十二指肠溃疡穿孔误诊原因分析及防范措施OA

Objective To analyze the causes of clinical misdiagnosis of duodenal ulcer(DU)perforation and the preventive measures against such misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 3 patients with DU perforation that were initially misdiagnosed and admitted during the period from June 2022 to June 2024.Results One patient presented with sudden right abdominal pain for 3.5 h and was initially diagnosed as acute peritonitis.During the operation,it was confirmed as DU perforation.The misdiagnosis period was 1 d.After the diagnosis,repair of perforated DU and appendectomy were performed.The patient recovered well and there was no recurrence during follow-up.One patient had migratory right lower quadrant pain for 3 d,accompanied by fever,tenderness at McBurney's point,and elevated white blood cell count.The initial diagnosis was acute appendicitis.During the operation,it was confirmed as DU perforation.The misdiagnosis period was 1 d.After the diagnosis,drainage of fluid and catheter placement were performed during the operation,and postoperative gastrointestinal decompression and anti-inflammatory treatment were given.The patient recovered and was discharged 12 d afterwards.Postoperative gastroscopy confirmed ulcer healing.Another patient had persistent right lower quadrant pain for 3 d accompanied by diarrhea.The initial diagnosis was acute appendicitis.During the operation,mild congestion of the appendix was observed but no typical inflammation was present.Further exploration revealed DU perforation,accompanied by a small amount of abdominal cavity exudate.The misdiagnosis period was 1 d.After the diagnosis,repair of perforated DU and drainage were performed.Postoperatively,coffee-ground like gastric fluid was drained via nasogastric tube.After anti-inflammatory and acid-suppressing treatment,the patient recovered and was discharged.No recurrence was observed at 6-month follow-up.Conclusion DU perforation is prone to misdiagnosis as acute appendicitis or peritonitis.Clinicians should inquire in detail about the history and triggers,be vigilant for atypical signs,and,if necessary,expand the exploration scope to reduce misdiagnosis.