胆石性肠梗阻的CT诊断

目的:评价CT对胆石性肠梗阻的诊断价值。方法:回顾性分析5例经手术证实的胆石性肠梗阻患者的CT检查资料及临床表现。结果:所有病例CT表现均见肠腔内异位结石、肠梗阻、胆系积气及胆囊窝结构紊乱,1例显示腹腔游离积液,1例结石位于十二指肠降段,1例结石位于空肠,另3例结石位于回肠。结石呈圆形或椭圆形,直径2.5~5cm,梗阻以上肠管扩张,可见气液平,1例完全性肠梗阻病例梗阻以下肠管空虚。5例术前CT诊断准确率为100%。结论:胆石性肠梗阻有典型的CT表现,CT是胆石性肠梗阻的最佳方法。     

Case report: ultrasound in the diagnosis of gallstone ileus

Recent case reports have shown that ultrasound can be useful in the diagnosis of gallstone ileus. A further patient is presented in whom the ultrasonic demonstration of dilated bowel loops, air in the gall-bladder, and an ectopic gallstone clinched the diagnosis when the plain radiographs demonstrated only small bowel obstruction. A pitfall in the ultrasound diagnosis is also discussed.     

X线及CT联合应用对胆石性肠梗阻的诊断价值

目的：探讨X线及CT联合应用对胆石性肠梗的阻诊断价值。方法：回顾性分析10例胆石性肠梗阻患者的X线及CT表现。结果：10例患者中2例胆结石位于十二指肠,4例胆结石位于空肠,3例胆结石位于回肠,1例胆结石位于横结肠,结石直径2．5～6．5cn2,平均3．5cm;4例出现胆囊一十二指肠瘘,1例出现胆囊一结肠瘘,1例出现胆囊一十二指肠一结肠复合瘘,瘘口平均直径约1．5cm,其影像学表现包括肠管扩张积气积液、梗阻段肠腔内环形高密度结石影、胆囊积气及消化道造影剂外漏。结论：X线及CT联合应用可明确诊断胆石性肠梗阻,为临床治疗提供重要信息。     

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     

Value of ultrasonography in the diagnosis of gallstone ileus

Two patients are presented, both of whom were admitted to hospital because of abdominal pains. In both patients, ultrasonography showed gallstones in the lower abdomen and in the small bowel loops were found to be dilated. In both cases it was possible to diagnose the gallstone ileus by ultrasonography and to mark the abdomen as a guide to the surgeon.     

Role of helical CT in diagnosis of gallstone ileus and related conditions

OBJECTIVE: Small-bowel obstruction from gallstone impaction is a pathological entity frequently observed in elderly patients with a history of cholelithiasis or cholecystitis. Diagnostic imaging plays a great role in the management of patients with suspected gallstone ileus and overall in the correct predictive diagnosis: in the last years, some experiences in radiologic diagnosis of this entity by sonography, abdominal plain film and CT, and occasionally MRI have been reported. Some questions related to gallstone ileus are to be considered: one of them is the possibility of recurrence, which increases the operatory risk in these patients. Recurrence may be due either to the presence of overlooked stones that were already in the bowel at the time of surgery but not identified and not removed or to the migration of other stones in patients not previously cholcystectomized. In cases of acute abdomen, establishing an effective conservative therapy may be a critical point. The aim of this retrospective study was to evaluate the capabilities of helical single-detector and MDCT scanners to allow a correct diagnosis of this disease. CONCLUSION: Helical single-detector and MDCT may improve the diagnosis of gallstone ileus, providing important information regarding the exact number, size, and location of ectopic stones and the site of intestinal obstruction or direct visualization of a biliary-enteric fistula, to help clinicians in the therapeutic management of patients.     

胆石性肠梗阻的诊断与治疗

目的探讨胆石性肠梗阻的诊断与治疗。方法回顾性分析6例胆石性肠梗阻患者的临床资料。结合病史、临床症状与腹部B超、X片、CT等多种影像学检查,6例患者全部术前明确诊断。结果 6例患者全部采取手术行肠切开取石,均痊愈出院。结论结合胆结石病史和肠梗阻症状,再辅以影像学检查,特别是CT检查可确诊胆石性肠梗阻。积极行肠切开取石术是解除梗阻最安全、有效的方法。     

胆石性肠梗阻的影像诊断

目的研究胆石性肠梗阻影像表现及其诊断价值.方法回顾性分析15例经临床证实的胆石性肠梗阻患者的影像表现及其诊断价值.结果所有病例CT表现均见肠梗阻征象、肠腔内迷走结石（异位结石）及胆囊、胆系积气,2例显示腹腔游离积液,除1例胆囊切除者外另14例均见胆囊变形,胆囊与十二指肠分界不清,4例可见明确显示胆肠瘘.5例同时进行了腹部立卧位X线平片检查,其中1例碘水造影显示机械性肠梗阻、肠腔内充盈缺损、胆肠瘘,1例显示胆管积气,3例显示肠梗阻征象,2例未见异常.7例同时进行了腹部超声检查,均提示胆囊异常,其中3例显示胆系积气.结论胆石性肠梗阻有典型的CT表现,CT是胆石性肠梗阻最佳诊断方法,X线平片及超声可以作为筛查手段.     

