CT诊断胃肠道穿孔19例分析

目的 探讨胃肠道穿孔的CT表现及影像特征。方法 本组病例使用全身CT连续扫描，层厚／层距均为10mm，并用窄窗调节图像，观察腹部情况。结果 本组病例CT分析显示，膈下或腹腔内散在游离气体阴影可作为胃肠道穿孔定性诊断依据。结论 CT能清晰地显示消化道与周围组织间的关系，结合穿孔部位的病变特征，可以做出定位诊断。     

CT窗技术在诊断胃肠道穿孔中的价值

胃肠道穿孔是临床最常见的急腹症之一,早期诊断至关重要,近年来关于CT诊断胃肠道穿孔的文献报道多集中在穿孔部位的研究[1-3],关于CT窗技术在诊断胃肠道穿孔中的价值鲜有报道,本文运用不同窗技术分析了39例经手术证实的胃肠道穿孔病例,旨在探讨窗技术在胃肠道穿孔的诊断价值。     

MSCT征象在胃肠道穿孔精确定位中的价值

目的：探讨MSCT征象精确判别胃肠道穿孔部位的价值。方法：前瞻性术前对121例胃肠道穿孔患者行CT扫描，依据8种CT征象得出结论并与手术病理对照，运用Logistic多元回归分析就主要CT征象与穿孔部位的相关性进行分析。结果：术前综合运用主要CT征象对胃肠道穿孔部位诊断的正确率达83.5%（101/121），Logistic多元回归分析显示胃肠道壁腔外局限性小气泡影（P<0.01）、管壁节段性增厚（P<0.01）、管壁局限性缺损（P<0.01）对诊断胃肠道穿孔部位有显著性差异。结论：MSCT征象可在术前对胃肠道穿孔部位作出较为精确的诊断。     

多排螺旋CT在诊断胃肠道穿孔中的价值

目的:探讨多排螺旋CT在诊断胃肠道穿孔中的价值。方法:收集我院自2006年5月-2010年5月的42例胃肠道穿孔并行多排螺旋CT检查的患者,对其临床影像学资料加以分析,探讨多排螺旋CT在诊断胃肠道穿孔中的价值,提高影像诊断胃肠道穿孔水平。结果:多排螺旋CT在诊断胃肠道穿孔中气腹显示率高,可以弥补普通X线的不足,而且对定位诊断具有较高价值。结论:多排螺旋CT是诊断胃肠道穿孔的一种简单、可靠的影像检查方法。     

早期胃肠道穿孔的多层螺旋CT诊断价值

目的探讨多层螺旋CT(MSCT)在早期胃肠道穿孔诊断中的作用。方法分析32例发病6h内的胃肠道穿孔患者的多层螺旋CT平扫病例,全部病例均经手术证实。结果32例患者包括:胃壁穿孔10例,十二指肠球部穿孔11例,结肠穿孔4例,阑尾穿孔3例,外伤性肠道撕裂伤4例。多层螺旋CT平扫确诊29例(90%),表现为腹腔内不同位置、大小、形态的游离气体影。结论根据腹腔游离气体,多层螺旋CT在早期胃肠道穿孔时,能及时、准确做出定性诊断,优于其它影像学检查。     

