Objective To analyze the clinical manifestations,imaging and pathological features of chronic pancreati-tis(CP)in order to reduce clinical misdiagnosis and mistreatment.Methods The clinical data of 4 patients with misdiag-nosed CP admitted from May 2018 to May 2023 were retrospectively analyzed.Results Three of the four patients presented with recurrent abdominal pain,and one patient presented with persistent abdominal pain and diarrhea.However,none of them had typical imaging manifestations,and they were misdiagnosed as recurrent acute pancreatitis(RAP)with a space-occupying lesion of the pancreas,pancreatic cancer,RAP,and ulcerative colitis(UC),respectively.Misdiagnosis lasted from 6 months to 3 years.CP was diagnosed by endoscopic ultrasonography in 1 patient misdiagnosed with RAP and a space-occupying lesion of the pancreas.After diagnosis,endoscopic retrograde cholangiopancreatography(ERCP)and pancreatic duct stent implanta-tion were performed.One patient misdiagnosed with pancreatic cancer was diagnosed with CP by pathological examination after pancreatic head and duodenectomy and intestinal adhesion-lysis.One patient misdiagnosed with UC was diagnosed with CP by ERCP combined with upper abdominal magnetic resonance imaging and endoscopic ultrasound,and was given drug therapy af-ter diagnosis.The symptoms of the above three patients were relieved after treatment and did not recur.A patient misdiag-nosed with RAP was diagnosed as type 1 autoimmune pancreatitis(AIP)by IgG4 and endoscopy-guided fine needle biopsy.After diagnosis,there was no abdominal pain following treatment with corticosteroids.Liver function,IgG4 and imaging mani-festations improved after review,but the gastric variceal rupture and bleeding repeatedly occurred,and endoscopic hemostasis and conservative drug treatment were performed several times.Conclusion The clinical manifestations of CP are varied,the imaging manifestations may be atypical,the pathological sampling is difficult to obtain,and the early diagnosis is difficult.For patients with repeated attacks of abdominal pain or pancreatitis,or pancreatic exocrine insufficiency,relevant examinations should be performed as soon as possible to reduce the occurrence of misdiagnosis and missed diagnosis.
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