非增强螺旋CT对肠梗阻病因的诊断价值

目的：探讨非增强螺旋CT对肠梗阻病因的诊断价值.材料与方法：回顾性分析经手术及病理证实的23例肠梗阻的非增强CT表现,其中粘连性肠梗阻9例,肠道肿瘤6例,粪石性肠梗阻3例,肠扭转2例,肠套叠2例（均为肠肿瘤并发肠套叠）,门静脉和肠系膜上静脉血栓1例.结果：粘连性肠梗阻、肠道肿瘤、粪石性肠梗阻、肠扭转、肠套叠、肠系膜静脉血栓CT符合率分别为6/9、6/6、3/3、2/2、2/2、1/1.结论：非增强螺旋CT能对肠梗阻病因做出正确诊断,为临床治疗提供依据.     

小肠机械性肠梗阻的CT诊断

目的 探讨小肠机械性肠梗阻病因的CT表现和诊断价值。方法 对53例小肠机械性肠梗阻的CT表现与手术、病理和临床随诊结果对照分析。结果 53例小肠机械性肠梗阻病因中，肠粘连18例，炎症10例，肠肿瘤8例，腹外疝6例，腹内疝3例，异物4例，肠套叠3例，肠扭转1例，CT诊断小肠机械性肠梗阻病因的符合率5％(49／53)。结论 CT对小肠机械性肠梗阻病因有较高的诊断价值。     

螺旋CT对肠梗阻的诊断价值

目的探讨螺旋CT对肠梗阻的诊断价值。方法对44例经手术及临床证实的肠梗阻患者的螺旋CT表现进行回顾性分析。结果螺旋CT能正确诊断肠梗阻,临床符合率达100.0%,44例肠梗阻的病因中:肠肿瘤23例,肠粘连7例,疝6例,肠套叠4例,肠扭转2例,粪石1例,阑尾周围脓肿1例。结论螺旋CT对肠梗阻有较高的诊断价值,并显示梗阻部位及梗阻原因。     

多层螺旋 CT 对小肠梗阻的诊断价值

目的：探讨多层螺旋C T对小肠梗阻的诊断价值。方法对36例小肠梗阻患者进行多层螺旋C T平扫和增强扫描,并利用工作站对C T图像进行多平面重建,将C T诊断结果与手术病理结果相对照。结果36例小肠梗阻患者均通过多层螺旋C T扫描明确诊断,诊断准确率为100．0％,均表现为小肠扩张、积液和积气;梗阻原因中肠粘连16例,肿瘤性病变5例,炎症性病变5例,腹疝5例,肠套叠3例,粪石2例,病因诊断准确率为94．4％。结论多层螺旋CT结合三维重建能够准确诊断小肠梗阻,并且在确定梗阻病因方面具有优越性。     

老年人急性肠梗阻68例分析

老年人急性肠梗阻患者病情多较严重，且多伴有多种并存疾病，死亡率高，应引起临床医师的重视。现将我院收治的老年人急性肠梗阻68例分析如下。1临床资料 本组男39例，女29例，年龄60-83（平均69．4）岁。引起急性肠梗阻的原因：结直肠肿瘤27例，粘连性肠梗阻19例，嵌顿性腹外疝10例（其中女性腹疝7例），粪石性梗阻4例，乙状结肠扭转、肠套叠各3例，小肠肿瘤、小肠异物（柿团）各1例。本组并存1～3种慢性疾病49例，占72．1％；     

植物粪石性小肠梗阻的多层螺旋CT(256层)诊断

目的:探讨植物粪石性小肠梗阻的多层螺旋CT(256层)诊断。材料与方法:回顾性分析经手术证实15例植物粪石性小肠梗阻MSCT(256层)表现及临床资料。结果:植物粪石性小肠梗阻位于空肠3例,回肠10例,1例合并胃石,1例回盲部肿瘤并肠套叠。粪石CT表现为蜂窝状气泡征。其中5例MSCT增强检查,粪石不强化,周围肠壁明显强化。结论:蜂窝状气泡征为植物粪石性小肠梗阻特征性MSCT表现。全腹部CT检查是本病术前定位定性诊断重要检查方法。     

