| IntroductionThe acute abdomen referred to the rapid pathology changes that happened to the tissue of the abdominal cavity,the pelvis and after the peritonaeum,that produced main fact with belly symptom and Clinical manifestation reaction with whole body at the same time.The EHF which is not typical sometimes is only shown as abdominal pain,so it is likely to lead to misdiagnosis,in which non-typical EHF will be misdiagnosed for the inflammation disease in the abdominal cavity.Objective Analysis of the reasons of non-typical EHF misdiagnosed for the different surgical acute abdomens,probe effective precautionary measures for preventing from misdiagnosing from non-typical EHF to surgical acute abdomen.Methods Retrospective analysis of clinical data of the patients who were hospitalired in the department of general surgery due to surgical acute abdomen before diagnosis to EHF during the period 1996-2006. Results In 5 patients who underwent operation,appendix congestion and hydroncus were found and the pathology report were the simple appendicitis.After the operation,the patients still suffered from right lower abdomen pains.The patients suffered pain all over the body in 1 to 4 days after the operation and the range of pain expanded at the same time.Lack of the urine,the urine albumen appeared positive in the routine urine check;the patient temporarily diagnosed alimentary canal bleeding presented the inclination of bleeding all over the body after treament for 1 day,including conjunctiva congestion,nose bleeding,front cover putting the silt spot.,presenting the typical 3 red and 3 ache at the same time,so considered to be EHF;Other 4 patients who were treated to care and observe appeared following situation in 1-3 day, headache,pain in the back,pain all over the body,face,neck,chest flush,eyes conjunctiva,soft palate,swallowing department congested,the armpit,chest carried some forms and bleed and click,few urine,much urine appear;Check the low,heterotypic lymphocyte of blood platelet appeared in the blood routine,urine albumens appeared in the routine check of the urine.And then considered EHF.Infection department consider that there was possibility the EHF,so 10 patients were transfered to infectious department and continued treating after a consultation.DiscussionEpidemic hemorrhagic fever(EHF)belongs to henorrihagic fever with renal syndrome(HFRS),which is one of the virus hemorrhagic fever.EHF is a natural disease which is spread by the mouse carrying the Hantaan virus.It is one of the most dangerous EHF in the world.EHF virus can attack various organizations and be harmful to whole body.The disease has three main points: fever,bleeding and injure to kidney.The prominent appearance is "three red",that is,the patient's face,neck and front breast blood conflud and turn red.Besides these,there are "three pain",that is, eye ache,headache and kidney ache and will occur five periods, that is,fever period,low blood pressure period,lack of urine period,full of urine period and recovery period.Besides this main appearance,there are a variety of hetero-appearances,such as lung bleeding,inflammatory brain membrane and so on.parts of patients will have abdomen pain and will be easily misdiagnosed to surgical acute abdomen..The acute abdomen referred to the rapid pathology changes that happened to the tissue of the abdominal cavity,the pelvis and after the peritonaeum,that produced main fact with belly symptom and Clinical manifestation reaction with whole body at the same time.The mechanism of the surgical acute abdomen involves into the inflammation disease in the abdominal cavity the organ with a hole breaks,systematic calculus of biliary tract,acute intestinal obstruction,abdominal cavity internal organs turn back,the bleeding disease,abdominal cavity blood vessel pathological change that abdominal cavity internal organs break acutly. According to this report,it is successively acute appendicitis,acute cholangitis,acute intestinal obstruction from high to low that EHF was misdiagnosed for the possibility of surgical acute abdomen and disease.The main reason for misdiagnosis lie in EHF early symptom is not typical,there are not so many typical body symptom appearing in early stage in EHF,sometimes only suffering from abdominal pain.Other typical symptoms such as "three ache","three is red" were delayed appear or not interfere into diagnosing.What is more,most EHF patients appear the white blood cell increasing,combining suffering from abdominal pain, belly tenderness and beating ache,the surgeon is earily to consider that inflammation pathological changes are caused of suffering from abdominal pain.EHF belong to the department of medicine disease,surgeon is not