑尾炎患者应详细询问病史,对可疑病例实施相关检查是减少右半结肠癌误诊及漏诊的关键。     

右半结肠癌伴发急性阑尾炎12例分析

目的：探讨右半结肠癌伴发急性阑尾炎的诊断特点，以减少右半结肠癌的漏诊。方法：回顾分析2000-2004年，本院12例右半结肠癌伴发急性阑尾炎临床资料。结果：12例患者初步诊断均为急性阑尾炎。5例术中发现右半结肠肿瘤；3例切除阑尾后症状未缓解，纤维结肠镜发现肿瘤；4例在内科治疗过程中，常规行B超检查发现结肠肿块。结论：术前B超检查和对可疑者阑尾炎术中探查右半结肠可明显降低漏诊率。     

右半结肠癌误诊为慢性阑尾炎5例分析

对我院1996-01~2005-12右半结肠癌误诊为慢性阑尾炎5例分析如下。1临床资料1.1一般资料本组均为女性,年龄36~68(平均52)岁。1.2治疗本组中有2例曾在2 a前有右下腹疼痛病史,曾在多家医院多次被诊断为慢性阑尾炎,反复多次输液抗炎治疗且抗炎治疗后可以缓解部分症状,最后终因抗生素治疗无效收入院准备手术治疗,手术前行钡灌肠检查提示升结肠及回盲部占位、癌瘤可能性大而行剖腹探查术,术中病理证实为结肠癌,均行右半结肠癌根治术。1例右下腹反复间断性疼痛9个月余,以慢性阑尾炎行阑尾切除术,术中见阑尾轻度充血,阑尾腔内有少许粪石。手术后患者…     

右半结肠癌误诊12例分析

现将我院1992/2007年右半结肠癌误诊为阑尾炎12例分析如下。1临床资料1.1一般资料本组男7例,女5例,年龄38~79(平均52)岁。有典型转移性右下腹痛4例,表现为持续性右下腹痛者8例。伴寒颤、发热9例,恶心呕吐8例,轻度贫血、乏力3例,近期大便性状改变5例,自觉消瘦1例。体检:有局限性腹膜炎6例,弥漫性肠系膜炎1例,右下腹可扪及包块2例。1.2误诊情况和方法本组误诊为阑尾周围脓肿2例,其中1例经保守治疗后出院,3个月后复发,行结肠镜检查确诊右半结肠癌,另1例保守治疗期间行结肠镜检查确诊为右半结肠癌,行右半结肠癌根治术。误诊为阑尾炎10例,急诊行阑尾切除术,术中发现右半结肠肿瘤3例,回盲部肿瘤3例;5例Ⅰ期行右半结肠癌根治术,1例因肿瘤无法切除,行回结肠短路术;4例行单纯阑尾切除术,术后腹痛症状未缓解或复发,经钡灌肠、结肠镜检查确诊为右半结肠癌后,行右半结肠癌根治术。2结果本组升结肠癌8例,回盲部肿瘤4例。其中腺癌9例,黏液腺癌3例。3讨论3.1误诊原因(1)右半结肠癌生长缓慢,常继发感染引起腹膜炎;出现恶心、呕吐、畏寒发热、血白细胞及中性粒细胞升高等炎症表现,尤其是回盲部肿瘤坏死穿孔就更易误诊[1]...     

结肠癌误诊为阑尾炎31例分析

目的：探讨结肠癌误诊为阑尾炎的原因及预防措施。方法：2003／2007年我院共收治结肠癌误诊为阑尾炎患者31例,所有患者均行手术治疗并经病理检查证实诊断。结果：31例误诊为急性阑尾炎。27例急诊行阑尾切除术。14例术中发现升结肠癌行根治性手术。13例仅行阑尾切除,术后均引出现消化道症状而复诊,平均出现症状时间46d。4例误诊为阑尾周围脓肿,因反复出现症状行钡灌肠检查明确结肠癌的诊断。结论：病史采集不详细、思维惯性的影响、以及术中切口选择不当是结肠癌误诊为阑尾炎的主要原因。加强病史的询问,完善必要的辅助检查,可以有效地减少误诊的发生。     

结肠癌误诊为阑尾炎18例分析

目的：探讨右半结肠癌误诊为急性阑尾炎的原因。方法：回顾性分析大庆龙南医院200303／200910收治的右半结肠癌误诊为急性阑尾炎18例的临床资料。结果：术后恢复良好,无死亡病例。术后并发局限性腹膜感染1例,经保守治疗治愈;并发切口感染2例,经换药愈合。结论：早期结肠癌患者症状不典型,详细的病史询问及体格检查和术中仔细探查是避免结肠癌误诊、漏诊的有效措施。     

右半结肠癌误诊为急性阑尾炎88例诊治分析

目的:分析右半结肠癌误诊为阑尾炎的原因,探讨预防措施.方法:回顾20年误诊右半结肠癌为阑尾炎的88例患者临床资料,对病史、体格检查、手术所见以及结果进行回顾性研究,探讨误诊原因.结果:右半结肠癌误诊为急性阑尾炎88例,误诊率2.4%.结论:对右半结肠癌的临床特点缺乏足够的重视,满足于阑尾炎诊断.对病史询问不够仔细,查体不足是误诊的主要原因.细致的询问病史是基础,详细体检是根本,辅以实验室检查是避免此类情况的关键.     