Ultrasonic detection of gallstone ileus

A woman of 60 years of age with acute abdominal pain, vomiting, constipation and radiological signs of small bowel obstruction was subjected to sonographic examination. Careful examination of the entire abdomen demonstrated a hyperechoic object within the distended terminal ileum with an intensive acoustic shadow. The gallbladder was not visible. This strongly suggested gallstone ileus, especially since the patient had a history of gallbladder disease. She was treated immediately by enterotomy and extraction of a noncalcified obstructing stone. The value of ultrasound in detecting gallstones causing small bowel obstruction is discussed.     

Resolution of gallstone ileus with spontaneous evacuation of gallstone

Gallstone ileus (GSI) is a rare cause of small bowel obstruction (SBO). Even more extraordinary is the spontaneous evacuation of a gallstone, which has caused SBO. A 69-year-old gentleman presented with symptoms and signs of SBO. His plain abdominal X-ray revealed dilated loops of the small bowel and opacity in the region of the terminal ileum consistent with a diagnosis of GSI. Because of severe cardiorespiratory co-morbidities, the patient was treated conservatively and improved within 24 h. A CT scan revealed that the stone had passed into the rectum and was spontaneously evacuated. If the gallstone is <2.5 cm on CT scan, spontaneous evacuation is a real possibility and initial conservative treatment in a high-risk surgical patient is a consideration.     

胆石性肠梗阻伴胆肠瘘2例

例1 男,77岁. 因腹痛,腹胀伴恶心呕吐2 d入院. 查体:心肺(-),腹稍隆起,肠鸣音亢进,未见明显包块, 实验室检查未见异常.CT示:胆囊变形缩小,胆囊壁增厚,胆囊腔内少量积气影.回肠内见一约4 cm×3.5 cm大小环形高密度病灶,近端小肠明显扩张积液增多.手术结果:探查腹腔距回盲部约10 cm回肠内见4 cm×3 cm×3.5 cm大小结石,近端小肠明显扩张,胆囊明显缩小,与十二指肠、胆总管及肝脏广泛致密粘连,胆囊体部与十二指肠球部上缘形成内瘘,瘘口直径约3 cm(图1).     

Air in gallbladder: a frequent finding in gallstone ileus.

A retrospective assessment of the presence of air in the biliary tract is presented, based on plain film findings in 16 proven cases of gallstone ileus. In addition to five cases that demonstrated air in the biliary radicles, four cases exhibited air exclusively in the gallbladder and duodenal bulb. A clearly identifiable radiographic appearance composed of two adjacent small air-fluid levels in the right upper quadrant is described. This radiographic feature represents the air- and fluid-filled duodenal cap adjacent to the visualized shrunken gallbladder. Recognition of this combination of findings helps in establishing a prompt preoperative diagnosis in cases of gallstone ileus.     

Use of imaging procedures in gallstone ileus

Gallstone ileus is a rare complication of cholecystolithiasis with a high mortality and a high rate of postoperative complications caused by the advanced age of the patients and the often delayed diagnosis. The article shows that the consistent use of conventional radiological methods helps to reduce the high incidence of undetected gallstone ileus. A plain film of the abdomen is mandatory because it yields important information on the presence of an ileus and allows to diagnose gallstone ileus if air in the biliary tree and an aberrantly located gallstone is visible. Signs of an ileus are a frequent finding on abdominal scout films (9 of 9 cases) while the additional signs are often absent (5 of 9 cases). Contrast x-ray studies of the intestine, especially the upper gastrointestinal series with water-soluble contrast media, are of importance because they can help in detecting biliary enteric fistulas or gallstones located in the intestine. Hence, the consistent use of this roentgenologic routine methods can promote the accuracy of correct preoperative diagnosis (4 of 7 cases).     

Fanconi氏贫血的临床X线诊断

This paper reported 4 cases of Fanconi's anemia, which is a rare disease usually seen in children under 10 years of age. Its clinical features comprise familial pancytopenia, hypoplasia of bone marrow, and conspicuous megakaryophthisis, with multiple malformations predominantly occurring in the skeleton and kidney. Some cases may be associated with abnormalities of the chromosome.     

Kaolinosis: a radiological review

A short account of the industrial process used to produce kaolin is given. The chest radiographs of 68 selected cases of kaolinosis were reviewed and the radiological appearances are presented. We also describe two cases of Caplan's syndrome occurring in kaolinosis.     

Contrast-induced renal failure: a radiological problem and radiological diagnosis.

Renal failure induced by intravenous iodinated contrast media is a frequent medical problem. While such cases are generally reported first by the clinician, the phenomenon can be seen even earlier by the radiologist. An abnormally persistent nephrogram is a sign of abnormal clearance, which in turn should alert the physician to the likelihood of renal failure.     

Elastofibroma dorsi: a radiological diagnosis

Elastofibroma dorsi is a rarely made radiological diagnosis. The rarity of the condition, lack of a suitable imaging modality, and an inconsistent clinical approach in evaluating indeterminate soft tissue tumors has contributed to this failure. With magnetic resonance imaging now being recognized as the examination of choice for all indeterminate soft tissue tumors, a prebiopsy diagnosis can frequently be made by radiologists familiar with the characteristic periscapular location, predilection for elderly females, and short T2 on magnetic resonance imaging.