小儿美克尔憩室的超声诊断

目的：探讨出现临床表现的儿童美克尔憩室的超声影像特点及超声诊断价值。方法：回顾性分析超声诊断儿童美克尔憩室35例,经手术病理证实33例与超声诊断一致,诊断符合率94.3%（33/35）。结果：美克尔憩室出现并发症时,患儿将出现临床症状,此时超声可检查到憩室,表现为壁较正常肠壁增厚,固定的肠管结构,一端与小肠相通,另一端为盲端。结论：小儿美克尔憩室出现并发症后,在超声图像上具有特异性,可作为本病诊断的首选方法。     

高频超声对小儿美克尔憩室的诊断价值

小儿美克尔憩室是小儿外科常见的先天性消化道畸形之一。正常人群发病率为2％左右,术前确诊率低,以往主要依靠临床病史、小肠钡餐造影来诊断．有关该疾病的超声诊断少有报道。本文就我院术后31例小儿美克尔憩室的超声声像图表现进行回顾性分析．探讨其超声声像图特点及其临床诊断价值,现报告如下。     

成人回肠远端美克尔憩室1例报告

患，女，63岁。反复右中下腹疼痛，压痛伴大便潜血。时有血便6个月，面色苍白乏力1月余。血常规：Hb 81g/L，其他实验室检查均无异常发现。B超全腹探察及胸腹透视均未见异常。上消化道及大肠双对比造影检查未见异常改变。小肠钡灌肠造影：回肠远段突出肠外向左下走行大约4cm的形似肠段影。     

美克尔憩室核素显像与临床特征相关性分析

目的：研究99mTc-高锝酸盐（99cmTcO4^-）异位胃黏膜显像特点与临床特征之间的相关性。方法：观察MD异位胃黏膜患者，行99cmTcO4^-显像与手术后病理诊断的符合率，核素扫描特征与临床特征，并用Pearson相关分析法进行分析。结果：MD异位胃黏膜患者消化道出血临床严重程度与病检中憩室合并溃疡、出血率密切相关（rp=0．68，P〈0．01），与核素扫描中异位胃黏膜最大直径显像时间明显负相关（rp=-0．57，P〈O．05），与核素扫描中异位胃黏膜显像的最大直径无明显相关（rp=0．32，P〉0．05）。结论：99cmTcO4^-显像诊断MD异位胃黏膜的敏感性高、阳性预测值强。憩室黏膜溃疡、出血可能是导致MD异位胃黏膜患者发生消化道出血的重要原因。     

小儿美克尔憩室及其合并症的CT表现

目的 探讨儿童美克尔憩室合并症的CT表现及诊断价值.方法 回顾性分析25例经手术及病理证实的儿童美克尔憩窒患者的临床及CT资料,25例均行CT平扫及增强扪描.结果 (1)直接征象:5例未发现明确憩室;20例于脐周或右下腹见憩室影,其中平扫呈含液管形表现9例,增强后均呈环形强化.憩室平扪呈实性结节样表现11例,增强后4例不强化,7例强化,其中3例呈均匀强化,4例呈不均匀强化.(2)间接征象:肠梗阻表现8例,憩室周围脂肪层肿胀、模糊9例,憩窒周边游离气体影3例,邻近肠系膜和(或)网膜增厚异常强化8例,腹水4例,继发肠套叠呈"同心圆"征1例.(3)CT分型:合并憩室炎和(或)出血型20例;合并小肠梗阻和(或)肠套叠型8例,其中索带压迫粘连7例,肠套叠1例;合并穿孔周围炎症型3例.结论 儿童美克尔憩室出现合并症后具有特征性CT表现,CT 可以清楚地显示其形态、内部成分和周边结构.

Abstract：

Objective To investigate the CT manifestations of Meckel's diverticulum and its complications in children. Methods Retrospective analysis of Clinical and CT findings in 25 cases with pathologically proved Meckel's diverticulum. The unenhanced and contrast-enhanced CT were obtained in all patients. Results (1)The direct signs: the diverticulum cannot be shown in 5 cases; the diverticulums were found around the navel or in lower right abdomen in 20 cases. The blind-ending fluid-filled or gas-filled structures were found in 9 cases, with heterogeneous ring-enhancement. The tubercle-like structures were detected in 11 cases, which showed no enhancement in 4 cases, and homogeneous enhancement in 3 cases,and heterogeneous enhancement in 4 cases. (2) The indirect signs included intestine obstruction in 8 cases,swelling fat layer surrounding the diverticulum in 9 cases, free gas around the diverticulum in 3 cases,thickened mesentery in 8 cases, ascites in 4 cases, and intussusception due to inverted Meckel's diverticulum with "target sign" in 1 case. (3) CT classification: with diverticulitis or diverticular bleeding in 20 eases; with intestine obstruction or intussusception in 8 cases; bands-caused obstruction in 7 cases;intussusception in 1 case; with perforation in 3 cases. Conclusion Meckel's diverticulum and its complications have typical CT findings, and CT can clearly demonstrate diverticulum's shape, margin,internal components and surroundiug tissues.     

