Clinical and Radiological Evaluation of Misdiagnosed Cases as Acute Appendicitis

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  • 急性虫垂炎誤診例の検討
  • キュウセイ チュウスイエン ゴシンレイ ノ ケントウ

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Background/aims : It is sometimes difficult to diagnose acute appendicitis in emergent setting. Postoperative histopathology discloses the appendix to be lack of inflammation in such cases. We assessed characteristics of misdiagnosed cases as acute appendicitis. Patients and Methods : Between 4/2009 and 10/2012, 25 misdiagnosed cases and 119 cases of pathologically confirmed acute appendicitis were compared for age, gender, clinical symptoms, laboratory data, and CT findings. Results : The misdiagnosed cases were finally diagnosed as diverticulitis (10 cases), colitis (five cases), gynecological diseases (three cases), and pyelonephritis (one case) ; the remaining six cases were undetermined. Between the two groups, no significant differences were observed in age and gender. In the misdiagnosed group, fewer cases had nausea (8.0 vs.33.6%, P=0.01). There were no significant differences in the laboratory data between them. In CT findings, the appendixes in the misdiagnosed group were fewer identified (44.0 vs. 94.1%, P<0.0001). In the misdiagnosed group, the mean diameter of appendixes was shorter (7.1 vs. 9.9mm, P=0.016) and fluid collection in the appendix (27.2 vs. 90.2%, P<0.0001) and ascites (8.0 vs. 55.5%, P<0.0001) were fewer found than in the properly diagnosed group. Conclusion : We could reduce the misdiagnosed cases of acute appendicitis if we pay more attention to the digestive symptoms and CT findings.

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