Surgical Pathology of Abdominal Organs or Acute Intestinal Infections. Diagnostic Difficulties

Introduction. The polyetiology and diversity of clinical manifestations of acute intestinal infections determine the difficulties of the differential diagnosis with acute surgical pathology of the abdominal organs.

This study aims to elucidate the causes of the erroneous diagnosis of surgical pathology of the abdominal organs which have symptoms similar to acute intestinal infections.

Materials and methods. The paper presents an analysis of 2940 medical records of patients hospitalised in the intestinal infections department of the Infectious Diseases Hospital No. 4 of Ufa with suspected acute intestinal infections. Among these in 42 patients following the clinical and laboratory examinations, the nature of the disease was established as a disorder requiring surgical treatment, and they were transferred  — urgently, more often than not  — to appropriate hospitals.

Results and discussion. The authors identified the earliest and most informative clinical, anamnestic and laboratory parameters aimed at making a timely differential diagnosis of acute intestinal infections with a variety of surgical pathology of the abdominal organs, primarily with acute appendicitis, intestinal tumours, somatic diseases of the gastrointestinal tract, haemorrhagic fever with renal syndrome and myocardial infarction.

Conclusion. When a non-infectious disease was diagnosed the authors carefully examined the results of general clinical tests, fecal panel, results of bacteriological and enzyme-linked immunosorbent assays of feces and vomit for pathogenic and opportunistic enterobacteria, rotaviruses, ultrasound and X-ray images of the abdominal organs.

1. Lobzin Yu.V., Finogeev Yu.P., Vinakmen Yu.A., Zakharenko S.M., Uskov A.I. “Masks” of infectious diseases. Saint Peterburg; 2003. 145 p. (In Russ.).

2. Nikonorova M.A., Saldan I.P., Karbysheva N.V., Pak S.G., Belaia O.F., Bobrovsky E.A., et al. Acute intestinal infections in ambulatory practice. Epidemiology and Infectious Diseases. 2018;23(2):85–8 (In Russ.). DOI: 10.18821/1560-9529-2018-23-2-85-88

3. Khaliullina S.V., Anokhin V.A. Specificities of diagnosing and therapeutic tactics in acute enteric infections of unknown etiology. Infectious diseases. 2015;13(2):55–60 (In Russ.).

4. Tarasova L.V., Trukhan D.I. Diagnostic algorithm for diarrhea. Eksperimental’naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology. 2015;(12):105–10 (In Russ.).

5. Balmasova I.P. Modern laboratory diagnostics and biomarkers of infectious diseases. Infectious diseases: News. Opinions. Education. 2015;(2):18–25 (In Russ.).

6. Filippov P.G., Ogienko O.L., Balmasova I.P., Levanchuk T.S., Tsvetkova N.A., Evsyukov O.A. Possibilities of a differential diagnosis between acute appendicitis with diarrhoeal syndrome and acute diarrhoeal infections. Infectious diseases. 2013;11(4):78–81 (In Russ.).

7. Levanchuk T.S., Balmasova I.P., Filippov P.G., Ogienko O.L. Early differential diagnosis of acute intestinal infections and acute appendicitis in patients with diarrhea syndrome. Infectious diseases: News. Opinions. Education. 2016;(2):35–41 (In Russ.).

8. Michailidou M., Sacco Casamassima M.G., Karim O., Gause C., Salazar J.H., Goldstein S.D., et al. Diagnostic imaging for acute appendicitis: interfacility differences in practice patterns. Pediatr Surg Int. 2015;31(4):355–61. DOI: 10.1007/s00383-015-3669-0.

9. Chen K.C., Arad A., Chen K.C., Storrar J., Christy A.G. The clinical value of pathology tests and imaging study in the diagnosis of acute appendicitis. Postgrad Med J. 2016;92(1092):611–9. DOI: 10.1136/postgradmedj-2015-133865

10. Yu Y.R., Shah S.R. Can the diagnosis of appendicitis be made without a computed tomography scan? Adv Surg. 2017;51(1):11–28. DOI: 10.1016/j.yasu. 2017.03.002

11. Ermolov A.S., Samsonov V.T., Guliaev A.A., Abdulamitov Kh.K., Titova G.P., A Tlibekova M., et al. Videolaparoscopic and morphological parallels in diagnosis of different forms of acute appendicitis. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal imeni N.I. Pirogova. 2016;(2)19–23 (In Russ.).

12. Hong G.S., Lee C.W., Kim M.H., Kim C. Appendiceal location analysis and review of the misdiagnosis rate of appendicitis associated with deep pelvic cecum on multidetector computed tomography. Clin Imaging. 2016;40(4):714–9. DOI: 10.1016/j.clinimag.2016.02.013

13. Zhang X., Li Z., An D., Liu J., Li W. Investigation of diagnostic method and treatment on acute appendicitis with acute intestinal obstruction as presenting manifestation. Zhonghua Weichang Waike Zazhi. 2016;19(4):432–5. PMID: 27112479

14. Farzal Z., Farzal Z., Khan N., Fischer A. The diagnostic dilemma of identifying perforated appendicitis. J Surg Res. 2015;199(1):164–8. DOI: 10.1016/j.jss.2015.04.058

15. Starostina V.I., Valishin D.A., Murzabaeva R.T., Valieva T.A., Burganova A.N. Renin-angiotensin-aldosterone system in patients with hemorrhagic fever with renal syndrome. Transbaikalian medical bulletin. 2016;(4):75–83 (In Russ.).