小儿美克尔憩室及其合并症的CT表现

目的 探讨儿童美克尔憩室合并症的CT表现及诊断价值.方法 回顾性分析25例经手术及病理证实的儿童美克尔憩窒患者的临床及CT资料,25例均行CT平扫及增强扪描.结果 (1)直接征象:5例未发现明确憩室;20例于脐周或右下腹见憩室影,其中平扫呈含液管形表现9例,增强后均呈环形强化.憩室平扪呈实性结节样表现11例,增强后4例不强化,7例强化,其中3例呈均匀强化,4例呈不均匀强化.(2)间接征象:肠梗阻表现8例,憩室周围脂肪层肿胀、模糊9例,憩窒周边游离气体影3例,邻近肠系膜和(或)网膜增厚异常强化8例,腹水4例,继发肠套叠呈"同心圆"征1例.(3)CT分型:合并憩室炎和(或)出血型20例;合并小肠梗阻和(或)肠套叠型8例,其中索带压迫粘连7例,肠套叠1例;合并穿孔周围炎症型3例.结论 儿童美克尔憩室出现合并症后具有特征性CT表现,CT 可以清楚地显示其形态、内部成分和周边结构.     

99mTcO4-异位胃粘膜显像诊断小儿美克尔憩室

目的:探讨99mTcO4异位胃粘膜显像对小儿美克尔憩室的临床诊断价值.方法:对32例疑美克尔憩 室患儿行99mTcO4-异位胃粘膜显像,以腹部出现异常放射性核素浓聚影为阳性.阳性者全部行手术治疗;阴性者行内窥镜或其它检查.结果:32例患儿中核素浓聚影阳性者10例,经手术病理证实9例为异位胃粘膜,1例为肠重复畸形.结论:...     

小儿美克尔憩室及其合并症的CT表现

目的 探讨儿童美克尔憩室合并症的CT表现及诊断价值.方法 回顾性分析25例经手术及病理证实的儿童美克尔憩窒患者的临床及CT资料,25例均行CT平扫及增强扪描.结果 (1)直接征象:5例未发现明确憩室;20例于脐周或右下腹见憩室影,其中平扫呈含液管形表现9例,增强后均呈环形强化.憩室平扪呈实性结节样表现11例,增强后4例不强化,7例强化,其中3例呈均匀强化,4例呈不均匀强化.(2)间接征象:肠梗阻表现8例,憩室周围脂肪层肿胀、模糊9例,憩窒周边游离气体影3例,邻近肠系膜和(或)网膜增厚异常强化8例,腹水4例,继发肠套叠呈"同心圆"征1例.(3)CT分型:合并憩室炎和(或)出血型20例;合并小肠梗阻和(或)肠套叠型8例,其中索带压迫粘连7例,肠套叠1例;合并穿孔周围炎症型3例.结论 儿童美克尔憩室出现合并症后具有特征性CT表现,CT 可以清楚地显示其形态、内部成分和周边结构.     

美克尔憩室翻转入肠腔一例

患者 女,54岁.于3个月前无明显诱因出现黑便,呈间断性发作,伴全身乏力,无腹痛、腹胀.在当地医院做胃镜示"慢性胃炎",结肠镜未见明显异常.对症治疗后症状无明显好转遂来我院就诊.血常规示HGB76g/L.口服钡剂小肠造影显示距回盲瓣口约60cm处肠腔内见一孤立、细长、边界光滑的腔内肿块,呈棒状,其纵轴与肠管长轴平行,病变在肠腔内有一定的移动度,邻近肠管黏膜形态正常,管壁柔软,蠕动对称(图1、2).拟诊:回肠息肉.     

Gastrointestinal Amyloidosis Presenting with Multiple Episodes of Gastrointestinal Bleeding

Amyloidosis is characterized by the extracellular deposition of amyloid protein in various organs. Gastrointestinal involvement in amyloidosis is common, but a diagnosis of amyloidosis is often delayed. Severe gastrointestinal hemorrhage in amyloidosis is rare but can be fatal in some cases. We experienced a case of a 49-year-old man who presented with recurrent massive hematochezia. Although embolization was performed eight times for bleeding from different sites of the small intestine, hematochezia did not cease. We report the case, with a review of the literature.     

