Multidetector CT of bowel obstruction: value of post-processing

The value of imaging in patients with suspicion of bowel obstruction is dependent on the ability to answer questions relevant to the clinical management of patients. Is there mechanical obstruction? Is it a small bowel obstruction (SBO) or a large bowel obstruction (LBO)? What is the transition point? What is the cause of the obstruction? What is the severity of the obstruction? The results of studies published more than 10 years ago using axial and single-slice helical CT gave rise to findings based on axial slices that enables CT to answer these different questions. With the recent advent of multislice CT, large numbers of thin sections can be generated with short image intervals, which is well suited to postprocessing. Postprocessing techniques include standard reformatting methods such as sagittal, coronal and oblique reformatting, curved reformatting, maximum and minimum-intensity projection, variable thickness viewing, and volume and surface rendering. This pictorial review illustrates the added value of postprocessing for answering different questions concerning patients with suspicion of bowel obstruction.     

多层螺旋CT后处理技术在肠梗阻诊断中的价值

目的:评价多层螺旋CT在肠梗阻诊断的临床意义。方法:对34例临床怀疑为肠梗阻的病例进行多层螺旋CT扫描检查,22例扫描前60min分次口服等渗甘露醇溶液1000～1500ml,余12例因腹张、呕吐频繁等原因未服甘露醇溶液。均行平扫+三期增强扫描。成像方法包括薄层横断面、多方位重建成像(MPR)、容积再现法(VR)和最大密度投影(MIP)血管成像。结果:在34例临床怀疑肠梗阻病例中,经MSCT检查明确为肠梗阻者27例,其中低位小肠梗阻14例,较高位小肠梗阻2例,11例为不同部位的结肠梗阻。其中炎性病变9例、粘连8例、肠道原发肿瘤7例、肿瘤术后复发或转移2例、腹股沟斜疝1例。结论:多层螺旋CT对判断肠梗阻的部位、程度及原因、有无闭袢性肠梗阻及肠缺血、肠绞窄有重要临床意义。     

术后早期炎性肠梗阻38例诊疗体会

目的探讨术后早期炎性肠梗阻的临床特点及处理方法。方法分析38例术后早期炎性肠梗阻的临床特点及治疗结果。结果38例均经胃肠减压,应用激素和生长抑素,肠外营养等支持疗法,平均治愈时间为13.5 d,无一例再手术。结论术后早期炎性肠梗阻多发生在术后5~9 d,可表现为典型的肠梗阻体征,多由小肠无菌性炎症广泛肠粘连引起,多数病例采用非手术疗法可治愈。     

Colonic diseases: the value of US examination

The colon is affected by a number of diseases, mainly inflammatory, ischemic, and neoplastic conditions. Depending upon clinical indications endoscopy, US, CT, or other radiological methods are used for evaluation. The fact that US is frequently used as the initial imaging method in patients with non-specific clinical symptoms allows for greater influence in further diagnostic evaluation and with treatment, provided the investigator is familiar with the features of different intestinal diseases. This article will describe the anatomical characteristics of the colon, the US technique for examination of the colon, and the typical US features of the more common diagnoses of the colon.     

Non-traumatic abdominal emergencies: imaging of acute intestinal obstruction

The purpose of this paper is to give an overview of the main clinical questions in bowel obstruction, to discuss the value of various imaging modalities, including conventional radiography, ultrasound, and CT, to underline the impact of imaging in the management of patients with suspect bowel obstruction, and then to suggest a diagnostic triage in such patients.     

肠梗阻的手术治疗时机的选择

目的：探讨肠梗阻的手术时机,降低肠梗阻的病死率,提高外科治疗肠梗阻的质量和水平.方法：回顾性分析2004年～2011年我科共收治的113例不同类型肠梗阻的临床资料.结果：113例病例中,9例为动力性肠梗阻,104例为机械性肠梗阻（92%）,保守治疗成功47例（42%）,手术治疗66例（58%）,其中63例临床治愈,3例死亡（4.5%）.结论：及时判断肠梗阻的严重程度和准确的选择恰当的手术治疗时机,对肠梗阻病人的愈后有重要的意义.     

Calcified fecolith—a rare cause of large bowel obstruction

The authors present a rare case of colonic obstruction caused by a fecolith in a 59-year-old female who presented with symptoms suggestive of intestinal obstruction. The computed tomography (CT) confirmed the diagnosis. The patient was managed by laparotomy and colotomy to remove the fecolith.     

