肠腔内异物所致机械性小肠梗阻的CT诊断

【摘要】 目的 探讨CT对肠腔内异物所致机械性小肠梗阻诊断的价值。 资料与方法 回顾性分析8例经手术证实的肠腔内异物所致机械性小肠梗阻的CT表现。 结果 8例患者均有程度不等的肠梗阻;术前均能正确诊断肠梗阻。其中;小肠食入性异物小肠梗阻3例;粪石性小肠梗阻 3例;胆石性小肠梗阻 2例;均无肠缺血坏死、穿孔等并发症。 结论 通过典型的征象分析;CT能术前诊断肠腔内异物所致机械性小肠梗阻。     

粘连性小肠梗阻中带状粘连和膜状粘连的CT特征分析

目的 研究粘连性小肠梗阻中带状粘连和膜状粘连的CT影像学特征。 方法 回顾性分析150例粘连性小肠梗阻手术患者,根据手术中发现分为带状粘连和膜状粘连两组,比较两组患者的临床特征和CT特征,采用Logistic回归分析预测带状粘连的独立危险因素。 结果 两组患者的带状粘连和膜状粘连中闭襻征（36.8%比14.3%,P=0.002）、肠系膜模糊征（43.7%比17.5%,P=0.001）、鸟嘴征（48.3%比17.5%,P<0.001）、脂肪切迹征（39.1%比9.5%,P<0.001）、腹腔积液（54.0%比34.9%,P=0.015）差异均有统计学意义。Logistic回归分析发现,鸟嘴征［OR=6.15,95%CI（2.55~14.84）,P<0.001］、脂肪切迹征［OR=6.19,95%CI（2.16~17.82）,P=0.001］、肠系膜模糊征［OR=3.34,95%CI（1.34~8.32）,P=0.009］是预测带状粘连的独立危险因素。 结论 鸟嘴征、脂肪切迹征、肠系膜模糊征是预测带状粘连的独立危险因素。     

CT在肠梗阻诊断中的应用

肠梗阻是外科常见的急腹症。肠梗阻的部位、程度及原因 ,有无闭袢性肠梗阻及肠缺血、肠绞窄对肠梗阻的治疗有指导意义。肠梗阻通过腹部平片只有 5 0 %～ 6 0 % [1] 可以确诊 ,且常不能确定肠梗阻的部位和程度。近年来 ,文献报道CT对肠梗阻诊断的敏感性和特异性很高 ,而且能显示梗阻的部位、程度及原因 ,并能对闭袢性和绞窄性肠梗阻作出诊断 ,本文将对CT在肠梗阻诊断中的应用综述如下。1　检查方法CT检查时机最好选择在胃肠减压之前进行 ,这有利于正确判断梗阻的部位和程度。疑有肠梗阻的病人在CT扫描前 30～ 12 0min口服 2 %的含碘造影…     

16层螺旋CT后处理技术诊断食源性食管异物

目的探讨16层螺旋CT后处理技术诊断食管异物的价值。方法对52例临床怀疑食管异物者均行X线平片、食管吞钡棉检查、CT平扫,比较不同方法对异物的检出率,并与食管镜或手术结果进行比较。CT后处理技术包括多平面重建（MPR）、最大密度投影（MIP）、容积再现（VR）等。结果经食管镜或手术证实的28例患者的食管异物为鸡骨、鸭骨、鱼刺等,形态、大小、长度及所在部位各异,均能被16层螺旋CT后处理技术清晰显示,X线平片发现5例,检出率为17.86%,食管吞钡棉检查发现8例,检出率为28.57%。结论16层螺旋CT后处理技术相对于X线平片、食管吞钡棉检查可明显提高食管异物的检出率,并可评价食管损伤程度及周围脓肿、食管气管瘘等并发症的情况及范围。     

多层螺旋CT诊断胸食管异物损伤的临床价值

目的探讨MSCT诊断胸食管异物损伤的临床价值。方法 22例胸食管异物损伤患者均接受MSCT平扫,其中13例接受增强薄层扫描及后处理成像。依据MSCT特征、结合临床表现决定诊断及治疗方案。结果 MSCT平扫及后处理影像诊断与临床诊断的总符合率分别为68.18%（15/22）和76.92%（10/13）,结合临床特征均确诊。22例中,痊愈20例,死亡2例。结论 MSCT是诊断胸食管异物损伤的最具临床价值的影像学方法,结合临床特征可确诊,对制定科学、合理的治疗方案具有指导意义。     

小肠间质瘤的CT诊断

目的探讨小肠间质瘤的CT诊断价值,提高对小肠间质瘤CT征象和临床表现的认识。方法回顾性分析14例经手术病理及免疫组化证实的小肠间质瘤患者的临床资料。临床主要症状为黑便、贫血、腹部不适、腹痛、呕吐、发热及腹部包块等。所有病例均行CT平扫及增强扫描。结果本组病例中,CT共检出病灶14个,均为单发,发生于十二指肠3例,回肠7例,空肠4例。良性9例,CT平扫表现为类圆形软组织块影,瘤体最大径均≤4.0cm,密度均匀,明显均一强化。恶性5例,分叶状或不规则形,瘤体最大径均〉4.0cm,多为腔外生长,肿瘤内可见囊变坏死,不均一强化,其中肝脏及肺转移各1例。结论 CT对小肠间质瘤具有重要诊断价值;以瘤体最大径4.0cm为界值对肿瘤的良恶性判断有一定参考价值。     

