Frank discrepancies between the pre-and postoperative diagnosis are occasionally experien-ced by every surgeon. During recent 5.5 years, the experience has reviewed 267 such cases out of 2948 true laparotomies at the Dept. of Surgery, Seoul Red Cross Hospital.
1. Except for the abdominal traumas, the total numbers of erroneous preoperative diagnosis were 258 out of 2762 laparotomies, giving an incidence of 9.37%.
2. Erroneous preoperative diagnosis had been appendicitis peritonitis of,unknown causes, "inflammatory disease of the biliary system"´ "peptic ulcer perforation", "uncertain intraabd-ominal tumors", "intestinal obstruction of unknown causes", etc., in the sequence of frequency.
3. Male to female ratio was 128: 139 and the peak age incidence was 3rd and 4th decades, which included 41.2% of total cases of the erroneous diagnosis.
4. 201(75.5%) had been undergone emergency laparotomies and 66 cases (24.5%), elective ones.
5. The 5 diseases that had been most frequently missed preoperatively were "enteric tuberculosis", "pelvic inflammatory disease", "stomach cancer", "nonspecific mesenteric lymphadenitis", "inflammatory disease of the biliary tract", in the sequence of frequency.
6. "Unwarranted" or "unproductive" laparotomies were 49 (18.4%) and they included 6 cases (2.2%) of negative laparotomies and 43 (16.2%) positive but unnecessary ones.
7. The remaining 218 laparotomies (81.6%) were erroneouslydi agnosed but "warranted" or "productive" and they included 38 procrastinated laparotomies (14.2%) and 170 (63. 7%) were not late for operation.
8. The final diagnosis that had undergone negative laparotomies were "negativee laparotomis after abdominal injury", "porphyria" and "gastroenteritis". Other unneccessary ones were "mesenteric lymphadenitis", "uncomplicated enteric tuberculosis", "pelvic inflammatory disease", etc. The final diagnosis that had undergone procrastinated laparotomies were "complicated small intestinal tumors", "mesenteric infarction," "liver abscess", "hepatoma with bleeding", "perforated appendicitis", etc., in the sequence of frequency.
9. "Unknown" or "uncertain" preoperative diagnosis were 85 cases(31.8%)and "probable´ or "fairly certain" ones were 182 (68.2%)
10. The most frequently misdiagnosed disease, according to the different age groups and sex were "mesenteric lymphadenitis" in childhood age without sex difference, "pelvic inflammatory disease" in young women, "enteric tuberculosis in young men and "stomach cancer" in elderly without sex difference.
11. The higher-error-rate-group diseases, reviewing by the final diagnosis were "small intestinal tumor (100%)", "mesenteric infarction (88.9%)", "enteric tuberculosis (60.8%)", "pancreas cancer (40.9%)", "hepatoma (29.1%)", etc., among the surgical diseases that had been experienced more than 5 cases each, during observational period.
12. The mortality rates were significantly higher in procrastinated and erroneously diagnosed groups (26.3%) and total erroneously diagnosed groups (7.9%), as compared with overall mortality of the total laparotomies (4. 1%).
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