Clinical Diagnosis And Differential Diagnosis Of Diabete Mellitus Complicated With Abdominal Masses

Objective: Abdominal mass is a usual clinical syndrome.When patients with diabetes mellitus,early and correct clinical diagnosing plays a vital role in the patients’ clinical treatment and prognosis.To analyse the clinical characteristics,diagnosis and differential diagnosis of diabetes mellitus complicated with abdominal masses by reporting a case and reviewing the literature.Methods: Report a case treated in our hospital.And using “lymphoma,tumor,abdominal lymph node enlargement,abscess,and diabetes mellitus” as keywords,we searched cases published in domestic and overseas in last two decades.Results: 1.We reported a case with diabetes mellitus in our hospital.This case had multiple liver masses.Had been diagnosed as lymphoma.Imaging diagnosing showed holangiocarcinoma with liver and lung metastasis.The patient improved rapidly by antiinfection treatment and tightly controlling of blood glucose.Pathological biopsy identified it as liver abscess.After 80 days with continuous antibiotic treatment,multiple liver and lung masses disappeared completely.2.A total of 326 related literatures in the past 20 years were retrieved,including 107 in English and 219 in Chinese.In all literature,8201 patients with diabetes mellitus(all type 2 diabetes mellitus)complicated with abdominal masses were reported.The average age of the patients was 58.6 years old,the age range was 8-81 years old,and the ratio of men and women was 1.53:1.3.The most common diagnosing was abdominal abscess,which had 7282 cases(88.79%).Abdominal tumors(benign tumors,malignant tumors,metastases)was secondary,which had 842 cases(10.49%).77 cases(0.72%)in the blood system.The cases were entirely confirmed by pathological biopsy.4.There were 5954 cases with single organ abscess in abdominal cavity infection.The most common was liver abscess(72.46%),followed by splenic abscess(5.67%),and the others are pancreatic abscess(1.9%),renal abscess(1.58%),and gastric abscess(0.27%);Multiple organ abscesses accounted for 18.2%.Abdominal tumors contain 842 cases of benign tumors,malignant tumors as well as metastatic tumors.Most were malignant tumors(98.46%)with few benign tumors(1.54%).Primary tumors were more frequently than metastases,808 cases(95.97%)of primary tumors in the abdominal cavity and 34 cases(4.03%)of metastatic tumors.The most common malignant tumors were liver malignant tumors(43.82%),intestinal malignant tumors(23.16%)ranked second,and the rest includes pancreatic malignant tumors(16.03%),gallbladder malignant tumor(5.93%),gastric malignant tumors(4.51%),and renal malignant tumors(0.95%).Diabetes complicated with hematological diseases was rare,but had an increasing trend year by year.There were more B-cell lymphomas in a total of 74 cases(96.10%),fewer T-cell lymphomas for only 2 cases(2.60%)and one case of Castleman disease.5.The clinical early symptoms were fever and abdominal pain,which account for 78.46% and 44.66% respectively.27 articles on the misdiagnosis of diabetes mellitus with abdominal masses are reported,including 14 in English and 13 in Chinese.71 cases of misdiagnosis were confirmed by pathological examination.66 cases were misdiagnosed with imaging which was the main reason and 6 are misdiagnosed due to clinical manifestations and laboratory indicators.6.There were 711 cases of abdominal abscess which had been completely counted through laboratory indicator.Majority of these patients had elevated leucocyte(71.03%)and creactive protein(66.4%).Half of the patients had abnormal liver function.A few of patients had anaemia(9%)and 10.5% had thrombocytopenia.There were 223 cases with hemoglobin(hemoglobin al,Hb A1c),almost all of them had elevated Hb A1c(93.56%).Among the statistical cases,640 cases had completed etiological examinations.The most common cases were Klebsiella pneumoniae with 475 cases(74.21%).Conclusion:Diabetes complicated with abdominal masses can usually be misdiagnosed as tumors.Most of these diseases were abdominal infections with fever and elevated white blood cells.Liver abscess was the most common mass.Although the diagnosing of abdominal masses was first detected by imaging,it may be misdiagnosed by solely relying on imaging.In clinical work,it was necessary to ask the patient’s history of diabetes in detail,combined with clinical symptoms and laboratory indicators for consideration.Abscesses caused by diabetes infections may not be typical in imaging.They were similar with tumors or metastases.It was difficult to distinguish.Therefore,when a patient with diabetes had multiple masses and his imaging diagnosing was tumor,attention must be paid to differential atypical abscesses in order to avoid missed diagnosis or misdiagnosis.