64层螺旋CT对消化道梗阻的诊断价值

目的探讨螺旋CT对消化道梗阻的诊断价值。方法回顾性分析了12例临床怀疑为消化道梗阻病例的螺旋CT检查结果并将其中螺旋CT确诊为消化道梗阻病例与临床结果对照,图像重建方法主要为多平面重建法（MPR）和最大密度投影法（MIP）。结果44例患者,无肠梗阻2例,有肠梗阻42例,其中33例经手术病理证实,4例经临床确诊。33例手术病例CT诊断梗阻部位与手术对照符合率为100％（33／33）,病因诊断符合率为100％（33／33）。结论螺旋CT扫描及重建对消化道梗阻具有重要诊断价值。     

小肠机械性梗阻肠管活力的判断

我们将240例病人的14项指标用计算机进行多因素逐步判别分析,结果发现腹痛、腹胀、肠鸣音、心率、反跳痛和白细胞数等6项指标与肠坏死的关系最为密切。计算机对肠梗阻的判别敏感性为94.7%,特异性为76.1%;正确判断率为87.9%。结果表明多因素逐步判别分析对小肠机械性梗阻时肠管活力的判别具有方法简便,准确率高的优点。特别是对肠梗阻病人进行动态跟踪判别将有助于部分病情复杂的病人手术时机选择,进一步降低死亡率。     

粘连性小肠梗阻中带状粘连和膜状粘连的CT特征分析

目的研究粘连性小肠梗阻中带状粘连和膜状粘连的CT影像学特征。方法回顾性分析150例粘连性小肠梗阻手术患者, 根据手术中发现分为带状粘连和膜状粘连两组, 比较两组患者的临床特征和CT特征, 采用Logistic回归分析预测带状粘连的独立危险因素。结果两组患者的带状粘连和膜状粘连中闭襻征(36.8%比14.3%, P=0.002)、肠系膜模糊征(43.7%比17.5%, P=0.001)、鸟嘴征(48.3%比17.5%, P<0.001)、脂肪切迹征(39.1%比9.5%, P<0.001)、腹腔积液(54.0%比34.9%, P=0.015)差异均有统计学意义。Logistic回归分析发现, 鸟嘴征[OR=6.15, 95%CI(2.55～14.84), P<0.001]、脂肪切迹征[OR=6.19, 95%CI(2.16～17.82), P=0.001]、肠系膜模糊征[OR=3.34, 95%CI(1.34～8.32), P=0.009]是预测带状粘连的独立危险因素。结论鸟嘴征、脂肪切迹征、肠系膜模糊征是预测带状粘连的独立危险因素。     

多层螺旋CT对少见小肠梗阻的诊断价值

目的 评价多层螺旋CT(MSCT) 对罕少见病因肠梗阻诊断的价值。 方法 回顾性分析18例经手术证实的少见病因肠梗阻的MSCT表现。 结果 18例患者均有程度不等的肠梗阻。术前病因诊断正确率达72.22%,其中,先天性小肠壁神经节细胞减少1例,小肠阴性异物3例,小肠粪石2例,腹茧症1例,腹内疝2例,闭孔疝4例,小肠扭转5例。2例肠扭转并缺血坏死,3例并穿孔。结论 MSCT能用于少见小肠梗阻的诊断及判断严重程度, 还能明确肠梗阻的罕少见病因及有无并发症。     

A curious case of foreign body induced jejunal obstruction and perforation

INTRODUCTION

Accidental and unnoticed ingestion of foreign bodies are not very uncommon. Most of such foreign bodies pass through gastrointestinal tract uneventfully and only on rare instances cause obstruction and/or perforation.

PRESENTATION OF CASE

We are reporting a case in which a 45 yr old male presented to accident and emergency department of our institute with complaints of pain abdomen, greenish vomiting, abdominal distension, fever and non passage of flatus and stool following alcoholic binge 15 days back. On presentation tachycardia, hypotension, generalised abdominal tenderness and guarding were present. After initial resuscitation and investigation diagnosis of perforation peritonitis was made and emergency exploratory lapratomy was done and a single perforation with plastic foreign body protruding through it was found in jejunum 5 cm distal to duodeno-jejunal junction.

DISCUSSION

The majority of ingested FBs that reach the stomach pass uneventfully through the gastrointestinal tract. The majority of cases occur in children. Only 1% of patient of patients requires surgical intervention depending upon nature, size and shape of the foreign body.

CONCLUSION

Present case report intends to draw the attention towards possibility of intestinal obstruction and perforation by a single plastic foreign body. High index of suspicion is needed as this foreign body is not even radio-opaque and cannot be picked up in X-ray investigations. Also with increasing use of such plastic materials there are increased chances of such incidents.     