小肠梗阻肠内残渣的CT表现、鉴别(粪石)与诊断价值

目的 分析小肠梗阻肠内残渣的CT表现及与小肠粪石的表现异同,探讨其临床应用价值.方法 回顾我院经64层螺旋CT诊断的小肠梗阻112例的临床与影像资料,对其中出现小肠残渣征的各种原因肠梗阻9例及小肠粪石性肠梗阻11例进行对比分析.结果 本组小肠梗阻中小肠粪石和小肠残渣征的发生率分别为9.82％和8.04％.小肠粪石均为散发病例,小肠残渣征见于机械性回肠梗阻6例(其中回盲肿瘤3例),动力性肠梗阻3例(缺血1例、肠麻痹2例).小肠残渣与小肠粪石的基本结构均为夹杂气泡的颗粒状物,区别在于病灶的部位、形态,以及气泡的含量和有无包壁;小肠残渣征较常见于回盲部肿瘤和动力性小肠梗阻.结论 尽管小肠残渣与散发性小肠粪石的结构类似,CT表现仍可资区别,区分小肠残渣与粪石有利于小肠梗阻病因判断.     

16层螺旋CT多层面图像重建对肠梗阻的诊断价值

目的:探讨16层螺旋CT多层面重建对肠梗阻的诊断价值.方法:回顾性分析2006年7月～2007年8月在我院行16层螺旋CT检查,并经手术或临床随访确诊的19例肠梗阻病例,采用多层面重建技术对16层螺旋CT原始数据进行冠状位、矢状位图像重建并进行分析.结果:本组CT诊断与临床手术结果或随访结果相符,其中CT扫描显示肠梗阻位于小肠11例,结肠8例;肠梗阻病因为肠粘连8例,肿瘤7例,肠套叠、胆石性肠梗阻各2例;单纯性肠梗阻15例,绞窄性肠梗阻4例.仅依据横断面平扫图像确定梗阻部位16例.结合多层面图像重建技术确定梗阻部位18例.结论:螺旋CT多平面重建技术在明确肠梗阻的诊断、梗阻部位和梗阻病因以及肠道血运状态方面优于单纯的横断面图像,对肠梗阻的诊断具有重要价值.     

继发性小肠扭转5例报告

我院1995年5月至1996年12月共收治小肠扭转患者6例。依据Frazee[1]病因分类符合继发性小肠扭转5例，并均经手术证实，现报告如下。1临床资料本组5例均为男性，年龄18～73岁，平均40岁，发病到手术时间为30小时至14天。全小肠扭转2例，部分回肠扭转3例，扭转角度270～540°。扭转原因：粘连带引起3例，粪石性小肠梗阻后引起2例。术前确诊为小肠扭转1例，余4例以绞窄性肠梗阻行手术探查。术中切断粘连带，取出粪石，行小肠扭转复位，均治愈出院。2讨论2.1粪石性小肠梗阻继发小肠扭转机制继发性小肠扭转原因较多，常见有粘连带、中肠旋转不良…     

多排螺旋CT对急性肠梗阻诊断的临床价值

目的:探讨多排螺旋CT扫描对急性肠梗阻诊断的临床价值。材料与方法:对通州三院及南通市第一人民医院经临床手术证实为肠梗阻39例患者的CT资料进行回顾性分析。结果:39例患者在CT检查后均能明确诊断,准确率为100%,其中对肠梗阻部位判断正确37例,符合率为94.9%;病因诊断正确33例,符合率为84.6%。39例手术结果包括肠粘连14例,结肠肿瘤12例,后腹膜脂肪肉瘤1例,肠套叠3例,肠扭转3例,肠粪石2例,腹股沟疝2例,阑尾脓肿及肠系膜动脉血栓各1例,CT检查确诊33例。结论:CT能明确肠梗阻的诊断,快速显示梗阻部位和原因,有助于临床及时制定正确的治疗方案,因此多排螺旋CT平扫在急性肠梗阻诊断中有较重要意义。     

