回盲部憩室炎的超声诊断

背景：急性回盲部憩室炎的临床表现与急性阑尾炎相似,易误诊为急性阑尾炎。近年来,超声检查在胃肠疾病诊断中的应用研究不断深入,但关于回盲部憩室炎超声诊断的报道尚少。目的：探讨超声检查对回盲部憩室炎的诊断价值。方法：纳入17例于2010年2月-2011年12月在天津市西青医院经急诊超声检查诊断为急性回盲部憩室炎,并经手术病理或相关检查证实的患者,对其超声声像图表现及其治疗和预后进行回顾性分析。结果：本组17例患者中,病灶位于盲肠或升结肠者7例,位于回肠末端者10例,包块大小0．62cm×0．80cm-2．30cm×1．32cm。所有患者均于腹部压痛点或其周围探及肠壁向外凸出的圆形或卵圆形包块,包块腔内通常为点状低回声,可伴有气体、液性、粪石样回声。憩室周围可见不同程度的脂肪组织、网膜系膜组织增厚。10例患者接受急诊手术治疗,7例接受保守抗炎治疗。所有患者均治愈,无严重并发症发生。结论：超声检查对回盲部憩室炎的诊断和鉴别诊断具有重要意义,除能早期明确诊断外,还可为临床医师选择正确的治疗方案提供依据。     

超声造影在小儿先天性巨结肠中的诊断价值研究

目的探析超声造影在小儿先天性巨结肠诊断中的应用效果。 方法回顾性分析2019年7月至2022年8月东莞市第八人民医院30例手术确诊为先天性巨结肠患儿,所有患儿均采取超声造影检查与X线检查,分析检查结果。 结果诊断准确率方面,X线检查准确率66.67%(20/30,漏诊10例,其中8例是超短段型,另2例为升结肠局灶型),超声造影检查准确率93.33%(28/30,漏诊2例为升结肠局灶型),超声造影准确率显著高于X线检查(P<0.05)。典型先天性巨结肠患者,根据巨结肠长短和位置,表现为近端扩张长度不同程度的粪石、气粪混杂强回声,后壁衰减显著,先天性巨结肠,扩张肠管管径在0.3~2.0 cm,随着管径的减小,肠段走形表现为僵硬,蠕动延缓。采用超声造影检查,能够将全结肠痉挛狭窄程度、近端扩张状况、肠壁增厚程度、肠壁蠕动情况等显示出来。 结论超声造影在小儿先天性巨结肠诊断中应用效果明显,不仅能够将患儿疾病程度清楚的反映出来,同时可以为疾病治疗方案的制定提供帮助。     

老年人结肠憩室病——关注以腹部包块为表现的憩室炎

结肠憩室是指结肠壁上发生的突出于肠腔的囊袋。分为完全性憩室与不完全性憩室。又称为真性憩室和假性憩室。完全性憩室为肠壁全层包括浆膜、肌层和黏膜层突出,深人到结肠周围脂肪组织而形成的囊袋。结肠憩室多为不完全性憩室,由于肠壁局限性肌层缺陷,在血管神经穿过肠壁肌层薄弱处,结肠黏膜和黏膜下层从环行肌束之间膨出形成憩室。结肠多个憩室称之为结肠憩室病。结肠憩室往往随年龄增加而患病率增高。结肠憩室病在西方和工业化国家常见,     

回盲部病变超声误诊为急性阑尾炎三例

1 病例简介 患者1,男,31岁。因突发性右下腹痛、伴恶心、呕吐1d就诊,无腹胀、腹泻症状。查体：体温36．8℃,右下腹局限压痛、反跳痛、肌紧张。实验室检查：WBC12．6×10^9／L。超声所见：右下腹回盲部见一长约4．3cm×0．9cm的管状回声,壁结构层次模糊,周围可见带状无回声及系膜样回声,回盲部肠管壁增厚,回声减低。超声提示：右下腹异常管状回声,考虑阑尾炎。手术所见：结肠脂肪垂扭转、坏死。     

