64层螺旋CT在腹部闭合性外伤所致肠及肠系膜损伤的应用价值

目的:探讨64层螺旋CT对腹部闭合性外伤致肠及肠系膜损伤的CT应用及诊断优势。方法:回顾分析我院32例闭合性腹部外伤患者导致肠及肠系膜损伤的CT表现,分析其不同部位损伤的CT表现。结果:肠管外游离气体﹑肠系膜增厚与血肿﹑肠壁血肿﹑肠管连续性中断﹑腹腔内游离积液等是肠管及肠系膜损伤的主要CT征象,十二指肠﹑空回肠﹑结肠及肠系膜不同部位CT表现有所不同,应用不同窗宽技术对病变的检出具有重要意义。结论:CT扫描对闭合性腹部外伤所致肠及肠系膜损伤具有可靠的定位及诊断依据,对临床早诊治具有重要指导作用。     

多层螺旋CT增强检查对肠和肠系膜钝性损伤的诊断价值

目的:探讨多层螺旋CT增强扫描检查对腹部肠和肠系膜损伤的诊断价值。方法:回顾性分析50例经手术证实为腹部钝性损伤患者的平扫及增强CT表现征象,并比较分析各种征象的诊断价值。结果:50例中,腹腔和(或)腹膜后积液44例,肠管水肿增厚25例,肠系膜血肿10例,气腹6例,肠壁血肿3例,肠系膜增厚与周边脂肪界面模糊不清或周边脂肪内有斑点状改变18例,腹腔内脓肿1例。结论:多层螺旋CT增强扫描对判断有无肠和肠系膜损伤及其程度都有重要作用,有助于及时诊治。     

MSCT在闭合性十二指肠损伤诊断的价值

目的探讨MSCT在闭合性十二指肠损伤诊断中的应用价值。方法回顾性分析我院2006年1月～2012年10月经手术证实的13例闭合性十二指肠损伤病例的CT以及临床资料。结果11例见腹膜后和腹腔游离气体。8例CT增强扫描有5例（62.5％）,5次观察到十二指肠肠壁破裂的破口及内容物外溢。13例均表现为十二指肠肠壁不同程度增厚,部分肠壁边缘模糊。13例均有腹腔、腹膜后积液及右侧肾周模糊、积液。4例肠系膜根部脂肪密度增高伴少许血肿形成。结论闭合性十二指肠损伤具有一定特征性的CT征象,CT薄层扫描、多平面重组及增强扫描能有效检查出闭合性十二指肠损伤,为临床诊断及治疗提供重要依据。     

腹部闭合性损伤中肠道外伤性穿孔的MSCT诊断

目的探讨腹部外伤引起肠道穿孔的多层螺旋CT（MSCT）表现，提高对肠道外伤性穿孔的表现。方法收集12例有明确外伤病史、进行了CT检查且手术确诊的肠壁穿孔，回顾分析MSCT平扫增强及三维重建图像。结果CT表现：腹腔或（和）后腹膜腔及肠壁周围局限性积液10例，肠系膜血肿11例，腹腔局部管壁增厚、间隙不清12例，气腹5例，肠壁内小气泡2例。结论MSCT检查对腹部闭合性损伤合并肠腔破裂有重要作用，有助于及时诊治。     

CT对腹部空腔脏器闭合性损伤的诊断价值

目的探讨CT对腹部空腔脏器闭合性损伤的诊断价值。方法对16例腹部空腔脏器闭合性损伤患者进行分析。结果本组腹部空腔脏器闭合性损伤患者,胃损伤3例,十二指肠损伤2例,空肠损伤3例,回肠损伤5例,结肠损伤3例。5例腹腔内可见气体,1例呈点状类圆形气体局限于肠系膜间伴肠系膜血肿,1例呈窄奈状气体局限于左肾旁前间隙内。腹腔积液或腹膜后积液11例。肠壁增厚或伴肠系膜血肿4例。口服可溶性造影剂外溢1例,局部胃壁周围脂肪间隙密度增高。结论对腹腔空腔脏器的损伤CT能检出X线或B超无阳性发现者,对此病早期诊断及预后具有重要价值。     