超声检查在胃肠道穿孔定位诊断中的价值研究

目的胃肠道穿孔是临床常见的急腹症之一，临床主要依据病史、X线和超声检查发现腹腔游离气体为佐证间接诊断，本研究旨在探讨超声检查对胃肠道穿孔的直接声像图特征和超声定位诊断的价值。方法对我院临床拟诊胃肠道穿孔病例常规超声检查或X线检查，并重点检查胃肠道有无异常改变，总结分析胃肠道穿孔的直接声像图和间接声像图改变，做出定位诊断。结果本组26例中，X线发现腹腔游离气体50．0％（13／26），超声发现游离气体65．3％（17／26）。超声检查发现胃肠道声像图改变23例，表现为：胃或肠道壁局部性增厚，中央凹陷全层回声中断缺损，局部见气体贯穿腔内。超声检查诊断胃肠道穿孔26例，定位诊断23例。超声诊断胃肠道穿孔与手术和保守治疗后内镜检查诊断符合率100％，超声定位诊断符合率88．4％。结论超声检查不仅可以显示胃肠道穿孔病变的间接声像改变而且可以发现穿孔部位的直接征象改变，可以较准确地做出定位诊断。因此，超声检查不仅弥补了X线和常规超声检查检查的不足，而且解决了临床定位诊断的难题，更重要的是能够在早期及时定位诊断，为临床决定治疗方案和赢得抢救时机提供了重要依据。     

26例胃肠道穿孔的超声图像分析及诊断价值

目的检查分析胃肠道穿孔的超声表现直接和间接声像图特征,探讨超声诊断价值。方法对26例胃肠道穿孔的声像图表现进行回顾性分析及总结,并与X线、CT检查结果对照。结果超声检查直接征象显示率26.9%:病变处胃肠壁连续性中断,局部可见穿透性线状或带状强回声。间接征象:腹腔游离性积气显示率61.5%,腹腔游离性或包裹性积液显示率92.3%。结合局部胃肠壁增厚、层次分辨不清,腹腔及小网膜囊内积液的性状,内有无沉积物等,超声诊断本病的准确率达76.9%。结论超声检查该类疾病具有简便、迅速、价廉等优点,是该类疾病的首选方法。     

多层螺旋CT扫描在胃肠道穿孔诊断中的应用价值

目的探讨多层螺旋CT扫描在胃肠道穿孔诊断中的价值。方法对19例胃肠道穿孔患者的X线摄片和16层螺旋CT扫描的影像学表现进行回顾性分析。结果立位腹部X线平片诊断胃肠道穿孔14例(73.7%),表现为膈下游离气体。螺旋CT扫描诊断胃肠道穿孔18例(94.7%),其中胃穿孔11例、十二指肠穿孔5例、回肠穿孔1例,结肠穿孔1例,表现为腹腔内游离气体。结论多层螺旋CT扫描较X线片检查能更早、更准确地诊断胃肠道穿孔,并能为其定位和鉴别诊断提供更多有价值的信息。     

化脓性腹膜炎的CT表现

目的探讨继发性化脓性腹膜炎（SPP）的CT表现特征。方法搜集64例有CT检查资料的SPP病例，其中经手术病理证实48例，经腹腔穿刺和／或其他临床综合指标诊断16例。着重观察引起SPP的原发病灶及腹膜炎的CT表现。结果64例除均具有SPP的CT表现外，它们的原发病灶的CT征象显示如下：无腹部手术史的50例腹膜炎中，胃肠道穿孔20例，急性阑尾炎14例，急性胆囊炎6例，腹、盆腔脓肿6例，升结肠炎症伴周围炎症4例；有腹部手术史的14例腹膜炎中，脓肿形成10例，引起腹腔感染4例。结论应用CT扫描诊断SPP，有利于显示SPP原发病灶及腹膜炎CT征象以及二者的解剖关联性，对临床表现不典型病例的诊断和鉴别诊断有较大价值。     

胃十二指肠溃疡穿孔的CT表现

目的：探讨胃十二指肠溃疡穿孔的CT表现及其诊断价值。材料与方法：回顾性分析5例经手术病理证实的胃十二指肠溃疡穿孔者的CT表现。结果：本组5例中，急、亚急性穿孔4例，慢性穿孔1例。穿孔部位包括：胃窦小弯侧1例，胃体大弯侧1例，十二指肠球部上壁及前壁各1例，十二指肠球后部后壁1例。溃疡穿孔的CT表现；定性征象有腹腔内游离气体；定位片像有局部管壁增厚，不规则，周围脂肪层模糊；同时能全面地显示穿孔后腹腔内的继发改变。本组5例中有3例未能确定穿孔部位。结论：CT对诊断胃十二指肠溃疡穿孔很有价值，优于其它影像学检查，但对部分急性穿孔的定应诊断、慢性穿孔的定性诊断有一定限度。     