憩室疾病

Diverticulardisease核心成员 :Dr.T.MurphyMDProf.RHHuntMDProf.MFriedMDDrs.J.H .Hrabshuis　　一、定义憩室 :穿过结肠肌层的黏膜囊袋状突起[2 5] (译者注 :憩室通常发生于结肠。突起发生于肠壁的薄弱区域 ,血管能穿出的部位。通常为 5～ 1 0mm大小。假性憩室仅含黏膜和黏膜下层 ,外层由浆膜层覆盖憩室疾病的组成憩室病 结肠内存在憩室憩室炎 憩室的炎症憩室出血憩室疾病的类型 75%为单纯型 ,没有并发症。2 5%合并有脓肿、内瘘、梗阻、腹膜炎或败血症。二、流行病学年龄发生率40岁　　　 50 %60岁　　　 30 %80岁　　　 65 % [2…     

电子肠镜诊治结肠憩室924例分析

目的 研究福建漳州地区人群结肠憩室的患病情况，探讨电子肠镜在结肠憩室诊治中的应用价值。方法 回顾性分析2012年1月至2017年12月在我院行电子肠镜检查并明确诊断为结肠憩室患者的病例资料。结果 共纳入患者924例，男603例，女321例，男性明显多于女性(P<0.0001)。83.7%患者主诉有腹痛、腹胀、排便习惯改变和血便/黑便症状。憩室部位以右半结肠多见(87.6%),单发与多发憩室差异有统计学意义(P<0.0001)。86例(9.3%)患者有憩室相关并发症，>60岁组并发症发生率较高，严重并发症多见。86例中，48例仅粪石嵌顿，20例粪石嵌顿伴憩室炎，15例憩室炎并出血，2例粪石嵌顿伴出血，1例憩室炎伴慢性溃疡并穿孔。47例粪石嵌顿的患者，门诊行肠镜检查时，使用活检钳钳除联合内镜下冲洗解除嵌顿。其余39例患者收入消化内科经内镜联合内科保守治疗，其中1例患者因再出血转外科手术，其余患者疗效确切。结论 本地区憩室检出率呈逐年上升趋势，患者年龄趋于年轻化，男性患者明显多于女性患者，憩室部位以右半结肠多见，并发症的发生率和严重程度与年龄呈正相关。对于>60岁结肠...     

彩色多普勒超声对急性阑尾炎的诊断价值研究

目的探讨彩色多普勒超声对急性阑尾炎的诊断价值。方法选取2013年9月—2016年12月成都市青白江区人民医院收治的疑似急性阑尾炎患者120例,均采用GELogic E9彩色多普勒超声诊断仪进行检查。观察急性阑尾炎的检出情况及影像学特征。结果 120例患者经术后病理学检查证实为急性阑尾炎58例(48.3%),经彩色多普勒超声检查检出48例(40.0%),诊断符合率为82.7%。彩色多普勒超声检查:单纯性阑尾炎阑尾盲端管状结构,管壁增厚且出现强回声,管腔内出现较弱回声,无积液;化脓性阑尾炎阑尾增粗、腔内积液、轮廓不清晰、阑尾壁薄、盲端膨大、张力高;坏疽性阑尾炎阑尾壁存在不均匀回声,阑尾形态不规则,黏膜层存在连续性较差,阑尾腔内可见强回声点和液性暗区,周围网膜反射较强,附近液性暗区较多;阑尾穿孔阑尾壁局部连续中断,且中断部位与阑尾腔相通,可见局限性无回声区;阑尾周围脓肿阑尾区囊性包块、不清晰边界、形态不规则,阑尾壁薄厚不均匀,浆膜层与黏膜层发生局部中断,囊内呈不等疏密的弱回声点,在盆腔与团块附近出现不等液性暗区。结论彩色多普勒超声在急性阑尾炎中的应用效果较好。     

超声诊断非肿瘤性肠壁增厚性病变73例

目的:探讨超声检查在非肿瘤性肠壁增厚性病变诊断中的应用价值.方法:对临床诊断明确的非肿瘤性肠壁增厚性病变患者73例进行超声检查,观察超声图像特点.结果:非肿瘤性肠壁增厚性病变声像图特征性表现为肠壁增厚,回声减低,正常结构可消失.克隆病肠壁增厚最明显,多伴有肠瘘形成包块,易合并肠梗阻;溃疡性结肠炎以肠壁增厚为主,少伴有肠梗阻等并发症;肠结核多发于回盲部,多伴有肠粘连包块,可见肠间淋巴结回声和肠间积液.结论:超声检查可用于非肿瘤性肠壁增厚性病变的诊断与疗效观察.     

