Missed diagnosis of periampullary diverticulum complicated with pancreatobiliary diseases

Objective To summarize the occurrence of missed diagnosis of periampullary diverticulum (PAD) with pancreatobiliary diseases and analyze its underlying reasons.Methods We conducted a retrospective analysis of 194 patients with PAD complicated with pancreatobiliary diseases from January 2006 to December 2011 in our hospital Results At the first onset of pancreatobiliary diseases,the diagnosis of PAD was made in 48 patients (correct diagnosis group) and missed in 146patients (missed diagnosis group),with a rate of missed diagnosis of 75.3％.At the second,third and fourth onsets of pancreatobiliary diseases in the missed diagnosis group patients,the rates of missed diagnosis were 37.7％,21.8％,and 0％ respectively.There were no significant differences between the correct diagnosis group and the missed diagnosis group with respect to sex,age or the kinds of pancreatobiliary diseases (P＞0.05).But there were significant differences in the two groups with respect to different medical groups,period of admission,the frequency of application of CT,magnetic resonance (MRI) and magnetic resonance cholangiopancreatography (MRCP),duodenal endoscopy/endoscopic retrograde cholangiopancreatography (ERCP) and upper gastrointestinal contrast radiography (P＜0.05).The accuracy rates of CT,MRI,MRCP,upper gastrointestinal contrast radiography and duodenal endoscopy/ERCP for the diagnosis of PAD were 30.0％,31.5％,36.3％,64.5％ and 100.0％ respectively.At the first,second,third and fourth onset of pancreatobiliary diseases,the application rates of duodenal endoscopy/ERCP were 18.0％,33.6％,70.9％ and 91.7％,respectively.Compared with the missed diagnosis group,recurrence rate of symptom were lower significantly in the diagnosis group 1,2,and 3 years post-treatmnet.Conclusions The missed diagnosis of PAD complicated with pancreatobiliary diseases is rather common,mainly due to insufficient understanding for PAD.As a result,for PAD patients with pancreatobiliary diseases,the correct diagnosis rates of CT,MRI,MRCP and upper gastrointestinal contrast are low and the use of duodenal endoscopy/ERCP is insufficient. Key words: Ampulla of vater; Diverticulum