Reappraisal of radiographic signs of pneumoperitoneum at emergency department

Purpose

This study aimed to evaluate the sensitivities of the reported free air signs on supine chest and abdominal radiographs of hollow organ perforation. We also verified the value of supine radiographic images as compared with erect chest and decubitus abdominal radiographs in detection of pneumoperitoneum.

Methods

Two hundred fifty cases with surgically proven hollow organ perforation were included. Five hundred twenty-seven radiographs were retrospectively reviewed on the picture archiving and communication system. Medical charts were reviewed for operative findings of upper gastrointestinal tract, small bowel, or colon perforations. The variable free air signs on both supine abdominal radiographs (KUB) and supine chest radiographs (CXR) were evaluated and determined by consensus without knowledge of initial radiographic reports or final diagnosis. Erect CXR and left decubitus abdominal radiographs were evaluated for subphrenic free air or air over nondependent part of the right abdomen.

Result

Upper gastrointestinal tract perforation was proven in 91.2%; small bowel perforation, in 6.8%; and colon perforation, in 2.0%. The positive rate of free air was 80.4% on supine KUB, 78.7% on supine CXR, 85.1% on erect CXR, and 98.0% on left decubitus abdominal radiograph. Anterior superior oval sign was the most common radiographic sign on supine KUB (44.0%) and supine CXR (34.0%). Other free air signs ranged from 0% to 30.4%.

Conclusions

Most free air signs on supine radiographs are located over the right upper abdomen. Familiarity with free air signs on supine radiographs is very important to emergency physicians and radiologists for detection of hollow organ perforation.     

彩色多普勒超声对胃肠道穿孔的诊断价值探讨

目的探讨胃肠道穿孔的声像图特点及其诊断价值。方法对116例经手术证实为消化道穿孔患者的彩色多普勒超声检查结果与X线检查结果进行回顾性对比分析。结果 116例患者中,彩色多普勒超声诊断腹腔游离气体为103例,占88.8%;腹盆腔积液107例,占92.2%;腹腔包块和包裹性积液8例,占6.9%;发现穿孔部位51例,占43.9%;X线诊断腹腔游离气体95例,占81.9%;13例包裹性消化道穿孔彩色多普勒超声和X-线均未发现游离气体。结论彩色多普勒超声检查对胃肠道穿孔的早期诊断具有重要价值。     

New method for the detection of intraperitoneal free air by sonography: scissors maneuver

PURPOSE: This study was conducted to investigate the diagnostic value of a new sonographic technique for the detection of intraabdominal free air. METHODS: Seventy-two patients with a suspected gastrointestinal tract perforation were included in the study and prospectively evaluated by sonography and abdominal and chest radiography for the detection of intraperitoneal free air. A new sonographic technique (the scissors maneuver) was used to detect intraperitoneal free air superficial to the liver; the maneuver consists of applying and then releasing slight pressure onto the abdominal wall with the caudal part of a parasagittaly oriented linear-array probe. The results of the imaging studies were correlated with surgical findings when possible. RESULTS: Sixteen patients had a surgically proven gastrointestinal tract perforation causing pneumoperitoneum. Sonography and radiography each showed pneumoperitoneum in 15 patients, with 1 false-negative result for each modality. The sensitivity and specificity values of sonography and radiography were identical; sensitivity was 94% and specificity was 100% for both imaging modalities. The scissors maneuver was positive in all patients with sonographically detected pneumoperitoneum. CONCLUSIONS: Sonography is an effective tool in the diagnosis of pneumoperitoneum, with sensitivity and specificity equal to those of radiography. The scissors maneuver may be a useful adjunct for improving the diagnostic yield of sonography.     