东西方结肠憩室发病原因及影响因素

消化道憩室指局部消化系病理性疝于肠壁的囊袋状突出.近年来,通过尸检报告发现憩室病发病率不断增高.在发病机制上,结肠憩室的发生与结肠本身的解剖特点、肠道运动神经功能紊乱、肠内细菌过度繁殖、激素水平紊乱等诸多因素相关.与此同时,结肠憩室还受种族、性别、地区环境、食物摄入、运动情况等因素影响.以往研究结显示,结肠憩室在东西方不同地区的流行病学特点存在明显的差异,且目前造成这一差异的原因尚未明确,其中西方国家人群的高脂、低纤维饮食习惯可能是重要的诱发因素.本文从结肠憩室的发病原因、发病机制以及影响因素等方面对东西方结肠憩室的差异及特点进行了综述.     

深在性囊性胃炎1例

深在性囊性胃炎(gastritis cystica profunda,GCP)是一种罕见的胃黏膜下病变,多有腹痛、腹胀、食欲不振、出血、贫血等表现。胃镜检查可见胃黏膜炎症,活组织检查可无异常,超声胃镜检查可见特异性的胃壁增厚伴局部深达黏膜下层甚至固有肌层的不规则低回声区。本文结合相关文献对1例GCP患者进行报道。     

Hepatic Abscess That Formed Secondary to Fish Bone and Had a Fistula With the Ascending Colon

We present the case of a liver abscess that formed secondary to foreign bodies and formed a fistula the ascending colon and was successfully treated with percutaneous abscess drainage and colonoscopic removal of foreign bodies. A 64-year-old man presented with right upper and lower quadrant pain of 2 weeks' duration. Abdominal computed tomography was performed, demonstrating a single 3.5×1.9-cm abscess of the liver's right lobe and eccentric thickening of the colon wall at hepatic flexure. A percutaneous hepatic drainage catheter was placed under ultrasound guidance. Colonoscopic examination revealed multiple diverticula of the ascending colon and two 1.5-cm long fish bones at the ascending colon near the hepatic flexure. One end of each fish bone had impacted the edematous colonic mucosa and was surrounded by exudate polypoid inflammatory tissue. The fish bones were extracted with forceps. The patient was feeling well and was discharged after 12 days of treatment.     

Ultrasound of colon diverticulitis

Overall, the diagnosis of diverticulitis is more reliably made by computed tomography (CT) than by ultrasound (US). However, since US is often used as a first modality in acute abdomen, it is important to be aware of the US signs of diverticulitis. Besides, in not too obese patients, US may be superior to CT. US is most useful in early, uncomplicated diverticulitis. Daily, repeated US examinations in patients with diverticulitis have taught that diverticulitis, in the majority of cases, runs a predictable and benign course. Initially, there is local wall thickening of the colon with preservation of the US layer structure. Within the inflamed diverticulum, a fecolith is present, and the diverticulum is surrounded by hyperechoic, noncompressible tissue, which represents the inflamed mesentery and omentum 'sealing off' the imminent perforation. US follow-up shows evacuation of the fecolith to the colonic lumen, with or without the transient development of a small paracolic abscess, sometimes with disintegration of the fecolith. This process of spontaneous evacuation of pus and fecolith via local weakening of the colonic wall at the level of the original diverticular neck towards the colonic lumen takes place within 1 or 2 days, rarely longer. The residual inflammatory changes remain present for several days after the evacuation, and it is not uncommon to find an empty diverticulum at first presentation. If, in such cases, patients are specifically asked for their symptoms, they invariably declare that 'the worst pain is over'. Whenever diverticulitis takes a complicated course, CT is superior to US, especially in the detection of free air, fecal peritonitis and deeply located abscesses, and in general in obese patients. Finally, US, if necessary followed by CT, has an important role in the diagnosis of alternative conditions: ureterolithiasis, pyelonephritis, perforated peptic ulcer, appendicitis, Crohn's disease, epiploic appendagitis, gynecological conditions, colonic malignancy, pancreatitis, etc. Right-sided colonic diverticulitis in many respects differs from its left-sided cousin. Diverticula of the right colon are usually congenital, solitary, true diverticula containing all bowel wall layers. The fecoliths within these diverticula are larger and the diverticular neck is wider. There is no hypertrophy of the muscularis of the right colonic wall. My observations with US and CT in 110 patients with right colonic diverticulitis clearly show that it invariably has a favorable course and never leads to free perforation or large abscesses. Although relatively rare (left:right = 15:1), it is crucial to make a correct diagnosis since the clinical symptoms of acute right lower quadrant pain may lead to an unnecessary appendectomy or even right hemicolectomy.     

