Due to the complex causes of misdiagnosis of acute pancreatitis, the variety of misdiagnosed diseases, and the serious consequences of misdiagnosis, I reviewed the relevant literature, combined with nearly 30 years of clinical experience and the problems often mentioned by patients’ families, and summarized the most likely causes of clinical misdiagnosis and misdiagnosis for the reference of primary medical workers and patients’ families.
I. Reasons for misdiagnosis and mistreatment
(A) Reasons of patients and their families
Due to the economic difficulties of patients and their families, they do not know enough about the seriousness of pancreatitis and do not cooperate with the diagnosis and treatment, which leads to misdiagnosis and mistreatment.
1. Self-perception of acute gastroenteritis: For example, abdominal pain after drinking alcohol, high-fat meals or eating hot pot is mistaken for acute gastroenteritis, and the patient buys medicine at a pharmacy or seeks medical treatment at a nearby clinic, resulting in aggravation of the condition.
2, mistaken for the original disease attack: for example, often gallbladder stones cause abdominal pain, buy their own painkillers to eat, such as bile relief capsules can relieve pain, mistaken that the attack is still due to gallbladder stones, ignoring the presence of biliary acute pancreatitis.
3, economic difficulties: after the occurrence of abdominal pain is not willing to do relevant examinations, such as blood, urine amylase, lipase or abdominal ultrasound, CT and other examinations.
4, not enough attention: knowing that the onset of pancreatitis, do not go to a large hospital for treatment, and then transfer to a large hospital after the aggravation of the condition in a small hospital, and finally lose the time to rescue. One of the reasons for this is the convenience, close to home, easy to take care of; reason two is to save money; reason three is not understand the prognosis of pancreatitis.
(ii) Reasons of doctors
Patients have been to the hospital for abdominal pain, and misdiagnosis and misdiagnosis are caused by the doctor’s skills, thinking and responsibility.
1, superficial understanding of the causative factors: the appearance of epigastric pain with nausea and vomiting after a poor diet or fatty meals and alcohol, rarely think of checking amylase and imaging, and misdiagnosed as acute gastroenteritis or an acute attack of chronic gastritis, given antispasmodic and analgesic treatment, the condition worsened, and only after another visit to the emergency blood and urine amylase, B ultrasound or CT examination, was the diagnosis of acute pancreatitis confirmed.
2, satisfied with the diagnosis of the original disease: patients with previous gallbladder stones, right upper abdominal pain, only think of acute attacks of chronic stone cholecystitis, but ignore the biliary acute pancreatic, emergency gallbladder surgery, intraoperative pancreatitis was found, increasing the postoperative complications and death rate. Patients with a history of hepatitis present with abdominal pain and jaundice and are misdiagnosed as jaundiced hepatitis. Patients with left kidney stone presented with left upper abdominal pain and lumbar rib distension, which was misdiagnosed as left kidney stone. A patient with coronary artery disease presented with epigastric pain with vague pain in the precordial region and electrocardiogram suggestive of ST-segment changes, and was misdiagnosed as angina pectoris, and after supervised treatment, shock developed and was misdiagnosed as cardiogenic shock. The diagnosis of severe acute pancreatitis was confirmed by blood and urine amylase, B-ultrasound or CT examination only after the abdominal pain increased and total peritonitis appeared.
3. Lack of correct analysis of total peritonitis: Some of the severe acute pancreatitis, which develops rapidly, has total peritonitis at the time of consultation, and pus cells and leukocytes are found in the smear of peritoneal puncture fluid, or bloody ascites, and amylase and lipase of ascites and blood and urine amylase and lipase and CT examination are not done, but misdiagnosed as perforated peptic ulcer and perforated appendicitis and intestinal strangulation, and diagnosed as severe acute pancreatitis in emergency surgery.
