肠梗阻的CT诊断价值

目的 :探讨CT检查对肠梗阻的诊断价值。方法 :对 3 6例肠梗阻患者的腹部X线平片和CT表现进行分析。其中 2 4例行手术治疗 ,12例行胃肠减压、抗感染保守治疗。 12例有腹部手术史。结果 :腹部X线平片和CT准确显示梗阻程度的病例分别为 2 0例 ( 5 5 .6% )和 3 4例 ( 94.4% )。CT直接准确诊断梗阻病因 19例 ,包括结肠直肠癌 16例 ,肠系膜囊肿伴绞窄性肠梗阻 1例 ,结肠淋巴瘤合并肠套叠 1例 ,结肠脂肪瘤合并肠套叠 1例。 12例有腹部手术史者中 10例为粘连性肠梗阻 ,2例为麻痹性肠梗阻 ,结合手术史 ,CT诊断无误。结论 :对梗阻病因的判断CT明显优于腹部X线平片 ,CT可显示狭窄移行段的形态 ,有助于判断病因 ,可为临床确定治疗方案提供较可靠的依据。     

婴幼儿肠梗阻X线表现回顾

目的：为了增强对肠梗阻X线诊断价值的认识，以达到早期诊断、及时治疗，本文回顾分析了经CT检查(4例)和经手术证实的肠梗阻患者的常规X线表现。方法：用4例婴幼儿肠梗阻CT表现与常规X线表现进行对比分析。结果：CT检查准确显示出了梗阻的病因(小肠结石、畅套叠、绞窄性小肠梗阻和炎症性小肠梗阻)。结论：CT对发现肠绞窄和肠壁积气的敏感性较腹平片高；CT对梗阻的定位和抉窄肠段的形态表现也优于X线检查，所以为及时确定临床治疗方案提供了可靠的依据。     

小肠机械性梗阻的CT诊断

目的 :探讨 CT对小肠机械梗阻的诊断价值。方法 :对 2 1例手术和临床证实的小肠机械性肠梗阻病人的 CT表现进行了分析。全部病人为腹平片和临床检查确诊为小肠机械梗阻病人。男 14例 ,女 7例 ,平均年龄 44 .8岁。结果 :完全性小肠梗阻 13例 ,绞窄性小肠梗阻 5例 ,不完全性小肠梗阻 3例。 1/ 3病例术前 CT显示梗阻病因 ,包括腹腔肿块 ,炎性狭窄。 5例中 4例 (80 % ) CT征象提示肠绞窄存在 ,早于腹平片。肠壁郁血增厚大于 3 mm,肠腔大量积液 ,气液平面中液多于气 ,腹腔广泛性液体渗出伴肠系膜水肿则提示绞窄性肠梗阻。结论 :在明确梗阻病因上 CT较腹平片有明显优势。显示典型绞窄性梗阻征象的敏感性与特异性较腹平片高 ,但无典型征象并不能排除绞窄性肠梗阻存在     

先天性小肠狭窄及肠闭锁的X线检查与诊断

目的 探讨先天性小肠狭窄及肠闭锁X线检查与诊断价值.方法 回顾性分析15例经手术证实的先天性小肠狭窄及肠闭锁病例,15例均行立位腹部平片检查,其中6例行口服医用硫酸钡检查,9例行口服非离子型含碘对比剂检查.结果 立位腹部平片显示12例高位肠梗阻,3例低位肠梗阻,造影检查显示十二指肠闭锁2例,空肠狭窄7例,空肠闭锁3例,回肠闭锁3例.结论 X线检查先天性小肠狭窄及肠闭锁具有重要价值.     