Cytomegalovirus enteritis with jejunal perforation in a patient with endometrial adenocarcinoma

Cytomegalovirus (CMV) infection of the gastrointestinal tract has been reported most frequently in the setting of immunodeficiency. The whole gastrointestinal tract can be affected; however, the small bowel is rarely affected. We report a case of CMV enteritis with jejunal perforation in a 53-year-old woman with a history of chemoradiation therapy for endometrial cancer 8 years previously. At follow-up evaluation, lower abdominal pain, diarrhea and vomiting appeared. Abdominal computed tomography showed intra-abdominal free air in the subphrenic space and porta hepatis. The jejunal segment revealed serosal purulent exudates with a perforation. The resected jejunal segment showed a large geographic ulcerative mucosal lesion. The microscopic findings revealed a diffuse ulcerative mucosal change with a prominent granulation tissue formation and many large atypical vascular endothelial cells and stromal fibroblasts with intranuclear or intracytoplasmic inclusion bodies. These cells were positive for CMV antibody. The final diagnosis was CMV-associated jejunitis with a jejunal perforation.     

超声检查在消化道穿孔诊断中的临床价值

目的 探讨超声检查在消化道穿孔中的诊断价值。方法 回顾分析经手术证实的64例消化道穿孔的超声表现,并与腹部X线检查结果与手术结果进行对比分析。结果 在64例消化道穿孔患者中,手术证实胃穿孔10例,十二指肠球部穿孔39例,阑尾穿孔14例,外伤致小肠破裂1例。术前超声提示消化道穿孔58例,病变的定性诊断符合率90.6％,其中发现腹腔游离气体41例,占64%;腹腔游离积液或局限性积液54例,占84%;局部网膜聚集23例,占35.9%,直接发现穿孔部位21例,占32.8%;腹部X线检查发现膈下游离气体44例,诊断符合率68.7%,与超声检查发现游离气体的符合率相差不大。结论 X线和超声检查均可发现腹腔内游离气体,但是超声还可以发现由消化道穿孔引起的腹腔积液、局部网膜聚集等征象,对腹腔脏器穿孔的检出率较高,具有很高的临床应用价值。      

128层螺旋CT诊断胃肠道穿孔的价值

目的评价并提高螺旋CT(multi-slice spiral CT,MSCT)对胃肠道穿孔的诊断价值。方法回顾性分析32例经手术证实胃肠道穿孔病例的临床资料及影像学表现。结果 32例患者包括:胃穿孔10例,十二指肠球部穿孔l3例,小肠穿孔2例,结肠穿孔4例,阑尾穿孔3例。所有患者均行X线平片和MSCT检查,29例CT表现为腹腔内不同部位的游离气体影,诊断符合率为90.6%(29/32),X线平片诊断符合率为65.0%(13/20)。结论 128层MSCT有助于对少量腹腔游离气体的定性诊断。     

外伤性肠穿孔的CT征象

目的:探讨CT对外伤性肠穿孔的诊断价值。材料与方法:对2002年7月至2006年1月在我院住院,并经手术证实的42例外伤性肠穿孔患者的CT图像进行回顾性分析。其中腹部钝挫伤27例,锐器伤15例。所有病例均未口服造影剂,也没有进行增强扫描。结果:穿孔发生在十二指肠5例,空肠12例,回肠9例,结肠18例,直肠1例。外伤性肠穿孔的CT征象包括:腹腔游离气体(20/42)、腹膜后游离气体(6/42)、肠壁增厚(21/42)、腹腔游离积液(25/42)、肠袢间(系膜)积液(5/42)、系膜浸润(19/42)、系膜血肿(4/42)及肠管扩张积液(4/42)等。结论:肠穿孔的CT所见均为间接征象,单一CT指征对外伤性肠穿孔的诊断价值有限,综合分析是提高诊断率的有效方法。     