4, lack of experience in special types of pancreatitis: such as early pregnancy combined with pancreatitis nausea and vomiting is obvious, misdiagnosed as early pregnancy reaction. Late pregnancy combined with pancreatitis, abdominal symptoms and signs are not typical, misdiagnosed as contractions or obstetric complications, emergency caesarean section, intraoperative diagnosis of severe acute pancreatitis, some patients were diagnosed as severe acute pancreatitis only after surgery by amylase, lipase, B ultrasound or CT examination. Elderly and pediatric pancreatitis, signs and symptoms are mostly atypical, and doctors ignore amylase, lipase and imaging examinations, or amylase and imaging examination results are mildly abnormal, and misdiagnosed as other diseases, missing the best time for early diagnosis and early treatment.
5, over-reliance on auxiliary tests:: amylase is the most basic and simple indicator for the diagnosis of acute pancreatitis, but due to the time of consultation, the degree of pancreatic necrosis, hyperlipidemia and other factors, some patients with elevated blood and urine amylase is not obvious and mistaken for other acute abdominal diseases, and finally dynamic detection of blood and urine amylase, lipase, abdominal ultrasound or CT, and even caesarean section to confirm the diagnosis of acute pancreatitis. Some of the acute abdominal diseases are misdiagnosed because of the lack of obvious enlargement of the pancreas in the early stage of acute pancreatitis or the obvious distension of the intestine that interferes with the ultrasound findings.
This shows that unfamiliarity with the evolution of pancreatitis and subjective assumptions about the test results are one of the main reasons for misdiagnosis.
(iii) Hospital reasons
The main reasons are poor hospital equipment, staff limitations, and delayed examinations due to many examinations not carried out at night or on holidays, leading to misdiagnosis and misdiagnosis.
II. Consequences of misdiagnosis
(a) Delay in treatment: Early diagnosis and early treatment of acute pancreatitis can interrupt the development of the disease in time, and the clinical efficacy is better. If the timing is delayed, the development of multi-organ failure, the outcome is poor. Many patients can not afford the expensive medical costs and give up treatment due to serious complications caused by misdiagnosis and mistreatment; some patients spend a lot of money, but in the end, the patient still died, people and money are empty, responsible for the tired, really tragic!
(ii) Misdiagnosis leads to mismanagement: early conservative treatment of acute pancreatitis is advocated, and emergency surgery due to misdiagnosis as other acute abdominal diseases increases postoperative complications and morbidity and mortality, thus increasing the economic burden.
III. Measures to reduce misdiagnosis
(a) Raise vigilance: Whenever a sudden onset of persistent abdominal pain is encountered, detailed medical history should be taken to clarify the location, nature, concomitant symptoms, and causative factors of abdominal pain; careful physical examination, combined with auxiliary examinations, and comprehensive analysis of positive and negative signs can reduce misdiagnosis.
(2) Cultivate normal thinking: for patients with peritonitis of unknown cause suspected to be biliary disease, gastrointestinal perforation, intestinal obstruction, appendicitis, blood and urine amylase and lipase should be routinely checked in a timely manner; abdominal ultrasound should be done in a timely manner for abdominal enhancement CT examination when the intestinal distension is not clear; do not forget to do amylase and lipase examination when doing ascites examination; be especially vigilant for acute pancreatitis combined with pregnancy, as it is related to the life of mother and child. Most obstetricians are unfamiliar with acute pancreatitis, so it is easier to misdiagnose and mistreat it. The elderly acute pancreatitis is often combined with geriatric diseases, which can easily conceal the disease and should be taken seriously.
(iii) Objective analysis of auxiliary examinations: As amylase and ultrasound examination affect more factors, if amylase is normal or mildly elevated, and ultrasound pancreas is normal or does not show well, the diagnosis of acute pancreatitis cannot be easily abandoned. Early auxiliary examinations for severe acute pancreatitis are atypical and can be easily mistaken for mild acute pancreatitis and paralyzed; we must analyze objectively and master the timing of the examination to obtain correct results; enhanced CT examination of the abdomen has a high value for the diagnosis of acute pancreatitis and should be done as much as possible.