Pneumatosis cystoides intestinalis treated with hyperbaric oxygen therapy: usefulness of an endoscopic ultrasonic catheter probe for diagnosis

A 67-year-old woman was admitted to our hospital with a complaint of abdominal pain. Barium enema examination and colonoscopy showed numerous round polypoid lesions covered with normal mucosa in the area from the ascending colon to the splenic flexure. Endoscopic ultrasound examination with an ultrasonic catheter probe revealed a strong echo with distal acoustic shadowing in the third layer of the diseased colonic wall, which suggested the presence of gas in the submucosa. The gaseous cysts disappeared completely after hyberbaric oxygen therapy at 2 to 3 atmospheres absolute (60 minutes, twice a day) for 30 consecutive days.     

Ascending Colon Stenosis:A Rare Presentation of Perforated Appendicitis

Abstract : Described is a 49-year-old Japanese male who developed an ascending colon stenosis secondary to perforated appendicitis. The patient was examined at our hospital because of an abdominal pain and the presence of a firm mass in the right flank. A barium enema and colonoscopic examination revealed an ascending colon stenosis with multiple nodular elevations. On laparotomy, an inflammatory mass, originating from a ruptured appendix, was found adhered to the cecum and the ascending colon. Thus, a right hemicolectomy was performed. Microscopic examination revealed a periappendiceal abscess with marked submucosal fibrosis and lymphoid hyperplasia of the ascending colon and cecum. Large intestinal stenosis is a rare complication of appendicitis, and there have been only a few reported cases involving the ascending and sigmoid colon, and the rectum. In these cases, however, the polypoid lesions as seen in our case have never been described. In reviewing the literature, we found only two other cases in which a coarse or a polypoid lesion, similar to our case, was noted in the cecum, though the mucosal change was localized and luminal stenosis did not occur. Thus, when a patient with an ascending colon stenosis is encountered, a possibility of periappendiceal abscess must be kept in mind.     

Uncommon features of giant colonic diverticula

Two patients with giant colonic diverticula were operated upon within one week. Uncommon features of this rare condition were observed in both patients: 1) the diverticulum was located outside the sigmoid colon, 2) smooth-muscle fibers and ganglion cells were present in the wall of the diverticulum, and 3) free perforation into the peritoneal cavity was the presenting symptom. Barium enema in one patient showed no communication between the diverticulum and the colonic lumen, despite evidence of such communication on histologic examination. Both patients were successfully treated by simple excision of the diverticulum without colonic resection.     

Chronic ischemic lesions of the colon caused by phlebosclerosis of ileocolic mesenteric vein

Phlebosclerosis of the mesenteric vein is a rare cause of intestinal ischemia. We report a case of chronic ischemic lesions of the colon caused by phlebosclerosis accompanied by marked venous calcification. A 77‐year‐old Japanese man with intestinal obstruction was admitted to Kanazawa University Hospital. Barium enema examination demonstrated narrowing in the right colon, while colonoscopy showed dark purple‐colored edematous mucosa and erosions from the cecum to the transverse colon. Computed tomography disclosed a substantially thickened colonic wall with intramural calcification and a calcified mesenteric vein in the right colon. As abdominal pain persisted, despite treatment with total parenteral nutrition for 3 months, a right hemicolectomy was performed. The pathological findings of the resected specimen were marked fibrous thickening of the submucosal layer, and fibrous thickening of the venous wall accompanied by hyalinization and calcification. These features indicated chronic ischemic lesion caused by phlebosclerosis.     

