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1.
本文报道8例胆石性肠梗阻,并复习有关文献。较大的胆石常经胆肠瘘进入肠道。结石直径大于4cm,肠腔狭窄等因素都易导致结石在肠道内嵌顿。本病多见老年慢性胆囊炎胆石症患者,女性尤为好发,临床上小肠梗阻常为不完全性,症状呈间断变化为其特征。主要X 线表现有:(1)肠梗阻;(2)腹部直接或间接显示胆石影;(3)胆管积气或存在胆肠瘘。CT 和超声对诊断有帮助。胆石嵌顿于十二指肠球部造成胃出口梗阻为本病的罕见类型,称为Bouveret‘s 综合征。  相似文献   

2.
胆石性肠梗阻的影像诊断   总被引:5,自引:0,他引:5  
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.  相似文献   

3.
The preoperative diagnosis of biliary ileus was correctly made by US in two cases (87 and 80-year-old females) referred to US studies because of nonspecific abdominal symptoms and to rule out possible acute appendicitis, respectively. Plain-film findings were unremarkable in one patient, small-bowel obstruction was detected in the latter. In both cases sonography revealed a small amount of air within the thick-walled gallbladder; the presence of mechanical ileus, and a gallstone impacted within the ileal loop. These features, together with collapsed bowel lumen distally to the stone, enabled a reliable diagnosis of biliary ileus to be made. This was confirmed by ensuing laparotomy, when a large cholesterol stone was removed in both cases. Correspondence to: V. Simonovský  相似文献   

4.
胆石性肠梗阻的CT诊断   总被引:7,自引:0,他引:7  
目的探讨CT对胆石性肠梗阻的诊断价值。资料与方法回顾性分析8例经手术证实的胆石性肠梗阻患者的CT检查资料。所有病例均有胆囊结石、胆囊炎病史1~10年,并经B超和临床证实,其中5例有明确胆囊炎反复发作病史。发病时患者出现持续性中上腹痛,腹胀,恶心,呕吐,3例患者出现停止肛门排气排便典型肠梗阻症状,5例患者表现为不全性肠梗阻症状。结果所有病例CT图像上均可见胆囊窝结构紊乱,邻近胃窦或十二指肠降段壁增厚,胆囊空虚,胆囊及肝内胆管积气。1例胆石位于十二指肠降段;4例结石位于空肠段,其中2例结石位于屈氏韧带处;另3例结石位于回肠末段。结石呈圆形或椭圆形,直径2.7~5.0cm,梗阻以上肠管扩张,积气积液明显,可见液平面。3例完全性梗阻病例梗阻以下肠管空虚,5例不全梗阻病例梗阻以下肠管内仍可见少量气体及液体,结肠内可见粪便气体混合影。8例均在术前经CT得到正确诊断,准确率为100%。结论CT对胆石性肠梗阻的诊断准确性高。凡65岁以上老年人出现间歇性不完全性机械性肠梗阻,特别是既往有胆道病史而无腹部手术史者,应考虑胆石性肠梗阻的可能,应行CT检查明确诊断。  相似文献   

5.
Gallstone ileus analysis of radiological findings in 27 patients   总被引:9,自引:0,他引:9  
PURPOSE: We retrospectively compared the clinical value of plain abdominal film, abdominal sonography and abdominal CT in diagnosing gallstone ileus in 27 patients. MATERIAL AND METHODS: 27 patients (23 women and 4 men, age range 58-96 years; mean age 71.5 years) with surgically proven gallstone ileus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain films were performed in 19 cases in upright position (postero-anterior projection), in eight cases in supine position. Abdominal US were performed with 3.5 and/or 7.5 MHz probes. CT was performed with a helical unit (slice thickness 4mm, reconstruction interval 4mm, pitch 1.5), after intravenous contrast agent (120 ml) infusion (3 ml/s, 55 s acquisition delay from bolus starting) and using a power injector. The following findings were searched on: pneumobilia, air in gallbladder, cholecysto-digestive fistula, extraluminal fluid, bowel loops dilatation, intestinal air-fluid levels, ectopic stones. RESULTS: Plain abdominal films showed the following findings: air-fluid levels (77.78% of cases), bowel loops dilatation (88.89%), site of obstruction (44.4%), pneumobilia (37.04%), air in gallbladder (3.70%), ectopic stone (33.33%). Abdominal sonography demonstrated bowel loops dilatation (44.44%), extraluminal fluid (14.81%), ectopic stones (14.81%), gallbladder abnormalities, (37.04%), pneumobilia (55.56%). CT findings retrospectively observed were: bowel loops dilatation (92.59%), air-fluid levels (37.04%), bilio-digestive fistula (14.81%), pneumobilia (88.89%), ectopic stone (81.48%), extraluminal fluid (22.22%). The Rigler's triad, that is pneumobilia, bowel mechanical obstruction and ectopic stone detection was observed 4 times with RX (14.81%), 3 times with US (11.11%) and 21 times with CT (77.78%). CONCLUSIONS: Air-fluid levels and bowel loop dilatation were the radiological findings more frequently observed in our series. Plain abdominal film allowed us mainly to identify signs of obstruction, US were more effective in disclosing biliary pathology, CT allowed us to correctly diagnose biliary ileus with much higher accuracy.  相似文献   