Ultrasound ileus diagnosis

Bowel obstruction is an acute alarming situation with limited diagnostic conditions. Therapeutic decisions must be taken in time. Diagnostic differentiation between incomplete or complete bowel obstruction, intestinal obstruction and paralytic ileus is often uncertain and the underlying cause difficult to detect. Besides plain films in acute abdomen the ultrasound examination presents important additional informations: 1st Dilated intestinal loops and gas caps correlate with the characteristic x-ray finding, i.e. erected dilated intestinal loops with fluid levels. The location of the obstruction is defined in small bowel obstruction by differentiation between jejunum (with Kerckring folds) and ileum (without Kerckring folds). In large bowel obstruction the caecum is dilated and a collapse of the distal colon is detectable. 2nd Additional sonographical findings are: oedema of the intestinal walls, hyperpendulum peristalsis or absence of peristalsis, sedimentation of intestinal contents, pearlstring-like lined up gas bubbles under the ventral intestinal walls, and concomitant ascites. Duplex sonographical studies of the intestinal peristalsis may help to differentiate between mechanical obstruction and paralytic ileus. 3rd In bowel obstruction stenoses can be detected as a result of tumour, Crohn's disease diverticulitis, invagination, strangulated hernias or gall stone ileus. Intestinal adhesions cannot be found by ultrasound. Small and large bowel is dilated in paralytic ileus. Numerous causes like acute pancreatitis, ureteral colic, free gastrointestnal perforation and so on can be diagnosed. 4th In ileus of vascular disorder early diagnosis is high important, but inspite of colour flow imaging diagnostic possibilities are limited. 5th Sonographical diagnosis is of special interest when the x-ray plain films is "empty". The lack of massive fluid collection and meteorism allows an optimal ultrasound examination. In this early phase disorders of peristalsis and intestinal walls are reliably found, and it is easier to find the cause of bowel obstruction. In this way the definitive diagnosis can be arrived at earlier, because it still takes up to 6 hours to obtain the classical x-ray finding. There is a rule that the earlier ultrasound is done, the more findings one will get.     

MDCT features of strangulated ileus due to an appendix epiploica of the sigmoid colon: four cases and a review of the literature

Purpose

The aim of this study was to investigate the multidetector computed tomography (MDCT) features of strangulated ileus caused by epiploic appendix of the sigmoid colon.

Methods

We retrospectively evaluated MDCT images of four patients who underwent surgery in our hospital between 2011 and 2014. Patients were aged from 66 to 79 years, and two were female.

Results

Closed loop obstruction of the small bowel was confirmed in all patients. A fatty peritoneal band around the orifice of the ileus was detected in two patients, but was equivocal in the other two patients. Traction of the sigmoid colon toward the hilum of the closed loop of the small bowel was obvious in three patients.

Conclusion

When traction of the sigmoid colon is detected in MDCT in a case of closed loop obstruction of the small bowel, strangulated ileus caused by an epiploic appendix should be considered in the differential diagnosis.

     

Sonography of normal fetal bowel

This is a prospective study of the sonographic appearance of normal small bowel and colon in 300 fetuses. Normal fetal bowel can be frequently seen during sonographic examination. The diameter of the lumen of the small bowel and colon increases as gestational age increases. The fetal small bowel lumen rarely exceeds 6 mm in diameter, and fetal colon lumen diameter rarely exceeds 23 mm. Small bowel peristalsis can be seen with increasing frequency with increasing gestational age. Colon peristalsis is not seen. Haustral folds in the colon can be frequently demonstrated. Meconium in the colon always remains hypoechoic relative to the fetal liver and bowel wall. Hyperechoic appearance of the small bowel in early gestation and cystic appearance of parts of the colon in later gestation may mimic pathology. Normal herniation of bowel into umbilical cord can be seen in early (8 to 11 weeks) gestation.     

Ileosigmoid knot: case report and CT findings

Ileosigmoid knot (ISK) is an unusual clinical entity of small bowel obstruction in which the ileum wraps around the base of the sigmoid colon and forms a pseudo-knot. We present the case of a 75-year-old male in whom ISK was the definitive computed tomographic finding. ISK should be considered in differential diagnosis of patients who present with ileus.     

Enteroclysis in the diagnosis of intestinal obstruction in the early postoperative period

Intestinal obstruction in the early postoperative period may be difficult to diagnose clinically and on plain abdominal radiographs with failure to distinguish obstruction from ileus. During the last 11 years we have examined 14 patients with the enteroclysis technique (small bowel barium enema) for suspected early postoperative small intestinal obstruction. Evidence of obstruction was demonstrated in all cases, the site of obstruction was clearly shown in most patients, and the cause identified in 5.     