腹部闭合创伤性小肠、结肠破裂的CT征象分析

目的:探讨腹部闭合创伤性小肠、结肠破裂的CT影像学特点,提高术前准确诊断率。材料与方法:回顾性分析216例经手术证实的创伤性小肠、结肠破裂病人的临床及CT影像学资料,总结其CT影像学特点。结果:经手术证实小肠破裂186例,结肠破裂30例。CT影像学表现包括腹腔积血、积液210例,腹腔游离气体172例,肠壁增厚、血肿120例,肠系膜损伤64例,合并其他实质性脏器损伤40例。腹腔积血、积液出现率最高,但缺乏特异性;腹腔游离气体特异性最高;肠壁增厚、血肿对肠道破裂具有较高的定位价值。结论:创伤性小肠、结肠破裂具有典型的CT影像学表现,CT对诊断创伤性小肠、结肠破裂具有较高诊断价值。     

多层螺旋CT在腹部外伤影像诊断中的价值

目的评价多层螺旋CT检查对腹部外伤的临床诊断价值。方法对164例腹部外伤患者进行CT检查并进行回顾性分析。结果 164例腹部外伤患者中,肝破裂3例,脾破裂113例,肾破裂21例,复合伤19例,肠破裂8例,实质性器官损伤以肝、脾、肾多见,其CT共同特点表现在实质器官的破裂、血肿及包膜下、包膜外血肿和腹腔或腹腔后间隙积液。胃肠道破裂的CT表现为肠壁损伤征,受累肠壁局部低密度,增强扫描强化减弱,相邻肠管强化相对增强;腹腔及肠间隙积液,周围脂肪间隙或肠间隙模糊。结论 CT可为腹部外伤的正确诊断和临床治疗提供重要信息。     

肠及系膜损伤的CT表现与手术治疗的关系

目的 探讨肠及肠系膜损伤的CT征象，评价CT诊断在肠及肠膜损伤病人手术治疗价值。方法 19例闭合性腹部外伤病人，急诊行螺旋CT检查。结果 19例手术证实肠或肠系膜损伤病例，其中16例CT做出正确诊断，敏感性84％（16／19），其余3例CT诊断无肠及肠系膜损伤，临床诊治过程证实可保守治疗。结论 对于闭合性腹部外伤的病人，CT检查可以显示肠及肠系膜损伤和损伤程度，能够为临床治疗方案的选择提供帮助。     

CT平扫在肠及肠系膜损伤诊断的价值

目的 探讨CT平扫对肠及肠系膜损伤的诊断价值.方法 回顾分析129例腹部钝性损伤病例的CT平扫及临床资料.初步诊断结果为CT半扫诊断结果,临床最终诊断结果为手术结果.和/或临床跟踪结果,并作统计学分析.结果 CT平扫初步诊断49例肠及肠系膜损伤,其中41例得到证实,CT平扫对肠及肠系膜损伤诊断的准确性为79.1%,敏感性为68.3%,特异性为88.4%.CT初步诊断与临床最终诊断比较无统计学差异（X2=3.7.17＞0.05）.结论 CT平扫能对腹部闭合性外伤病人的肠及肠系膜损伤作出准确诊断.     

多层螺旋CT对肠扭转的诊断意义

目的探讨多层螺旋CT对肠扭转的诊断价值。方法回顾性分析2007年8月2009年11月经临床和手术证实为肠扭转15例的CT平扫、增强及多平面重建影像表现。结果 15例中,CT表现为肠系膜血管漩涡征9例,鸟嘴征1例,C型肠袢征呈5例,肠壁水肿征8例,腹水征3例,肠腔扩张、积气积液征14例。结论多层螺旋CT扫描及多平面重建检查,对肠扭转的诊断具有重要价值。     

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。     

The role of computed tomography in diagnosis of blunt intestinal and mesenteric trauma (BIMT)

