闭合性腹部创伤后早期隐匿性小肠破裂的CT排查

目的探讨闭合性腹部创伤中小肠破裂早期隐匿性临床特点的成因及其诊治要点，以提高早期检出率和治愈率，进一步提高腹部创伤的救治水平。方法回顾性分析我院2004年1月～2011年12月经手术证实的外伤性小肠破裂116例资料，分析患者术前CT检查的临床表现特点并分析漏诊原因。结果腹腔内或腹膜后游离气体、肠道壁连续性中断为小肠破裂的特异性直接征象，肠壁增厚、肠壁血肿、腹腔和肠间隙积液以及肠系膜渗出、血肿为小肠破裂的重要提示性间接征象。扫描技术、窗技术运用不当等原因可导致漏诊。结论加强对外伤性小肠破裂CT征象的认识，正确运用扫描技术及窗技术，及时做出明确的诊断，避免漏诊，为临床制定治疗方案提供重要依据。

CT investigation of early occult small intestinal rupture after closed abdominal trauma

Objective To investigate the causes of early occult characteristics of small intestinal rupture in closed abdominal trauma and its diagnosis and treatment keys in order to improve the early detection rate,cure rate and further improve the treatment level of abdominal trauma.Methods 116 cases with traumatic small intestinal rupture confirmed by surgery in our hospital from January 2004 to December 2011 were analyzed retrospectively.The clinical manifestation characteristics of preoperative CT examination was analyzed and the causes of missed diagnosis were studied.Results Intra-abdominal or retroperitoneal free gas and continuity interrupt of intestinal walls were the specific and direct signs of small intestine rupture while intestinal wall thickening,intestinal wall hematoma,abdominal cavity and intestinal clearance effusion and mesenteric exudation and hematoma were suggestive and indirect signs of small intestine rupture.Inappropriate use of scanning technique and window technique were considered to lead to missed diagnosis.Conclusion Strengthening understanding of CT signs of traumatic small intestine rupture,appropriate use of scan technique and window technique,timely diagnosis and avoiding missed diagnosis should be important bases for the development of clinical treatment protocols.