Laparoscopic repair of an incarcerated inguinal hernia containing the sigmoid colon with a colonoscope

Here, we report the first case of laparoscopic surgery to repair an incarcerated colonoscope in an inguinal hernia containing the sigmoid colon. After colonoscopy was performed on a 74-year-old man with positive fecal occult blood test results, the colonoscope could not be withdrawn. A bulge consistent with an incarcerated colonoscope was found on examination of the patient's left inguinal area. Computed tomography revealed and led to the diagnosis of an incarcerated colonoscope in the sigmoid colon within the inguinal hernia. After confirmation during emergency laparoscopic surgery, the incarcerated sigmoid colon was reduced, and the colonoscope was removed under radiographic and laparoscopic guidance. No ischemic changes or serosal injuries were observed, averting the need for resection. A transabdominal preperitoneal approach with a mesh was then used to repair the inguinal hernia laparoscopically. The patient's postoperative recovery was uneventful, and no recurrence was observed at the 1-year follow-up.     

Laparoscopic subtotal proctocolectomy for synchronous triple colorectal cancers: a case report

A 42‐year‐old woman presented with abdominal pain. On the basis of CT results, we diagnosed her condition as bowel obstruction caused by advanced transverse colon cancer. Colonoscopy findings showed three lesions: (i) an advanced tumor in the transverse colon; (ii) a laterally spreading descending colon tumor; and (iii) a rectal polyp. The tumors and the polyp were all pathologically diagnosed as adenocarcinoma. After inserting a self‐expanding metallic stent into the main tumor of the transverse colon to decompress the bowel, we performed endoscopic submucosal dissection of the laterally spreading descending colon tumor. Pathological examination results showed submucosal invasion and a positive margin. Because we endoscopically identified that the rectal polyp was invading the submucosa, we performed laparoscopic subtotal proctocolectomy and ileorectal anastomosis with lymph node dissection along the surgical trunk; we also performed central vascular ligation of the ileocolic artery, right and left branches of the middle colic artery, and inferior mesenteric artery. The patient's postoperative course was uneventful. We present this case because there have been few reports on laparoscopic subtotal or total proctocolectomy for synchronous multiple colorectal cancers.     

Pediatric sigmoid volvulus of an extremely long sigmoid colon with hypoganglionosis: a case report

Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pediatric patients. This condition occurs when a redundant sigmoid loop with a narrow mesenteric base of attachment to the posterior abdominal wall rotates around its mesenteric axis. This situation might result in vascular occlusion and large bowel obstruction. There are only a few predisposing factors of sigmoid volvulus, such as a long-term history of constipation or pseudo-obstruction with an excessive sigmoid colon. Underlying hypoganglionosis can also lead to large bowel obstruction. There have only been two reported cases of hypoganglionosis with sigmoid volvulus, and both were in adults. Sigmoid volvulus usually presents with abdominal pain, nausea, vomiting, constipation and abdominal distension, an absence of stool, or the presence of melenic stool in the rectum. Initial treatment options are non-surgical for stable patients, although surgical management might be necessary. If sigmoid volvulus is not recognized and resolved, it may lead to serious complications and death. Pediatric sigmoid volvulus is frequently the fulminant type, and therefore, a decision about treatment must be prompt. We present an unusual pediatric case of an extremely long sigmoid colon with hypoganglionosis, which twisted and caused obstruction. This condition was resolved with surgical resection.     

INFLAMMATORY FIBROID POLYP OF PROXIMAL ILEUM CAUSING RECURRENT INTUSSUSCEPTION

SUMMARY A 64-year-old female presented with episodes of small bowel obstruction. Ultrasound and barium meal showed a polypoidal lesion in the proximal segment of small bowel. The patient underwent emergency surgery because of signs of impending acute intestinal obstruction. Pathology showed characteristic features of an inflammatory fibroid polyp (IFP) which is an important though rare benign cause of small bowel obstruction. We document clinical and pathological aspects of this case.     

电子肠镜检查前3种肠道准备的比较

目的观察电子肠镜检查前3种肠道准备方法的清洁效果及其不良反应。方法484例电子肠镜检查肠道清洁前数字化随机分为口服甘露醇组、口服番泻叶组及结肠灌洗组。根据电子肠镜检查中肠道清洁程度和清洁范围评价肠道清洁效果。结果结肠灌洗组肠道清洁程度和清洁范围最理想,其肠道清洁有效率(96％),显高于口服甘露醇组(90％)和口服番泻叶组(91％);肠道清洁范围最大,全结肠清洁率(88％),显高于口服甘露醇组(15％)和口服番泻叶组(17％)。而且结肠灌洗组不良反应发生率(2％)显低于口服甘露醇组(46％)和口服番泻叶组(50％)。结论结肠灌洗法是比较理想的全结肠清洁方法．特别是对肠梗阻等特殊病例应用结肠灌洗法可替代口服泻剂。