右半结肠癌合并急性阑尾炎21例诊治分析

目的 探讨结肠肿瘤并急性阑尾炎的临床特点,以降低急性阑尾炎诊治中结肠癌的漏诊及误诊率.方法 回顾性分析21例右半结肠癌合并急性阑尾炎患者的临床资料.结果 入院诊断为急性阑尾炎15例,阑尾周围脓肿4例,2例经外院行阑尾切除术后以右下腹包块急诊转入我院.病理类型为结肠腺癌16例,粘液腺癌4例,未分化癌1例.术后2例并发切口感染,1例并发肺部感染,均痊愈出院.结论 结肠癌与急性阑尾炎并存,易引起误诊、漏诊.对急性阑尾炎患者要详细地询问病史,对可疑患者实施相关检查是减少误诊及漏诊的关键.     

It is not always appendicitis

BACKGROUND: Patients who are suspected of having acute appendicitis usually undergo surgery in order to avoid life-threatening complications such as perforation and peritonitis. However, acute appendicitis is difficult to distinguish from other sources of right-sided abdominal pain. The clinical picture is almost indistinguishable from appendiceal diverticulitis, which is a rare entity and remains a difficult diagnostic problem. PATIENTS AND METHODS: We describe the case of a 39-year-old male with perforated appendiceal diverticulitis. The patient was admitted to our surgical unit with acute appendicitis-like symptoms and underwent surgery with a diagnosis of suspected acute appendicitis. RESULTS: The patient was found to have perforated appendiceal diverticulitis and standard appendectomy with abdominal lavage was carried out. DISCUSSION: Most patients presenting with acute right-sided peritonitic pain are diagnosed and managed as cases of acute appendicitis. Acute pain in the lower right side of the abdomen caused by appendiceal diverticulitis is very rare and clinically indistinguishable from acute appendicitis. Inflammatory complications of appendiceal diverticula mimic acute appendicitis. CONCLUSION: Every surgeon should be aware of the possibility of diverticulitis of the appendix in the operating room, even if this does not change the operative management. As diverticula of the cecum can be found as solitary lesions, as multiple lesions confined to the right colon, or as part of a generalized disease of the entire colon, postoperative barium enema examination may be useful.     

Colorectal cancer: the case for barium enema.

Both colonoscopy and barium enema are important techniques for examining the colon for polyps and cancer. They are approximately equally sensitive in detecting polypoid lesions of 7 to 10 mm or larger. A major limitation of colonoscopy is that the cecum cannot be visualized in 10 to 36% of cases. The comparable accuracy for detecting significant lesions, greater safety, and greater cost-effectiveness of barium enema favor its use in most patients.     

Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer

BACKGROUND AND STUDY AIMS: Colonoscopy has replaced barium enema as the primary method for direct diagnosis of colorectal cancer, but detection may fail, and the reasons for this are not completely understood. PATIENTS AND METHODS: In order to analyze the accuracy of colonoscopy for detecting invasive colorectal cancer, 7365 colonoscopic examinations were matched with the most accurate local government population-based cancer registry in Japan. RESULTS: In 15 colonoscopic examinations, patients were not diagnosed as having invasive colorectal cancer, but disease of this type was detected within 3 years of the examinations (false-negative examinations). During the same period, 233 colonoscopies were identified as true-positive examinations. The false-negative rate for detecting invasive colorectal cancer with colonoscopy was 6% at 3 years. The false-negative rate was significantly higher in individuals between 60 and 69 years of age and in invasive cancers located to the right of the splenic flexure. CONCLUSIONS: Colonoscopists should receive adequate training in achieving easy cecal intubation, detecting small or flat lesions, and carrying out adequate biopsies.     

The role of barium enema in detecting colorectal disease. A radiologist's perspective.