大肠癌致争性完全机械性肠梗阻的X线更平片表现

目的：探讨大肠癌致急性完全机械性肠梗阻的X线平片表现特征。材料与方法：搜集33例曾于术前作腹部X线平片检查并经手术或纤维结肠镜病理证实为大肠癌致急性完全机械性肠梗阻病例，就以下X线表现进行分析：⑴梗阻近、远侧肠管表现；⑵梗阻部位改变；⑶全并症X线征象。结果：梗阻发生于盲肠及回盲部平面3例，仅表现为小肠梗阻改变；升结肠及结肠肝曲平面6例，其中5例现现盲袢综合征；左半结肠及直肠平面24例，均显示一般机械性肠梗阻特点，其中1例并盲袢综合征。全组33例中，14例（42.4%）于硬阻部位可见软组织肿块影、肠腔狭窄或局部密度增高影，且梗阻部位征象显示与摄片体位有关；6例（18.2%)见肠穿孔或腹腔转移致腹膜炎征；4例（12.1%)可见慢性肠梗阻表现。结论：大肠癌致急性完全机械性肠梗阻X张平片检查，不仅可判断梗阻部位，部分症例还可依据梗阻部位表现判断梗阻原因。合理的的摄片体位，有利于梗阻病因征象的显示。     

结肠癌致肠梗阻的CT诊断

目的：探讨结肠癌致机械性肠梗阻的螺旋CT诊断的优越性。材料和方法：搜集64例曾于术前做腹部CT检查并经手术或纤维结肠镜病理证实为结肠癌引起机械性肠梗阻病例，就以下CT及腹部平片表现进行分析：①梗阻近、远侧肠管表现；②梗阻部位改变；③并发症的CT征象。结果：64例肠梗阻中，判断肠梗阻的有无，CT检查诊断64例（100％），X线平片诊断60例（93．7％）；肠梗阻病因的判断，CT诊断64例（100％），平片诊断0例（0％）。全组64例在CT上均见肠腔内软组织肿块影、肠壁增厚和肠腔狭窄，其中4例见缺血性结肠炎。结论：结肠癌引起机械性肠梗阻的CT检查，对诊断梗阻的原因、部位、程度及发病缓急可提供更有价值的资料。     

肠梗阻的腹部X线平片和CT诊断

目的 :探讨腹部X线平片和CT检查在肠梗阻诊断中的价值。方法 :经手术病理证实的 5 6例肠梗阻病人 ,男性2 9例 ,女性 2 7例 ,平均 4 2 .3± 11.5岁。术后均行腹部CT和X线平片检查。将腹部CT和X线平片表现与手术病理对照 ,分析其在判断肠梗阻有无、部位、类型及病因的准确性。结果 :5 6例肠梗阻中 ,判断肠梗阻的有无 :CT检查诊断 5 5例(98% ) ,X线平片诊断 4 5例 (80 .4 % ) (P <0 .0 5 )。肠梗阻部位的判断 ,CT正确诊断 5 0例 (89.3% ) ,平片正确诊断 38例(6 7.9% ) (P <0 .0 5 )。肠梗阻类型的判断 ,39例单纯机械性肠梗阻 ,CT诊断 36例 (92 .3% ) ,平片诊断 35例 (89.7% )(P >0 .0 5 ) ;10例绞窄性肠梗阻 ,CT诊断 9例 (85 .7% ) ,平片仅 1例做出诊断 (10 .0 % ) (P <0 .0 5 ) ;8例动力性肠梗阻 ,CT诊断 7例 (87.5 % ) ,平片诊断 5例 (6 2 .5 % ) (P >0 .0 5 )。肠梗阻病因的判断 ,CT诊断 5 0例 (89.3% ) ,平片诊断 2 8例(5 0 0 % ) (P <0 .0 1)。结论 :腹部X线平片和CT检查均可准确诊断肠梗阻 ,但在判断肠梗阻的部位、类型和病因方面 ,CT检查优于X线平片。     

小儿肠梗阻的腹部X线平片和CT诊断价值分析

目的：分析腹部X线平片和CT对小儿肠梗阻的诊断价值，重点探讨小儿绞窄性肠梗阻的CT表现。材料和方法：收集2002年1月-2004年6月复旦大学附属儿科医院手术证实肠梗阻23例，术前24h均拍摄腹部正侧位X线平片，其中14例行腹部CT扫描。结果：23例肠梗阻术前诊断正确率：腹部X线平片为69．6％（16／23）：CT为100％（14／14）。其中，绞窄性肠梗阻术前诊断正确率：腹部X线平片为38．9％（7／18）；CT为90．9％（10／11）。11例绞窄性肠梗阻的主要CT表现包括：小肠壁增厚9例；CT平扫肠壁密度增高7例和“靶征，，2例；CT增强扫描肠壁强化低于正常者6例，3例延迟扫描强化。肠系膜血管增粗水肿5例，4、肠壁积气4例，腹水6例。结论：CT诊断小儿肠梗阻，特别是显示肠绞窄，较腹部X线平片优越。     

