Analysis of misdiagnosis of ulcerative colitis and improvement of diagnostic quality
WANG Dan
ZHANG Ge
WANG Ning
Abstract：Objective To analyze the causes of clinical misdiagnosis of ulcerative colitis(UC)and preventive measures.Methods The clinical data of 2 patients with misdiagnosed UC admitted from August 2019 to August 2022 were retrospectively analyzed.Results One patient was admitted to the hospital due to abdominal pain and diarrhea for 20 d,and the initial diagnosis was bacillary dysentery.The anti-infective treatment was ineffective,and the symptoms worsened,with the appearance of mucopurulent bloody stools.There was no obvious abnormality in the physical examination,but the blood count was elevated.Red blood cells and white blood cells were detected in the stool,and the stool culture was negative.UC was confirmed by colonoscopy.The misdiagnosis lasted 38 d.After treatment with Sulfasalazine,Metronidazole and Dexamethasone enema,the condition improved and the patient was discharged.There was no recurrence during the 6-month follow-up.The other patient was admitted due to recurrent hematochezia for 11 years,which was aggravated with diarrhea for 3 years.The patient was repeatedly diagnosed with chronic enteritis and bacillary dysentery,and symptomatic treatment was ineffective.Physical examination showed severe anemia,emaciation,and edema of both lower limbs,and laboratory tests indicated anemia and inflammation.Colonoscopy showed diffuse congestion,edema and multiple shallow ulcers throughout the colon.Biopsy showed chronic inflammatory cell infiltration(mainly lymphocytes and plasma cells).A diagnosis of severe UC was made.The duration of misdiagnosis was 11 years.Prednisone and Sulfasalazine were given,supplemented with Montmorillonite powder to protect the intestinal mucosa.The symptoms were significantly improved at 50 d after hospitalization,and colonoscopy reexamination at 6 months after discharge showed that the ulcer was completely healed.Conclusions The symptoms of UC are similar to those of bacillary dysentery and chronic enteritis,so it is more likely to be misdiagnosed.Improving the understanding of UC,combined with colonoscopy and pathological examination,can reduce the misdiagnosis rate.
Keywords：ulcerative colitismisdiagnosisacute bacillary dysenterychronic enteritischronic bacillary dysenterydifferential diagnosis
Publication Date：2025-09-13
Online Publishing Date：2025-09-23(First online date of this platform, not the publication date of the document)
Pages：5( 1-5 )