并发肠梗阻的小肠憩室病变的CT表现

目的：评价多层螺旋CT(MSCT)对引起小肠梗阻的小肠憩室病变及相关并发症的诊断价值。方法回顾性分析13例经手术证实引起小肠梗阻的小肠憩室及相关并发症的CT表现,并与20例未并发梗阻的小肠憩室进行对比分析。结果13例并发肠梗阻患者中,憩室发生于空肠8例,回肠5例。CT表现梗阻端管腔呈圆柱状增宽扩张,单纯性憩室炎3例,管腔内充满肠内容物及少许气泡影,憩室炎伴穿孔2例,管腔如增粗阑尾,周围脂肪间隙条索影,憩室炎伴粪石2例,增大管腔内见环形高密度,憩室炎伴肠扭转6例,表现为旋涡状肠系膜及血管伴扩张管腔影。憩室管壁平均厚度为(3.06±0.31)mm,憩室平均体积为(98.98±38.59)cm3,分别与对照组进行统计学分析,2种征象具有统计学意义(P 值分别为0.000和0.000)。结论 MSCT 有助于并发肠梗阻的小肠憩室及相关并发症诊断。     

Recurrent gallstone ileus: a case report

Gallstone ileus is a rare complication of recurrent gallstone cholecystitis and usually occurs in elderly female patients. Recurrent gallstone ileus occurs in 5% of patients with a previous episode of gallstone ileus and is associated with a mortality of 20%. We present a 52-year-old female with recurrent gallstone ileus 1 year after her initial episode. Electronic Publication     

Identification of adhesions on CT in small-bowel obstruction

Identification of adhesions on computed tomography (CT) in cases of small-bowel obstruction (SBO) is currently a diagnosis of exclusion. The purpose of this study is to examine whether the presence of findings suggestive of an extraluminal band can be used as a CT sign for adhesive SBO. CT scans of 142 patients with surgically proven SBO performed within 72 h of exploratory surgery were reviewed. The studies were evaluated for the cause of SBO and the presence of extraluminal bands. An extraluminal band was considered present if there was a change in the conformation of the transition zone, suggesting extraluminal compression of the bowel by a linear obstructive band. The presence of extraluminal bands in the area of the transition zone had a high positive predictive value for adhesive SBO. Of the 73 cases in which bands were present, SBO was due to adhesions in 52 instances, with a corresponding positive predictive value of 71% (95% confidence interval 0.60–0.80) and a p value of 0.008. The extraluminal band was 61% sensitive and 63% specific for adhesive SBO. The presence of an extraluminal band on CT in the area of the transition zone in cases of SBO correlates well with a diagnosis of SBO secondary to adhesions. In the absence of a source of SBO, the presence of an extraluminal band can serve as a helpful diagnostic adjunct for adhesive SBO.An editorial comment on this paper is available at .     

左半结肠癌并发肠梗阻的诊断及处理

目的：总结左半结肠癌致肠梗阻的诊断及处理体会.方法：分析1999-2004年间16例左半结肠癌致肠梗阻的临床资料.结果：16例患者,Ⅰ期左半结肠切除吻合9例,横结肠造口,Ⅰ期左半结肠切除,Ⅱ期吻合闭瘘2例;肿瘤无法切除,行乙状结肠造瘘5例.吻合口漏1例,围手术期无死亡病例.结论：正确认识左半结肠癌致肠梗阻,合理选择术式,可有效提高疗效.     

Small bowel obstruction due to inflammation secondary to ingested bone

We report the CT appearances of an ingested pork bone in the lumen of small bowel in a 66-year-old man with an intact and virgin gastrointestinal tract. CT scan demonstrated the site of obstruction at distal jejunum with associated irregular narrowing and proximal small bowel dilatation as well as the bone lodged in the non-dilated terminal ileum. Laparotomy and histology of the resected small bowel confirmed the CT appearances that the obstruction was caused by adhesions and extensive inflammation across the bowel wall in the distal jejunum from trauma as the bone traversed down the lumen. We believe that this is the first reported preoperative CT scan finding of a case of small bowel obstruction due to adhesions and inflammation secondary to ingested bone.     