6.
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).  相似文献   

7.
目的探讨多层螺旋CT平扫对Bouveret综合征的诊断价值。资料与方法回顾性分析7例经手术证实的Bouveret综合征患者的CT表现及临床资料。结果 7例CT平扫均见肠腔内异位结石,结石上方肠梗阻,梗阻以下肠管空虚;胆道及胆囊积气2例,胆囊窝结构紊乱伴积气5例。结石位于空肠1例,位于回肠6例。1例随访可见胆石梗阻部位移动。结石呈圆形或类圆形,直径3~5 cm,高密度阳性结石4例,低密度阴性结石3例。7例术前CT平扫确诊为Bouveret综合征,准确率为100%。结论单纯CT平扫能对Bouveret综合征进行确诊,"肠袢扩张、胆系积气、异位结石"为Bouveret综合征三大重要的CT平扫表现。  相似文献   

8.
胆石性肠梗阻的CT诊断   总被引:5,自引:0,他引:5  
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。  相似文献   

9.
OBJECTIVE: To describe the multidetector computed tomography (CT) findings in 3 patients with atypical gallstone ileus. METHODS: We retrospectively evaluated computed radiography and CT images from three cases of surgically proven gallstone ileus. Two radiologists evaluated by consensus all images for the presence of ectopic gallstone, small bowel obstruction, intrahepatic pneumobilia, cholecystic pneumobilia. One author recorded whether diagnosis of gallstone ileus was made prospectively on radiologic reports and correlated findings to pathology. RESULTS: All cases of gallstone ileus were atypical in that one patient had porcelain gallbladder, one had recurrent pyogenic cholangitis, and one was only 35 years of age. Prospective clinical diagnosis of gallstone ileus was made in only 1 patient at computed radiography and all 3 patients at CT. Retrospectively, small bowel obstruction and cholecystic pneumobilia were identified retrospectively in all 3 patients at both computed radiography and MDCT, and an ectopic gallstone, intrahepatic pneumobilia, and choledochoduodenal fistula was seen in 2, 1, and 0 patients at computed radiography and 3, 2, and 3 patients at CT respectively. CONCLUSION: Multidetector CT is an accurate means to diagnose gallstone ileus, even in patients with atypical features. In particular, multidetector CT is useful for identifying the ectopic gallstone at the transition point between dilated and decompressed bowel.  相似文献   

10.
Gallstone ileus: CT findings   总被引:6,自引:0,他引:6  
Gallstone ileus is a rare complication of recurrent gallstone cholecystitis. The classic radiographic triad of small bowel obstruction, pneumobilia and ectopic gallstone on abdominal plain radiograph is described with CT imaging. Because of the better resolution of CT compared with abdominal radiography and its recent accession to emergency use, radiologists should be aware of CT findings of gallstone ileus. We report a case in which gallstone ileus was initially diagnosed by CT. Received: 30 July 1999; Revised: 18 October 1999; Accepted: 18 October 1999  相似文献   

11.
W Schima  E Steiner 《Der Radiologe》1992,32(3):132-134
Gallstone ileus is an uncommon but severe complication of cholecystitis, which can only occur following perforation of the gallbladder and formation of a cholecystoenteric fistula. The diagnosis can be established by means of abdominal plain film when the classic triad described by Rigler (small-bowel obstruction, ectopic gallstone and pneumobilia) is observed. A patient with abdominal obstruction and equivocal findings on plain film X-ray and abdominal sonography is presented, in whom the gallstone ileus was reliably diagnosed by CT.  相似文献   

12.
Gallstone ileus is the result of a sequence of events that are initiated in the gallbladder. Inflammation of the gallbladder wall allows erosion of a gallstone through the wall into the small bowel and subsequent bowel obstruction. We present a unique case in which CT scans done over a period of 1 year demonstrate this progression in a patient and alter the clinical management by identifying the correct cause of small bowel obstruction. The clinical presentation, radiologic findings, and management of gallstone ileus are reviewed.  相似文献   

13.
We report a case of gallstone ileus in which CT was the first study to suggest the diagnosis by demonstrating an ectopic gallstone and biliary gas not visible on abdominal plain radiography. Radiologists should be aware of the CT findings in gallstone ileus, so that a more rapid preoperative diagnosis may lead to decreased morbidity and mortality in these patients.  相似文献   

