The present report is a clinical study on the accuracy of the preoperative diagnosis in 1057 laparotomy patients who were operated at the Department of Surgery of Chungnam National University Hospital from July 1, 1972 to July 31, 1976.
1. In the preoperative diagnosis of 1057 cases, erroneous diagnosis were made in 135 cases giving an incidence of 12.8%.
2. The sequence of error rates in each disease were enteric tuberculosis (33.3%), colorectal cancer (15.7%), subphrenic abscess (13. 3%), stomach cancer (13.2%), typhoid fever with ileal perforation (12. 5%), peptic ulcer (with or without pyloric stenosis) (12.1%), peptic ulcer perforation (11.7%), peptic ulcer bleeding (9.3%), appendicitis (8.6%), inflammatory disease of biliary tract (5.3%), adhesive intestinal obstruction (4.0%) and etc.
3. The frequency of laparotomy in 1057 cases which were calculated in the final diagnosis were appendicitis (331 cases, 31.3%), inflammatory disease of biliary tract (82 cases, 7.8%), stomach cancer (77 cases, 7.4%). Abdominal trauma (73 cases, 6.9%), peptic ulcer perforation (61 cases, 5.7%), adhesive intestinal obstruction (52 cases, 5.0%), colorectal cancer (41 cases, 3.8%), typhoid, fever with ileac perforation (39 cases, 3.7%), enteric tuberculosis (15 cases, 1. 4%) and etc.
4., Rates of missed cases resulted from erroneous preoperative diagnosis were appendicitis (0.9%), inflammatory disease of biliary tract (12: 2%), stomach cancer (6.5%), peptic ulcer perforation. (4.9%), peptic ulcer (with or without pyloric stenosis, 9.3%) adhesive intestinal obstruction (4.0%), colo-rectal cancer (21.9%), typhoid fever with ileal perforation (10.0%), enteric tuberculosis (73. 3%) and etc.
5. The diseases which were frequently missed preoperatively in 135 cases were enteric tube-rculosis (ii cases), inflammatory disease of biliary tract (10 cases), colo-rectal cancer (9 cases), PID (9 cases), stomach cancer, (5 cases), typhoid fever with ileal perforation (4 cases), appendicitis (3 cases), adhesive intestinal, obstruction (2 cases) and etc.
6. Unnecessary laparotomies were 14 cases giving an incidence of 10. 3% of 135 cases, or 1.3% of 1057 cases.
7. Of 135 cases, emergency, operations were 63% and elective operations were 37%. In the emergency cases 89. 1% were operated within 24 hours and in the elective cases 70% within 7 days.
8. The mortality rate in 135 cases was 8. 1% (11 cases).
|