CT findings of phytobezoar associated with small bowel obstruction

The purpose of this study was to evaluate CT findings of phytobezoar associated with small bowel obstruction. We evaluated abdominal CT of 19 patients with phytobezoar. Abdominal CT of 6 patients with small bowel feces was included for the comparison. On CT we analyzed morphological features of phytobezoars such as location, number, size, shape, and the presence or absence of an encapsulating wall. The sites of the phytobezoar were in the jejunum in 12 patients (63%) and the ileum in 7 (37%). The phytobezoars were single in number in 13 patients (68%) and multiple in 6 (32%). The mean short- and long-axis diameters of the phytobezoars measured 3.2 cm (range 2.1–5.2 cm) and 5.2 cm (range 2.2–11.0 cm), respectively. The phytobezoars were ovoid in 9 patients, round in 6, and tubular in 4. On CT, phytobezoars appeared as gas-containing masses in 17 patients (89%) and as a solid mass without gas in the remaining 2 patients (11%). An encapsulating wall was noted in 6 patients (32%). Small bowel feces were much more tubular in shape but did not have encapsulating wall on CT. The CT imaging is useful in making the diagnosis of phytobezoar associated with small bowel obstruction. Electronic Publication     

Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities

Small bowel obstruction is a leading cause of acute surgical admissions for abdominal pain. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. This has resulted in a growing reliance on radiological investigations to reassure the surgeon that medical therapy can be safely instituted. The onus therefore rests with radiologists to guide their surgical colleagues by correctly interpreting the plain abdominal radiograph and suggesting appropriate further investigation if warranted. Recently, computed tomography (CT) has been proposed as the test of choice to define the level and cause of acute small bowel obstruction and to identify complications such as ischaemia and perforation which will prompt surgical intervention. This review will discuss the utility of early CT in the diagnosis of acute small bowel obstruction and outline its impact on patient management.     

小肠梗阻CT表现对手术治疗的预测价值

目的：探讨小肠梗阻(SBO)CT 表现对手术治疗的预测价值。方法70例 SBO 患者按照治愈方式分为非手术治疗组与手术治疗组,回顾性比较2组间 CT 表现有无差异,分析有意义 CT 表现对于手术治疗的预测价值。结果70例 SBO 中,33例采用非手术治疗,37例采用手术治疗。移行带肠壁完全瘪陷、肠系膜水肿、腹水、肠系膜静脉淤血增粗、肠壁强化减低、肠系膜动脉和静脉强化减低出现的几率在手术治疗组显著高于非手术治疗组(P <0.05),预测手术的比数比分别为10.56、5.13、4.72、5.45、5.77、3.02、6.59。而扩张肠管内径、肠壁厚度、环靶征、肠壁积气、肠系膜血管移位、聚集和扭曲出现的几率在2组间无统计学差异。结论SBO 多种 CT 表现对其手术治疗具有预测价值,可为 SBO 的治疗提供重要信息。     

An unusual case of herniation of small bowel through an iatrogenic defect of the falciform ligament

Internal herniation through a congenital defect in the falciform ligament is extremely rare. We report an unusual observation of small bowel obstruction through an iatrogenic defect of the falciform ligament. Prompt diagnosis was made by helical CT, permitting a rapid surgical procedure to preserve the viability of the obstructed segment.     

多层螺旋CT技术在肠梗阻诊断的应用探讨

目的:探讨多层螺旋CT(MSCT)扫描技术在肠梗阻诊断中的应用价值。方法:回顾分析78例临床怀疑为肠梗阻病例的MSCT检查结果。所有患者均进行双期增强扫描,32例行MPR-冠状位、矢状位图像重建,并将其中MSCT确诊为肠梗阻的病例与临床最终结果对照。结果:经手术病理证实或临床随访证实共78例。CT提示肠梗阻阴性5例,阳性73例,与临床最终结果符合,诊断肠梗阻敏感性达100%。大肠各段及十二指肠的定位诊断准确率达100%(43/43),空肠及回肠的定位诊断准确率达84.3%(27/35)。影像对于病因诊断符合率达90.4%(66/73),不符合率6.7%(7/73)。结论:MSCT技术的应用发展,已成为肠梗阻检查的重要手段。在肠梗阻定位诊断、病因诊断、血供情况的了解具有极大的优势,值得进一步研究。     

MR enteroclysis: technical considerations and clinical applications

Magnetic resonance enteroclysis (MRE) is an emerging technique for the evaluation of small bowel abnormalities. Adequate luminal distention, achieved by the administration of iso-osmotic water solution through a nasojejunal catheter, in combination with ultrafast sequences, such as single-shot turbo spin echo, true fast imaging with steady precession, half-Fourier acquired single-shot turbo spin echo, and 3D fast low-angle shot, results in excellent anatomic demonstration of the small bowel. Magnetic resonance fluoroscopy can be performed during MRE examination and might be useful in studying low-grade stenosis or motility-related disorders. Magnetic resonance enteroclysis is very promising in detecting the number and extent of involved small bowel segments in patients with Crohn’s disease, and in disclosing lumen narrowing and extramural manifestations and complications of the disease. Initial experience shows that MRE is very efficient in the diagnosis of small bowel tumors and can be used in the evaluation of small bowel obstruction. Electronic Publication