The single-contrast barium enema examination remains useful for patients with acute diseases such as bowel obstruction, diverticulitis, appendicitis, and fistulas. It is also the procedure of choice for those patients who are too elderly, debilitated, or ill to cooperate with the maneuvers necessary for a double-contrast examination. The double-contrast technique is more sensitive than the single-contrast technique for detection of polyps, early inflammatory bowel disease, and lesions of the rectum. In the older population, there has been an increase in the incidence of colonic polyps and carcinomas in the right side of the colon. This emphasizes the need to examine the entire colon in these patients. The double-contrast barium enema is a safe, accurate, and cost-effective tool for accomplishing this. It is also recommended as the initial procedure in the examination of patients with positive results on fecal occult blood testing.     

Prolonged rectal bleeding associated with hemorrhoids: the diagnostic contribution of colonoscopy

We studied 387 patients with prolonged rectal bleeding and hemorrhoids (grades 2 and 3) routinely examined by anoscopy, proctoscopy, single contrast barium enema, and hemoglobin measurements. Normal results were obtained in 86 patients above the age of 40. Total colonoscopy in these patients revealed one patient (1.2%) with cancer, 19 (22.1%) with colorectal polyps, and one (1.2%) with angiodysplasia. These findings indicate that in patients above age 40, a full investigation of the large bowel should be done in every case of prolonged rectal bleeding despite the presence of substantial hemorrhoids. Double contrast barium enema or colonoscopy must be used, rather than single contrast barium enema, which proved to be an inaccurate method of investigating prolonged rectal bleeding.     

Radiographic and endoscopic findings in penicillin-related non-pseudomembranous colitis

The characteristic findings of barium enema and colonofiberscopic studies and their changes over time were investigated in 10 patients with penicillin-related non-pseudomembranous colitis. Radiographic examination within 6 days of onset revealed abnormal findings such as narrowing of the lumen, loss of haustral markings, thumb-printing, transverse ridging, and saw-toothed irregularities. These findings tended to be more pronounced on the right than on the left side of the colon. Endoscopy revealed lesions characterized by mucosal reddening, edema, and hemorrhage, without definite ulceration or erosion. In 5 of the 10 patients, non-continuous distribution of the lesions was noted. In 4 patients, the rectum was unaffected. Reversion to normal occurred within an average of 15.7 days following onset of the symptoms. Thus, for an accurate diagnosis of this disease, barium enema and/or total colonoscopy should be performed within 6 days of onset.     

Streptococcus bovis septicemia and large bowel neoplasia

Streptococcus bovis septicemia is a relatively uncommon entity that is associated with an increased incidence of colonic neoplasms. Three of four patients with S. bovis endocarditis subsequent to septicemia underwent colonoscopy. The fourth patient underwent a barium enema and a proctoscopic examination. Polyps were found in three patients, and adenocarcinoma of the colon in one. Patients with S. bovis endocarditis should be considered at high risk for colonic neoplasms. Screening colonoscopy is recommended for these patients, and follow-up colonoscopy may be warranted.     

特殊人群急性阑尾炎影像学检查及治疗新进展

急性阑尾炎是一种常见病和多发病,结合临床表现、实验室检查诊断典型阑尾炎并不困难,但是对于一些临床表现不典型,阑尾位置变异又高度怀疑阑尾炎的患者,尤其是对于儿童、孕妇及老年患者的诊断显得较为困难。此时,结合影像学检查对于诊断具有重要意义,检查手段包括超声、CT、磁共振影像、钡剂灌肠X线、结肠镜等。诊断明确后,开腹手术作为急性阑尾炎的经典手术方案曾经在临床上被广泛使用,而腹腔镜阑尾切除术作为一种新的微创手术已被人们接受。近年来,内镜下逆行阑尾炎治疗作为一种创新性手术引起国内外学界的广泛关注,在未来可能成为治疗急性阑尾炎的一种新模式。本文就急性阑尾炎,尤其特殊人群急性阑尾炎的诊断及治疗进展做一综述。     

急性肠扭转早期诊治体会

目的：总结急性肠扭转的早期诊断及治疗的经验。方法：对我院近5年中的62例急性肠扭转患者的临床表现、检查及治疗方法回顾性分析,探讨肠扭转的早期诊断及治疗问题。结果：51例肠扭转患者经螺旋cT检查确诊。8例经行稀钡灌肠确诊,3例经腹腔镜探查确诊;52例行手术治疗（其中35例系腹腔镜下手术）．2例经稀钡灌肠时复位,3例肠镜下复位成功,5例保守治疗好转。结论：早期在临床出现“症征分离”性腹痛时。立即行螺旋CT检查,但检查阴性征象不能轻易排除本病,必要时行腹腔镜探杏。对于有急性期肠扭转超过180°以上的患者建议及时早期手术（包括腹腔镜下复位）．对于乙状结肠扭转患者,如果症状较轻,可考虑肠镜下或稀钡灌肠试复位,如保守治疗失败或出现肠坏死症状时应及早进行手术。