Blunt intestinal mesenteric trauma (BIMT) is a rare injury with a high morbidity and mortality. It is a diagnostic dilemma for Trauma Surgeons and Emergency Physicians. This study was undertaken to assess the role of computed tomography (CT) in BIMT. Data were analyzed from 1995 to 2002. Thirty-six cases of BIMT were identified: 16 isolated and 20 non-isolated injuries. Initial CT scan was abnormal in 74% (17 out of 23), and 83% on retrospect (2 additional cases). CT scans were abnormal (initial and repeat) in 96% (22 out of 23). The most common abnormalities were free fluid (78%), mesenteric stranding or edema (39%), bowel wall hematoma, or edema (30%). Free air was seen in 31% and oral contrast extravasation in 15% of cases of bowel perforation. CT scan findings in BIMT can be subtle and non-specific. Suspicion of BIMT warrants close observation and probably further diagnostic testing.     

Evaluation of bowel and mesenteric injury: role of multidetector CT

The development of thin-section multidetector computed tomography has improved the accuracy of computed tomography in the evaluation of abdominal trauma. Multidetector computed tomography is more sensitive and specific than diagnostic peritoneal lavages, abdominal sonography, and clinical examination for the detection of bowel and mesenteric injury. Computed tomographic findings include pneumoperitoneum, visualization of direct tears in the bowel wall, intraperitoneal fluid, bowel wall thickening, abnormal bowel wall enhancement, and mesenteric infiltration or hematoma.     

The Risk of Intra‐abdominal Injuries in Pediatric Patients with Stable Blunt Abdominal Trauma and Negative Abdominal Computed Tomography

Objectives: This review examines the prevalence of intra‐abdominal injuries (IAI) and the negative predictive value (NPV) of an abdominal computed tomography (CT) in children who present with blunt abdominal trauma. Methods: MEDLINE, EMBASE, and Cochrane Library databases were searched. Studies were selected if they enrolled children with blunt abdominal trauma from the emergency department (ED) with significant mechanism of injury requiring an abdominal CT. The primary outcome measure was the rate of IAI in patients with negative initial abdominal CT. The secondary outcome measure was the number of laparotomies, angiographic embolizations, or repeat abdominal CTs in those with negative initial abdominal CTs. Results: Three studies met the inclusion criteria, comprising a total of 2,596 patients. The overall rate of IAI after a negative abdominal CT was 0.19% (95% confidence interval [CI] = 0.08% to 0.44%). The overall NPV of abdominal CT was 99.8% (95% CI = 99.6% to 99.9%). There were five patients (0.19%, 95% CI = 0.08% to 0.45%) who required additional intervention despite their initial negative CTs: one therapeutic laparotomy for bowel rupture, one diagnostic laparotomy for mesenteric hematoma and serosal tear, and three repeat abdominal CTs (one splenic and two renal injuries). None of the patients in the latter group required surgery or blood transfusion. Conclusions: The rate of IAI after blunt abdominal trauma with negative CT in children is low. Abdominal CT has a high NPV. The review shows that it might be safe to discharge a stable child home after a negative abdominal CT. ACADEMIC EMERGENCY MEDICINE 2010; 17:469–475 © 2010 by the Society for Academic Emergency Medicine     

Sonographic diagnosis of mesenteric hematoma.

Blunt abdominal trauma is common in children. Handlebar injuries may produce duodenal hematoma and pancreatic injuries, but mesenteric hematoma is relatively uncommon. We report a mesenteric hematoma resulting from a handlebar injury in a 4-year-old boy. Abdominal sonography showed a heterogeneous hypoechoic mass with an echogenic wall in the central portion of the abdomen. Color Doppler study revealed vascularity at the periphery of the lesion, suggesting mesenteric hematoma. CT, upper gastrointestinal endoscopy, and a small bowel x-ray series confirmed the diagnosis.     