Ileocolic intussusception due to endometriosis.

Intussusception is a rare cause of bowel obstruction in adults. Clinical manifestations are not specific, making the preoperative diagnosis difficult to establish. We report a case of acute small-bowel obstruction due to ileocolic intussusception. An emergency explorative laparoscopy was performed and revealed a mass in the right colon proximal to the ileocecal valve. Conversion to open laparotomy allowed us to perform a right hemicolectomy. The pathologic examination of the resected sample revealed endometriosis of the terminal ileus.     

经口泛影葡胺对粘连性小肠不全梗阻疗效的前瞻性研究

目的 探讨泛影葡胺在急性粘连性小肠不全性梗阻的治疗使用,并与甘露醇与常规的保守治疗方法作前瞻性研究。方法 对１０９例急性粘连性小肠不全梗阻１１７例进行分析,随机将病人分成泛影葡胺组３７例经胃管注入７６％泛影葡胺溶液１００ｍｌ,甘露醇组３５例３６次经胃管注入１０％甘露醇溶液２００ｍｌ对照组３７例４０次一般保守治疗。     

Evaluation and management of acute upper airway obstruction

Upper airway obstruction can occur suddenly and result in a patient’s rapid deterioration. In this article we provide a structured approach to identifying those patients with acute airway compromise and stratifying them according to clinical urgency. This includes ways of distinguishing both the level of obstruction and its severity, based on the clinical signs and symptoms, and the role and timing of investigations. We describe the key aspects of emergency management, including temporizing measures and airway adjuncts. Management of rare, but important, situations are discussed such as post-thyroidectomy haematoma, occlusion of tracheostomy and laryngectomy stomas and post-obstruction pulmonary oedema (POPE) is discussed. We describe the situation when an emergency surgical airway should be considered, along with our technique of performing one.     

Evaluation and management of acute upper airway obstruction

Upper airway obstruction can occur suddenly and result in a patient's rapid deterioration. In this article we provide a structured approach to identifying those patients with acute airway compromise and stratifying them according to clinical urgency. This includes ways of distinguishing both the level of obstruction and its severity, based on the clinical signs and symptoms, and the role and timing of investigations. We describe the key aspects of emergency management, including temporizing measures and airway adjuncts. Management of rare, but important, situations are discussed such as post-thyroidectomy haematoma, occlusion of tracheostomy and laryngectomy stomas and post-obstruction pulmonary oedema (POPE) is discussed. We describe the situation when an emergency surgical airway should be considered, along with our technique of performing one.     

Enterolith Small-Bowel Obstruction Caused by Jejunal Diverticulosis: Report of a Case

We report the successful surgical treatment of intestinal obstruction caused by enteroliths formed in jejunal diverticula. A 78-year-old man with bowel obstruction of unknown etiology was initially managed conservatively, but suffered recurrence of the obstruction. Thus, we performed a laparotomy, which revealed multiple diverticula in the jejunum, with one enterolith inside a diverticulum and one enterolith in the terminal ileum. There was no abnormal communication between the gallbladder and the intestinal tract, excluding the possibility of a gallstone ileus. The stone in the terminal ileum could not be broken manually, so we performed an enterotomy to remove the stones. Intestinal obstruction caused by enteroliths in small-bowel diverticula is a rare event, which is difficult to diagnose and manage. To our knowledge, only 35 such cases have ever been reported.     

Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction?

BACKGROUND: Small-bowel obstruction (SBO) is a common dilemma faced by general surgeons. A timely and accurate diagnosis is crucial, based on history, physical examination, and radiographic studies. A computed tomography (CT) scan has become an increasingly common diagnostic modality. The aim of this study was to define a set of CT criteria that may help determine whether a patient would require operative intervention. METHODS: A retrospective chart review was performed over an 18-month period. Patients diagnosed with SBO or partial SBO (PSBO) who had a CT scan performed were included. CT scans were then reviewed independently by a staff radiologist blinded to the clinical outcome. A scoring system based on 7 radiographic criteria was then developed. Statistical analysis was performed on the data. RESULTS: From March 1, 2004, to August 30, 2005, 96 patients were found to have the diagnosis of SBO or PSBO and a documented CT scan. Seventy-four patients had undergone prior intra-abdominal procedures. Fifty-five percent were taken to the operating room (OR) over an average of 1.9 days (range 1-12 days). Seventy-nine percent of these patients went to the OR within the first 24 hours. Lysis of adhesions was performed in 38%, small bowel was resected in 47%, and incarcerated ventral hernias were found in 11%. Ischemic bowel was found in 11% of the cases. The CT scoring system was then correlated with the actual treatment. A score of 8 or higher predicted the need for surgery 75% of the time. When looking at the criteria individually, patients with a CT reading of complete obstruction, dilated small bowel, or free fluid were operated on 77%, 66%, and 65% of the time, respectively. CONCLUSION: A CT scoring system can successfully predict the need for surgery 75% of the time. Likewise, specific criteria, when present in combination, can predict the need for operative intervention in 79% of cases with SBO.