familiar with it,inadequate of experience lead to clinical misdiagnosis.Clinical thinking limitation,analysis lack of an all-round way.Ignoring the epidemiology materials and asking the illness history,for example whether the patient has been to the EHF-stricken area.Ignorance for other symptoms such as the eye socket aches,less urine and so on.pay attention only to the belly body while checking the body,do not carried on the physical examination of whole body.Ignorance or omition "three red", such as skin mucous membrane bleed etc.Do not be careful while consulting the laboratory test report,do not analyse conscientiously. Excessively rely on a certain result of laboratory test.Insufficient understanding of clinical manifestation of EHF,especially not typical case,lack of the vigilance.The main differentiation points between the surgical acute abdomen and EHF lie in the overall understanding patient history and look over in detail the belly body.Generally speaking,first of all,all acute abdomens except cholecystitis and enterobrosis are not typhoid fever at the beginning.In addition all acute abdomens all over are not with bleed inclination,also do not have characteristic soft palate and ball bleed and pieces of form of armpit bleed to form,there is no obvious blood platelet to reduce.The urine does not have a large amount of albuminuria.As doubting stomach enterobrosis,the EHF patients have no the history body that often surport the original disease.Not also find the liver voiced disappearance and leaves the gas in the diaphragm low reaches.According to above analysis,we think we can make efforts from the following respects in order to misdiagnose recuring:The standardization training should be strengthen in clinical hospital. The surgical doctor needs to rotate at the department of medicine in order to improve surgeon's understanding of disease of department of medicine.Carefully inquire the patient history,check the body, analyse the result of laboratory test conscientiously,don't only limit a certain symptom but judge the condition on the whole.When meeting confused symptom,body solicitting,result of laboratory test of diagnosing tentatively that the disease is difficult to explain,It is needed to discuss with higher authorities' doctor, colleague,relevant office's doctor togetherso that make the proper plan of making a diagnosis.Keep vigilance of EHF correctly.When the following situation appear,the possibility of EHF should be expected:acute heat,whole body is unable,obvious poor appetite,sick,vomits,suffering from abdominal pain,suffering from diarrhoea,the muscle ache,have a headache etc.Carefully check body who swallow,soft palate,ball combine membrane bleed and armpit skin pieces of form bleed and order.Have unidentified reason bleed person who inclined to,soft palate bleed armpit scratch kinds of pieces of form bleed and order.It is difficult with the person who explains illness of intestines and stomach that there are malignant symptoms of vomitting,suffering from abdominal pain etc..Suddenly generating heat,the companion had a headache,the eye socket ached,the pain in the back,kidney district knocked aching or whole body muscle arthralgia.Generate heat companion periphery blood leucocyte increase,poisonned the particle,the heterotypic lymphocyte increases,the blood platelet reduces,the urine albumen is positive.The violent abdominal pain of the unidentified reason can't be with the surgical person who explains acute abdomen.The pain in the back appears shortly, urine is little,have albumens,red blood corpuscles or particle in charge ofing type person in the renal shutdown,urine,especially the person who discharges membrane form thing in the urine. Acute infectious disease patient,after the body temperature drops, the whole body symptom does not alleviate the persons who aggravate instead.ConclusionClinical symptom of the non-typical EHF ofern is simple abdominal pain,because of lack of typical Clinical symptom it is easy to be misdiagnosed as the surgical acute abdomen..Fever on the early stage and injury of kidney function on the early or middle are the important reference that distinguish the EHF and surgical acute abdomen.Main diagnosis points between EHF and surgical acute abdomen lie in understanding medical history fully and looking over belly bodysolicit in detail,Especially to the young and middle-aged patients from the countrysidein the EHF popular season.The EHF mainly with acute abdomen is mostly misdiagnosed to acute apappendise.So the "acute apappendise" patients appear the right lower abdomen pain and fever but lack of the typical shifting abdominal pain should be attention. |
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