A case of colon perforation due to enteropathy-associated T-cell lymphoma

Enteropathy-associated T-cell lymphoma(EATL) is an extremely rare disease,which is often related to glutensensitive enteropathy.It is an uncommon intestinal lymphoma with very poor prognosis and high mortality rate.In the absence of specific symptoms or radiological findings,it is difficult to diagnose early.Major complications of EATL have been known as intestinal perforation or obstruction,and only 5 cases of EATL are reported in South Korea.In this study,we report a case of 71-year-old male with symptoms of diarrhea,which later it progressed into cancer perforation of the colon.The initial colonoscopic findings were normal and computed tomography scan demonstrated a segmental wall thickening of the distal ascending colon with nonspecific multiple small lymphnodes,along the ileocolic vessels,but no signs of mass or obstruction.The histologic findings of resected specimen confirmed EATL type Ⅱ.Patient expired two weeks after the operation.Therefore,we emphasize the need of random biopsy in the presence of normal mucosa appearance on colonoscopy for the early diagnosis of EATL.     

肝硬化患者胃肠壁增厚增强CT表现

目的：探讨肝硬化患者胃肠壁增厚增强CT表现。方法分析2013年4至11月浙江省台州市第一人民医院收治的59例肝硬化全腹部CT增强患者腹部增强CT表现。将胃壁厚度＞10 mm、小肠及结肠肠壁厚度＞3 mm作为胃、小肠及结肠壁增厚的判断标准。结果59例肝硬化患者中发现43例（72．9％）患者胃肠壁增厚。空肠与升结肠是胃肠壁增厚最好发部位。胃肠壁增厚表现为同心性、均匀性强化。结论肝硬化患者腹部增强CT扫描常发现胃肠壁增厚改变，表现为多段肠管累及，以空肠及升结肠多见。     

Sigmoid Colon Perforation Due to Endometriosis Not Associated with Pregnancy

A 38-yr-old woman presented with abdominal pain, hematochezia, and fever of 7 days' duration. Computerized tomographic scanning revealed a mass 6 cm in diameter adherent to the sigmoid colon. At surgery, the mass was determined to be an endometrioma with an associated tubo-ovarian abscess eroding the sigmoid colonic wall. This case, illustrating colonic perforation, represents a rare complication of intestinal endometriosis and, to our knowledge, represents the first reported case of colonic perforation secondary to endometriosis not associated with pregnancy. The clinical manifestations of intestinal endometriosis leading to perforation are reviewed.     

Giant sigmoid diverticulum: case report and review of the literature

Giant colonic diverticulum is a rare entity first described in 1946 by Bonvin and Bonte. It may be congenital or acquired and the average age of presentation is 65. There are less than 150 reported cases in the literature. A large abdominal mass was detected during a routine physical examination in an 82-year-old man. CT scan showed a large air-filled mass, barium enema showed multiple sigmoid diverticula, but no communication with the mass was found. A diagnosis of giant sigmoid diverticulum was made, elective sigmoidectomy and resection of the diverticulum was performed with no complications. The clinical picture may be different, varying from asymptomatic to acute abdomen, intestinal perforation or fistula. It can be diagnosed with abdominal X-ray, CT scan, barium enema or MRI, but colonoscopy is not effective. There are two accepted theories of the pathophysiology of this entity: first, a congenital origin and second, that inflammatory diverticula are caused by a perforation with a ball-valve that allows gas to enter, but not to leave the cyst, thus, enlarging the false diverticulum, and progressively destroying the bowel layers, causing secondary fibrosis. Elective treatment is a segmental resection of the affected colon with the diverticulum and in cases of acute abdomen two-stage bowel resection is preferred.