超声在腹部平片阴性肠梗阻中的诊断价值

目的研究超声在腹部X线平片检查阴性的肠梗阻诊断中的价值。方法回顾我院2002～2011年经CT、手术证实为肠梗阻且腹部X平片为阴性而B超检查为阳性的36例患者的临床资料,对诊断结果进行分析。结果36例患者经CT、手术证实梗阻原因中肠套叠18例,肠道肿瘤12例,粘连索带引起内疝3例,粪石梗阻1例,腹腔炎症引起肠梗阻2例。结论超声在肠梗阻诊断中具有一定的意义,可作为腹部X线平片诊断肠梗阻的补充检查。     

肠梗阻的腹部X线平片和CT诊断价值对比

目的探讨肠梗阻腹部X线平片和CT诊断价值差异。方法收治肠梗阻患者共80例腹部X线平片和CT影像学资料,比较两种检查方式用于肠梗阻诊断总符合率。结果 CT用于肠梗阻诊断总符合率显著高于腹部X线平片(P0.05);CT用于肠梗阻患者梗阻部位和梗阻原因诊断符合率均显著高于腹部X线平片(P0.05);CT用于肠梗阻诊断图像清晰度和检查舒适度均显著高于腹部X线平片(P0.05);腹部X线平片用于肠梗阻诊断操作简便度显著高于CT(P0.05)。结论 CT图像清晰度及检查舒适度优于腹部X线平片,但腹部X线平片操作更为简便,且价格低廉。     

CT findings of small bowel trichobezoar

A 14-year-old girl presented to our emergency room with abdominal pain and persistent vomiting. A plain radiograph of the abdomen showed features of small bowel obstruction, with dilated loops of small bowel and a mottled gas and debris pattern in the stomach and right lower quadrant. A CT scan of the abdomen and pelvis obtained to exclude appendicitis showed the distinctive appearance of a trichobezoar. A preoperative diagnosis of gastric and intestinal trichobezoar was made. Electronic Publication     

Small bowel obstruction caused by snail's shell: radiographic and CT findings

We report a case of small bowel obstruction in a 74-year-old woman presenting with abdominal pain due to the accidental swallowing of a snail shell. A diagnosis of obstruction was made by abdominal radiograph, and its etiology was found after abdominal CT was performed. This is an unusual case of small bowel obstruction due to a foreign body that was preoperatively diagnosed with imaging.     

Small bowell volvulus - combined radiological findings]

PURPOSE: We retrospectively evaluated the radiological findings observed at plain abdominal film, abdominal sonography and abdominal CT performed in 66 patients with surgically proven small bowel volvulus. MATERIAL AND METHODS: Sixty-six patients (35 women and 31 men, ranging in age 38-77 years) with surgically proven small bowel volvulus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain film was performed in the upright position (postero-anterior view) in 46 cases, and in the supine position in 20 cases. On plain abdominal film we evaluated the following findings: bowel loops dilatation, air-fluid levels and site of obstruction. At abdominal US, performed with 3.5 e 7.5 MHz probes, we retrospectively searched for: bowel loop dilatation, bowel wall thickening, peristalsis alteration, extraluminal fluid. CT was performed with a helical unit (thickness 4 mm, reconstruction interval 4 mm, 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 CT findings were searched for: whirl sign, beak sign, extraluminal fluid, bowel loop dilatation, bowel wall thickening, bowel wall or mesenteric alterations. RESULTS: Plain abdominal film showed the following findings: air-fluid levels (92.4% of cases), bowel loops dilatation (71.2%), site of obstruction (42.4%). Abdominal sonography demonstrated bowel loop dilatation (48.5%), extraluminal fluid (48.5%), peristalsis alteration (27.3%), bowel wall thickening (27.3%). The most frequent CT findings were: bowel loop dilatation (95.5%), bowel wall thickening (78.8%), beak sign (69.7%), mesenteric alterations (66.7%), extraluminal fluid (54.5%), whirl sign (13.6%). CONCLUSIONS: Air-fluid levels and bowel loop dilatation were the most frequent radiological findings in our series. Plain abdominal film allowed us to identify signs of obstruction, whereas signs of bowel wall necrosis were accurately shown by abdominal CT.     

