以消化道症状为首发表现的脾破裂临床误诊原因分析OA

Objective To investigate the clinical characteristics,causes,and prevention strategies of misdiagnosis of splenic rupture as acute gastroenteritis.Methods A retrospective analysis was conducted on clinical data of 5 patients with splenic rupture misdiagnosed as acute gastroenteritis from June 2023 to July 2024.Results Among the 5 patients,4 had a history of trauma to varying degrees,while 1 had an unclear history of trauma.Three patients presented with sudden persistent pain in the upper or left upper abdomen accompanied by nausea and vomiting.Physical examination showed no obvious abdominal muscle tension and reduced bowel sounds,and they were initially diagnosed with acute gastroenteritis.After ineffective treatment with anti-infection and fluid replacement,abdominal CT was performed due to progressive decrease in hemoglobin,confirming splenic rupture with hemoperitoneum.Two patients presented mainly with dull pain in the left upper abdomen,abdominal distension,and low-grade fever,without typical signs of peritoneal irritation.They were initially diagnosed with infectious gastroenteritis,but after 3 days of treatment,abdominal pain worsened.Bedside ultrasound revealed perisplenic fluid accumulation,and diagnostic abdominal puncture yielded non-clotting blood,leading to the final diagnosis.The misdiagnosis duration ranged from 2 to 7 d.All 5 patients underwent emergency splenectomy.Intraoperative findings confirmed splenic hilar laceration in 2 patients and rupture of the lower pole of the spleen in 3 patients.Postoperative pathology was consistent with traumatic splenic rupture.All patients recovered and were discharged at 7-12 d after surgery.Conclusion Splenic rupture is easily misdiagnosed as acute gastroenteritis in the absence of a typical history of trauma or peritoneal irritation.Clinicians need to be vigilant and perform imaging examinations as soon as possible for patients with unexplained abdominal pain accompanied by circulatory instability,and dynamically monitor changes in hemoglobin to reduce the risk of misdiagnosis.