Keywords: right colon cancer; delayed diagnosis; clinical
Right colon cancer is one of the most common malignant tumors of the gastrointestinal tract, and has a tendency to increase year by year. Due to the lack of clinically specific symptoms and signs, it is easy to be misdiagnosed and missed clinically and treatment is delayed. The author reviewed more than two articles in the literature in the past two years concerning the delayed diagnosis of right colon cancer. Selected 449 cases of 10 literatures and 54 cases of right colon cancer that were delayed in diagnosis in our hospital from January 1993 to June 2006 (503 in total Example), summarize and analyze the reasons for the delayed diagnosis of right colon cancer.
1 Clinical data
There were 449 cases of 10 literatures and 54 cases of right colon cancer (503 cases in total) that were delayed in diagnosis in this hospital. There were 287 males and 216 females, aged 17-88 years, average age 48.5-59.6 years, delayed diagnosis time 3 Month-3 years. 250 cases were misdiagnosed as appendicitis and abscess around appendix, 70 cases of gastritis and gastroduodenal ulcer, 46 cases of intestinal adhesions and intestinal obstruction, 38 cases of cholecystitis and gallstones, 32 cases of female adnexitis and adnexal mass, 24 cases of colitis , 13 cases of iron deficiency anemia, 10 cases of tuberculous granuloma in the ileocecal area, 4 cases of dysentery, 2 cases of hemorrhoids, 3 cases of intestinal tuberculosis, 1 case of gastrointestinal dysfunction, 1 case of Crohn’s disease, 6 cases of patient mistake , 3 cases were missed.
Comprehensive literature reports that right colon cancer is easily misdiagnosed as the following diseases, from high to low, appendicitis, peri-appendix abscess, gastritis, gastroduodenal ulcer, intestinal adhesions, intestinal obstruction, cholecystitis, gallstones, and female appendicitis , Adnexal mass, colitis, iron deficiency anemia, tuberculous granuloma of the ileocecal area, dysentery, hemorrhoids, intestinal tuberculosis, gastrointestinal disorders, Crohn's disease.
3.1 Causes of misdiagnosis of right colon cancer
Foreign literature reports that right colon cancer is misdiagnosed as appendicitis or peri-appendicular abscess in 10%-22.8%, and domestically it is 20.8%-25%. Right colon cancer is most commonly misdiagnosed as appendicitis and peri-appendic abscess, accounting for about half (250/503). According to the literature, all authors believe that neglect of medical history is the primary cause; the second is insufficient understanding of the relationship between colon cancer and appendicitis. Some scholars believe that some appendicitis is actually a symptom of right colon cancer. Some people think that acute appendicitis symptoms can be one of the early clinical manifestations of colon cancer, and colon cancer can be the first symptom of acute appendicitis. Analyze the causes of colon cancer coexisting appendicitis: the growth of colon cancer causes the pressure in the intestinal cavity to increase, and the pressure in the appendix cavity increases accordingly. The appendix is not drained smoothly or foreign bodies such as fecal stones cause obstruction in the appendix cavity and secondary appendix inflammation; tumor necrotic tissue The infection spreads to the surrounding area and can directly affect the appendix; patients with colon tumors have decreased immunity, the intestinal environment changes, and the flora is imbalanced; colon tumors cause the blood and lymph circulation of the appendix to be blocked, affect the blood supply of the appendix, and cause appendicitis.
At the anatomical position, the right colon is adjacent to more organs, such as stomach, duodenum, gallbladder, appendix, small intestine, female appendix, etc. These organ diseases are the most common clinical diseases. As the division of clinical specialties is getting finer, each Specialties that give too much consideration to undergraduate diseases while ignoring other specialized diseases, or only meet the common diseases suggested by auxiliary examinations and fail to complete the examination, can easily cause delay in diagnosis, causing clinical right colon cancer to be misdiagnosed as the dozens of diseases mentioned above. In addition, these diseases lack specific clinical symptoms, and there are many similar clinical signs between diseases, which bring difficulties to clinical diagnosis.
3.2 Measures to avoid misdiagnosis of right colon cancer
The consequences of the delayed diagnosis of right colon cancer are irreversible, but it still often occurs clinically. Combined with the literature and the author’s experience, the author’s experience on how to avoid the delayed diagnosis of right colon cancer is as follows:
First of all, pay attention to the medical history, make more distinctions before diagnosis, and exclude organic diseases before the diagnosis of functional diseases. For people at high risk of colon cancer, benign diseases of intra-abdominal organs have not improved after corresponding treatments, or the condition often recurs. Enteroscopy as soon as possible to rule out malignant diseases, most of the misdiagnosed cases can be found and treated early. Huang Jiasi Surgery has made it clear that the possibility of colon cancer should be considered when patients over 30 years of age have the following symptoms: (1) The recent occurrence of persistent abdominal discomfort, dull pain, flatulence, etc., the symptoms do not improve after general treatment; (2) The bowel habits change from normal to diarrhea or Constipation or diarrhea alternates with constipation; (3) stool with blood, mucus or pus without dysentery or other intestinal inflammation history; (4) unexplained anemia, fatigue or weight loss; (5) suspicious lumps in the colon. The above symptoms can also be appendicitis, abscess around appendix, gastritis, gastroduodenal ulcer, intestinal adhesions, intestinal obstruction, cholecystitis, gallstones, female adnexitis, adnexal mass, colitis, iron deficiency anemia, ileocecal area Clinical manifestations of tuberculous granuloma, dysentery, hemorrhoids, intestinal tuberculosis, gastrointestinal disorders, Crohn's disease and other diseases.
Secondly, for the missed colon cancer during the operation, the impact of appendicitis on the surgical exploration is a factor, and the lack of experience of the surgeon is also one of the reasons. Clinically, it is often that acute appendicitis surgery misses right colon cancer. Acute appendicitis surgery is mostly of low age. Physician, the author has experienced three cases, one case of ileocecal cancer, one case of ascending colon cancer, one case of colon hepatic flexure cancer. In the operation, the appendix is chronic inflammation, ileocecal cancer with ileocecal mass, ascending colon cancer, intestinal liver The ileocecal area of flexural cancer was obviously thickened with dilation, and the operation plan was changed after further exploration to confirm the diagnosis. In recent years, laparoscopic surgery is basically used for cholecystectomy. Unconventional exploration during the operation is the main reason for missing right colon cancer. The author encountered 2 cases of laparoscopic cholecystectomy in the outer hospital 6 months ago and received right colon in our hospital. Radical cancer surgery.
Comprehensive literature and the author’s experience: clinical attention is paid to medical history collection and differential diagnosis; colonoscopy for high-risk colon cancer; chronic appendix inflammation during emergency appendix surgery should be carefully explored, ileocecal mass or abnormal expansion, be alert to the possibility of right colon cancer , Other abdominal operations such as the gallbladder must be standardized exploration, which can reduce the misdiagnosis of the right colon.
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