Ulcerated Gastric Lipoma Presenting with Gastrointestinal Bleeding and Hypovolemic Shock

Teaching Point: Gastric lipomas are very rare and generally asymptomatic benign tumors; however, they can manifest as life-threatening complications, readily diagnosed by CT.     

Diagnostic Performance of CT Angiography in Patients Visiting Emergency Department with Overt Gastrointestinal Bleeding

Objective

To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding.

Materials and Methods

We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed.

Results

To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506).

Conclusion

Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.     

Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

Purpose

Regional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.

Methods

From December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).

Results

Technical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.

Conclusions

Transjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.     

The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

Objective

To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography.

Materials and Methods

We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates.

Results

Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure.

Conclusion

The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.     

^99mTcO4^-异位胃粘膜显像诊断小儿美克尔憩室

目的：探讨99mTcO4-异位胃粘膜显像对小儿美克尔憩室的临床诊断价值。方法：对32例疑美克尔憩室患儿行99mTcO4-异位胃粘膜显像,以腹部出现异常放射性核素浓聚影为阳性。阳性者全部行手术治疗;阴性者行内窥镜或其它检查。结果：32例患儿中核素浓聚影阳性者10例,经手术病理证实9例为异位胃粘膜,1例为肠重复畸形。结论：99mTcO4-异位胃粘膜显像是诊断小儿美克尔憩室特异性较高的一种方法,对临床诊断和治疗有重要的指导意义。     

原因不明胃肠道出血的DSA

目的：进一步提高消化道出血的诊断率，探讨ＤＳＡ的应用价值。材料和方法：对３０例原因不明胃肠道出血病例行选择性腹腔动脉和肠系膜上、下动脉造影。在常规ＰＵＣＫ快速摄片后，再行ＤＳＡ，比较两种方法所见。结果：３０例中２４例发现病理血管，检出病变，检出率为８０％。其中肿瘤６例（胃肠平滑肌瘤或肉瘤５例，腺瘤１例），血管病变１１例（ＡＶＭ６例，小肠毛细血管扩张症４症，胃底静脉曲张１例）；炎症性病变６例（麦克尔憩室２例，胆道出血１例，胃溃疡或糜烂３例）和十二指肠粘膜异位１例。ＤＳＡ较常规血管造影片显示病变更清楚，血管结构更仔细。２例小肠毛细血管扩张症在常规血管造影片上仅见小血管密集，紊乱，而ＤＳＡ则能清楚显示病变肠段较正常肠段染色异常增浓，因此术前得以确诊。本组资料显示ＤＳＡ对于提高胃肠道出血的病变检出率和诊断正确率很有价值。１例小肠毛细血管扩张症出血第一次检查阴性。一周后采用山莨菪碱药物血管造影，ＰＵＣＫ及ＤＳＡ见造影剂外溢及肠管异常染色而得到诊断。结论：胃肠道出血的血管造影检查结合应用ＤＳＡ，可进一步提高病变检出率和诊断正确率。     

Safety and Efficacy of Transcatheter Arterial Embolization for Lower Gastrointestinal Bleeding: A Single-center Experience with 112 Patients

PurposeTo assess the safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding (LGIB) and to determine the prognostic factors that affect clinical outcome.Materials and MethodsAll patients diagnosed with LGIB by angiography at a single institution from April 2006 to January 2013 were included in a retrospective study. The rates of technical success, early recurrent bleeding, major complications, clinical success, and in-hospital mortality for transcatheter arterial embolization were determined. The influence of possible prognostic factors on the outcome was analyzed.ResultsA total of 112 patients were included (36 with small-bowel LGIB, 36 with colon LGIB, and 40 with rectal LGIB). N-butyl cyanoacrylate (NBCA) was the embolic agent for 84 patients (75.0%), whereas gelatin sponge pledgets (n = 20), microcoils (n = 2), polyvinyl alcohol particles with adjunctive gelatin sponge pledgets (n = 1), and blood clots (n = 1) were used in the other patients. The technical success rate was 96.4%. For the entire group, the rates of early recurrent bleeding, major complications, clinical success, and in-hospital mortality were 17.4%, 4.6%, 74.5%, and 25.0%, respectively. These were 15.2%, 4.8%, 75.3%, and 26.2%, respectively, in the NBCA group. Hematologic malignancy, immobilization status, and coagulopathy were significant prognostic factors for clinical outcomes.ConclusionsTranscatheter arterial embolization is a safe and effective treatment for LGIB. NBCA could be used as a primary embolic agent for this procedure.