Sonographical diagnosis of pneumoretroperitoneum as a result of retroperitoneal perforation

A retroperitoneal perforation is a rare incident. It can occur as a complication of ERCP with papillotomy (0.2-0.5%). Leakage of contrast agent during endoscopy raises the suspicion that this complication has occurred but doesn't always give sufficient information about the leakage extent. In the case of extreme gas emission, a plain abdominal X-ray shows classic pneumoretroperitoneum. The abdominal CT scan can display small amounts of free air which is why it is used for diagnosis in such cases. Ultrasonography also provides a reliable diagnosis and is a good method for monitoring the progression of the condition. Alternative causes of pneumoretroperitoneum can be: trauma, inflammation, infection, tumor as well as ERCP and other interventional procedures, especially endoscopies. Presacral retroperitoneal pneumoradiography was used for the diagnosis of retroperitoneal tumors in the 70 s but is no longer used today. Perforations into the retroperitoneal space come from several locations in the gastrointestinal tract. In the different types of lesions the gas can penetrate the compartments and reach as far as the mediastinum, the intraabdominal cavity, subcutaneum (cervical) or the scrotal compartment (compartment shift). Based on 11 cases (7 perforations during ERCP, 2 perforation during colonoscopy, 2 cases with damage of the distal esophagus), we show the most extensive presentation of the sonographical picture of pneumoretroperitoneum. Typical signs on abdominal ultrasound are an increased echogenicity around the right kidney ("overcasted" or "covered" kidney), air dorsal to the gallbladder, around the duodenum and the head of the pancreas and especially ventral to the great abdominal vessel which can lead to the picture of "vanishing" vessels. The extent of free air is easy to assess. Even very small amounts are detectable ventral to the right kidney. In most cases, a conservative approach with no oral intake, antibiotic coverage, and analgesia in close gastroenterological-surgical cooperation is indicated. Especially after ERCP abscess formation is repeatedly described, sometimes even with a lethal outcome. Sonography is a suitable method for detecting free air in the retro-peritoneum. Pneumoretroperitoneum following bowel-perforation can be effectively shown by ultrasound, it is possible to assess the extent of free air, and sonographic monitoring of the treatment is possible and successful.     

超声检查在外伤性胃肠穿孔诊断中的应用价值

目的 探讨超声对外伤性胃肠穿孔的诊断价值.方法 回顾性分析我院98例经手术证实的外伤性胃肠穿孔患者术前超声和X线结果,比较两者对腹腔游离气体检出率、外伤性胃肠穿孔的检出率及定位诊断符合率.结果 ①超声与X线对腹腔游离气体检出率分别为52.0％、71.4％,二者比较差异有统计学意义(x2=7.797,P＜0.05);②超声定位诊断符合率82.6％,而X线不具备定位诊断能力;③超声与X线对外伤性胃肠穿孔检出率分别为87.8％、71.4％,二者比较差异有统计学意义(x2=8.410,P＜0.05).结论 超声对腹腔游离气体的检出率虽不及X线,但根据破裂口位置、异常包块部位、大网膜聚集方向等表现,对外伤性胃肠穿孔综合检出率较X线高,并能进行穿孔部位定位诊断,综合诊断能力优于X线.     

超声检查在消化道穿孔诊断中的价值

目的探讨超声检查在诊断消化道穿孔中的临床价值和体会。方法对2009年1月至2012年1月东莞市大朗医院收治的48例经手术病理证实的急性消化道穿孔患者的临床资料及超声表现进行回顾性分析。结果超声检查发现腹腔游离气体和游离包裹性积液的敏感性分别为85.4%(41/48)和87.5%(42/48);X线检查发现膈下游离气体的敏感性为75.0%(36/48)。结论超声检查可诊断出胃肠穿孔时腹腔内游离气体、积液以及异常回声等征象,弥补了X线检查的不足,为临床外科急腹症的快速诊断提供可靠依据。