腹腔游离气体阴性乙状结肠穿孔的CT诊断  

CT diagnosis of sigmoid colon perforation without peritoneal free gas

作　　者：焦利灼 谢福荣[1] 庄远迪 盛文双 杨运俊[1] J IAO Lizhuo;XIE Furong;ZHUANG Yuandi;SHENG Wenshuang;YANG Yunjun(Department of Radiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院放射科,浙江温州325000

出　　处：《实用放射学杂志》2018年第10期1546-1548,1552,共4页Journal of Practical Radiology

基　　金：2016年度浙江省卫生创新人才项目.

摘　　要：目的 探讨腹腔游离气体阴性时乙状结肠穿孔的CT诊断价值。方法 回顾性分析25例经手术证实但腹腔游离气体阴性的乙状结肠穿孔患者CT征象及临床资料。结果 25例乙状结肠穿孔主要表现为急性腹胀、腹痛，病程约6 h^2周。CT表现为：肠周及肠系膜小气泡20例；肠壁连续性中断12例；肠内容物外溢或“肠外粪块”征9例，其中破口处粪石嵌顿6例；穿孔周围渗出改变25例，其中脓肿形成2例；大量腹腔积液2例。结合多平面重建（MPR）观察，辨认小气泡位于肠外2例，增加破口显示1例，准确显示肠壁嵌顿异物5例。结论 乙状结肠穿孔时外溢气体可局限于下腹部，肠周及肠系膜内小气泡是重要的CT征象，通过MPR可提高小气泡、破口及异物等显示，减少乙状结肠穿孔误诊、漏诊。Objective To investigate the value of CT in the diagnosis of sigmoid colon perforation without peritoneal free gas. Methods The clinical and CT data of 25 patients of sigmoid colon perforation without peritoneal free gas confirmed by surgery were analyzed retrospectively.Results The 25 cases with sigmoid colon perforation mainly presented as acute abdominal pain and distension, and the duration ranged from 6 hours to 2 weeks. The CT findings were as follows： the peri-intestinal and mesenteric small air bubbles manifested in 20 cases,interruption of colonic wall in 12 cases,spilled feces or focal collection of extraluminal fecal matter in 9 cases including 6 cases with incarcerated fecal at the break, dirty fat sign in 25 cases including abscess formation in 2 cases and massive seroperitoneum in 2 cases.Combined with multiplanar reconstruction （MPR） ,small parenteral air bubbles were identified in 2 cases, colonic rupture was displayed additionally in 1 case and foreign body incarcerated in the bowl wall were accurately depicted in 5 cases.Conclusion The free gas of the sigmoid colon perforation can be confined to the lower abdomen, and the peri-intestinal and mesenteric small air bubbles are important CT sign.Furthermore,the MPR can be used to improve the display of small air bubbles, tiny ruptures and foreign body, which may reduce the misdiagnosis or missed diagnosis of sigmoid colon perforation.

关 键 词：乙状结肠 穿孔 游离气体 计算机体层成像 

分 类 号：R574.62[医药卫生—消化系统] R814.42[医药卫生—内科学]