Blunt bowel and mesenteric injury: MDCT diagnosis

Multidetector computed tomography (MDCT) has emerged as the imaging modality of choice for evaluating the abdomen and pelvis in trauma patients. MDCT readily detects injury of the solid organs as well as direct and indirect features of bowel and/or mesenteric injury—an important advance given that unrecognized bowel and mesenteric injuries may result in high morbidity and mortality. Nonetheless, challenges persist in the interpretation of abdominal and pelvic CT images in trauma patients. Difficulty in interpretation may result from lack of familiarity with or misunderstanding of CT features of bowel and/or mesenteric injury. Moreover, due to major technical advances afforded by MDCT, new CT features of bowel and/or mesenteric injuries have been recognized. Beading and termination of mesenteric vessels indicating surgically important mesenteric injury is an example of one of these new features. MDCT also allows for the detection of small or trace amounts of isolated intraperitoneal fluid in trauma patients, although the clinical management of these patients is still controversial. This pictorial essay illustrates the spectrum of typical, atypical, and newly reported MDCT features of bowel and mesenteric injuries due to blunt trauma. The features that help to differentiate these injuries from pitfalls are emphasized in these proven cases.     

肝脏顿挫伤的CT诊断与分级

目的:探讨肝脏顿挫伤CT诊断标准及CT分级的临床应用价值。资料与方法:回顾性分析1997~2004年在我院CT诊断为肝脏顿挫伤的病例147例,外科手术证实58例。结果:肝脏被膜下血肿95例,肝脏实质挫伤68例,肝脏撕裂伤23例,腹血16例,死亡8例。结论:CT是诊断肝脏顿挫伤的首选检查方法,具有方便、快速、准确和可重复的优点。依据CT表现结合临床作出的分级标准对临床治疗具有重要的指导意义。     

Blunt Abdominal Trauma: Current Imaging Techniques and CT Findings in Patients with Solid Organ, Bowel, and Mesenteric Injury

Imaging plays a critical role in the evaluation of patients with blunt abdominal trauma. In most institutions, computed tomography (CT) is the modality of choice when evaluating such patients. The purpose of this review is to highlight current techniques in trauma imaging and to review CT findings associated with solid organ, bowel, mesenteric, and diaphragmatic injury. In particular, emphasis is placed on the use of multidetector CT technology (MDCT), especially 64-row detector CT. The role of various techniques, including the use of oral and intravenous contrast, as well as the potential benefit of delayed imaging, is discussed.     

Is Hospital Admission and Observation Required after a Normal Abdominal Computed Tomography Scan in Children with Blunt Abdominal Trauma?

Objectives: The objective was to determine if hospital admission of children with blunt abdominal trauma for observation of possible intraabdominal injury (IAI) is necessary after a normal abdominal computed tomography (CT) scan in the emergency department (ED). Methods: The authors conducted a prospective observational cohort study of children less than 18 years of age with blunt abdominal trauma who underwent an abdominal CT scan in the ED. Abdominal CT scans were obtained with intravenous contrast but no oral contrast. The decision to hospitalize the patient was made by the attending emergency physician (EP) with the trauma or pediatric surgery teams. An abnormal abdominal CT scan was defined by the presence of any visualized IAI or findings suggestive of possible IAI (e.g., intraperitoneal fluid without solid organ injury). Patients were followed to determine if IAI was later diagnosed and the need for acute therapeutic intervention if IAI was present. Results: A total of 1,295 patients underwent abdominal CT, and 1,085 (84%) patients had normal abdominal CT scans in the ED and make up the study population. Seven‐hundred thirty‐seven (68%) were hospitalized, and 348 were discharged to home. None of the 348 patients discharged home and 2 of the 737 hospitalized patients were identified with an IAI after a normal initial abdominal CT. The IAIs in patients with normal initial CT scans included a 10‐year‐old with a mesenteric hematoma and serosal tear at laparotomy and a 10‐year‐old with a perinephric hematoma on repeat CT. Neither underwent specific therapy. The negative predictive value (NPV) of a normal abdominal CT scan for IAI was 99.8% (95% confidence interval [CI] = 99.3% to 100%). Conclusions: Children with blunt abdominal trauma and a normal abdominal CT scan in the ED are at very low risk of having a subsequently diagnosed IAI and are very unlikely to require a therapeutic intervention. Hospitalization of children for evaluation of possible undiagnosed IAI after a normal abdominal CT scan has a low yield and is generally unnecessary.