14.
We retrospectively analyzed the cholescintigrams and sonograms of 36 consecutive patients with gallbladder perforation to (a) determine the sensitivity of each for the preoperative detection of gallbladder perforation and (b) correlate the findings with the modified Niemeier classification. Cholescintigraphic criteria of perforation (free spill, pericholecystic hepatic activity, and scintigraphic gallstone ileus sign) were detected in 14 of 28 (50%) cases, while sonographic criteria of perforation (pericholecystic fluid or pneumobilia with gallstones) were present in 18% (4 of 22) of patients (p less than 0.05). Cholescintigraphic patterns of perforation associated with the Niemeier classification were: Type I (acute free perforation), 3 of 7 scans demonstrated free spill; Type II (subacute pericholecystic abscess), 9 of 19 scans showed pericholecystic activity; and Type III (chronic cholecystoenteric fistula), 1 of 3 scans showed a scintigraphic gallstone ileus. Thus, although cholescintigraphy appears superior to sonography, both modalities are relatively insensitive for the detection of gallbladder perforation.  相似文献   

15.
螺旋CT在胆囊癌诊断中的应用   总被引:7,自引:0,他引:7  
目的 探讨螺旋CT对胆囊癌的诊断价值。资料与方法 回顾性分析经手术病理证实的资料较完整的17例胆囊癌。结果 胆囊癌呈软组织肿块型 10例 ,胆囊壁弥漫增厚型 5例 ,腔内结节型 2例。肝脏受侵犯 7例 ,淋巴结转移 5例 ,肝内、外胆管扩张 5例 ,腹水 2例 ,11例合并胆囊炎、胆囊结石。结论 螺旋CT对胆囊癌的诊断和分期有很大的价值  相似文献   

16.
目的 探讨胆囊癌的螺旋CT表现及诊断价值。方法 对15例经手术病理证实的胆囊癌的影像学、临床及病理资料进行回顾性分析。结果 CT扫描显示,7例表现为胆囊壁的不规则增厚,4例腔内结节,4例胆囊区不规则软组织肿块,8例发现胆囊结石,4例胆管扩张。结论 中晚期胆囊癌具有较典型的CT表现,80%以上的病人术前可以确诊。CT可以明确病变位置、分型及扩散范围,是一种重要的影像学检查方法。  相似文献   

17.
OBJECTIVE: Gallstones are a rare cause of duodenal or gastric outlet obstruction and therefore are not commonly suspected. Rigler's radiographic triad of pneumobilia, bowel obstruction, and an ectopic gallstone is seen in few of these patients. The symptoms are insidious and nonspecific, and the diagnosis is usually made radiologically. Although CT scans are far more sensitive, 25% of cases are still missed, often because the size of the offending gallstone is underestimated. CONCLUSION: Better assessment of stone size, and therefore higher accuracy of diagnosis, could be achieved if attention is paid to more subtle but nonetheless important signs. These include compressed air in dependent areas of the duodenal lumen, an area of soft-tissue rather than fluid density surrounding the calcified rim of the stone, and a faint radiolucency in or beyond this soft-tissue area that could represent laminations of fat or air in the stone.  相似文献   

18.
Gallstone ileus is a rare pathology, occurring in an estimated 0.5% of cases, which preferentially affect females and the elderly population. This rare pathology is the result of a fistulous connection between the bowel and gallbladder. This connection allows gallstones to pass into the bowel leading to mechanical obstruction. On rare occasions the enteric gallstone can act as a lead point causing intussusception. We present a rare case of intussusception secondary to gallstone ileus in a young, relatively asymptomatic patient. CT played a critical role in diagnosis and appropriate management of our patient.  相似文献   

19.
目的:探讨螺旋CT对胆囊癌的诊断价值。方法:回顾性分析经手术病理证实的资料较完整的18例胆囊癌。结果:胆囊癌呈软组织肿块型7例,厚壁型6例,腔内结节型3例,混和型2例。肝脏受侵犯5例,淋巴结转移2例,肝内、外胆管扩张3例,腹水1例,3例合并胆囊炎、胆囊结石。结论:螺旋CT对胆囊癌的诊断和预后评估有很大的价值。可为临床手术提供依据。  相似文献   

20.
OBJECTIVE: The purpose of our study was to evaluate the sonographic and CT features of xanthogranulomatous cholecystitis, correlating the pathologic and surgical findings. MATERIALS AND METHODS: Xanthogranulomatous cholecystitis was pathologically diagnosed in 26 patients from January 1996 to August 1998. The patients were 15 women and 11 men with a mean age of 63 years. All patients had preoperative sonography and nine also underwent CT In five patients, sonography was performed on the surgical specimen. Clinical indications for imaging included cholecystitis (14 patients), biliary colic (six patients), stone-induced pancreatitis (three patients), tumor (two patients), and gallstone ileus (one patient). RESULTS: The most characteristic sonographic finding, confirmed by sonographic study of the surgical specimens, was the presence of hypoechoic nodules or bands in the gallbladder wall, which were seen in 35% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic (specific) CT finding was a hypodense band in the gallbladder wall, seen in 33% of the patients. Two of twelve patients who underwent laparoscopic cholecystectomy required conversion to open surgery. CONCLUSION: Although the preoperative imaging diagnosis of xanthoganulomatous cholecystitis is difficult, the presence of hypoechoic nodules or bands in the gallbladder wall on sonography or of a hypodense band around the gallbladder on CT, is highly suggestive of this disease.  相似文献   

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