MSCT在小肠机械性梗阻中的应用

目的：探讨多层螺旋CT(MSCT)在小肠机械性梗阻诊断中的临床应用价值方法回顾性分析经手术或临床证实的32例小肠机械性梗阻的临床资料及CT表现。其中男性19例，女性13例，年龄11岁～78岁，急性肠梗阻7例、慢性肠梗阻25例。结果：完全性小肠梗阻9例，不完全性小肠梗阻23例；本组MSCT诊断小肠梗阻的敏感性为100％，特异性为75％，准确率97．2％，29例病因诊断正确(87．8％)．结论：MSCT是诊断小肠机械性梗阻敏感、特异的影像学检查方法，特别是在诊断梗阻原因方面有较高价值。     

Evaluation of the gasless abdomen in the newborn and young infant with metrizamide

The finding of a gasless abdomen on the abdominal radiograph of an infant over 12 hr old is usually abnormal and may reflect a serious pathologic disorder. Accurate diagnosis is important to plan appropriate therapy. A careful review of the clinical history and the plain chest and abdominal radiographs will often permit an accurate diagnosis to be made. In cases where the diagnosis remains in doubt, contrast studies of the bowel with metrizamide have proved helpful. This report presents six infants with gasless abdomens of unknown cause. In each case, a metrizamide contrast study of the bowel was helpful in providing an accurate diagnosis.     

The acute contrast enema in suspected large bowel obstruction: value and technique.

In order to determine the value of the acute contrast enema (ACE) as compared to the plain abdominal film for the diagnosis of colonic obstruction and to determine the optimal technique for performing this examination, we reviewed 140 cases performed over a 4 year period. The study shows that when provided with the case history and the plain abdominal films of patients referred for an ACE the diagnosis of colonic obstruction can be made with a sensitivity of 84% and a specificity of 72%, whereas the ACE has a sensitivity of 96% and a specificity of 98%. The ACE resulted in two false negatives, one false positive and one technical failure, analysis of which has enabled an optimal technique for the performance of this examination to be recommended.     

Gallstone ileus: CT findings

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     

CT diagnosis of small-bowel obstruction: efficacy in 60 patients.

We retrospectively compared the CT findings in patients with and without surgically proved small-bowel obstruction to evaluate the role of CT in diagnosing the presence and cause of obstruction. In the patients with obstruction, we compared the CT findings with findings on plain abdominal radiographs and contrast studies of the small intestine. CT criteria used for the diagnosis of obstruction were dilated small-bowel loops proximal to the suspected site of obstruction and collapsed or normal-appearing loops of small bowel distal to the obstruction. Receiver-operating-characteristic analysis suggested the optimum balance of sensitivity and specificity was achieved when 2.5 cm was used to indicate dilatation of the small bowel. On the basis of these criteria, the presence of obstruction was correctly diagnosed in 27 (90%) of 30 patients with proved obstruction, and obstruction was not diagnosed in the patients without obstruction. The cause of the obstruction was evident on CT in 14 of the 30 obstructed patients: abscess (five), neoplastic lesion (three), peritoneal carcinomatosis (three), and other (three). Adhesions were responsible for the obstruction in 13 of 15 patients in whom the cause was not shown on CT. In six patients in whom findings on plain abdominal radiographs were normal, the CT scan was positive for obstruction. However, in the three patients whose CT scans were falsely negative for obstruction, findings suggesting obstruction were seen on plain films. Of 15 patients who had both CT and contrast studies of the small intestine, CT offered more information concerning the cause of obstruction in six (40%), primarily by demonstrating significant extraluminal abnormalities. CT and gastrointestinal contrast studies gave concordant results in eight patients with obstruction. In only one patient did the gastrointestinal contrast study give more diagnostic information. We conclude that CT scanning demonstrates accurately the presence of high-grade small-bowel obstruction and may be the technique of choice when extraluminal abnormalities are suspected or when prompt, efficient, and comprehensive evaluation is required.