闭袢性肠梗阻的影像学表现.pdf

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1、PictorialEssayCTofCecalVolvulus:UnravelingtheImageCarolynJ.Moore1,FrankM.Corl1,ElliotK.Fishman1,2olvulusofthececumisatorsionpearanceofcecalvolvulusandthediagnosticfirmedeitherbysurgeryorcolonoscopicdecom-Vofthebowelarounditsownmesen-benefitof3Dimaging.pression.TheCTtechniquevariedbecausetheterythat

2、oftenresultsinaclosed-imageswereobtainedfromseveraldifferentloopobstruction.Cecalvolvuluscanonlyscanners.Wecurrentlyscantheabdomenandoccurinthesmallpercentage(11–25%)ofTechniquepelvisaftertheIVadministrationof100–120thepopulationwhohaveadevelopmentalThisreportisbasedondatacollectedfromfivemLofiodi

3、natedcontrastmediuminjectedatafailureofperitonealfixation,allowingthepatientswithcecalvolvulusthathadbeencon-rateof2–3mL/sec.Scanningisperformedonaproximalcolontobefreeandmobile[1].Thesecondrequirementisrestrictionofthebowelatafixedpointwithintheabdomenthatservesasafulcrumforrotation,suchasanadhesi

4、on,abdominalmass,orscarringfromcalcifiedlymphnodes[2].RecognitionoftheCTsignsofcecalvolvu-lusiscriticalbecausethefindingsatclinicalexaminationareoftenvagueandbecauseCTisusuallytheimagingtechniqueofchoiceforpatientspresentingwithacuteabdominalpain[3].Furthermore,diagnosismaybedifficult:Theimagesonthe

5、patient’sabdominalradio-graphscouldbeobscurediftheclosedloopisfilledwithfluid,orientedinananteroposteriorplane,oroverlainbyloopsofair-distendedbowel[4].CTrevealsthepresenceandloca-tionofthevolvulusandgivestheaddedbenefitofallowingearlyidentificationofpotentiallyfatalcomplications,suchasischemiaandper

6、-foration.Three-dimensional(3D)reconstruc-tionsmayfurtherimprovediagnosticcapabilitiesbyallowingvisualizationoftheentirebowelinasingleimage.ThispictorialFig.1.—Drawingshowsloop-typececalvolvulus.Cecummaytwisteitherclockwiseorcounterclockwiseandessayusesschematicdiagramsandcasesoftheninvertsupward

7、.Twistedterminalileumisseentangledwithcecum.LowerleftillustrationshowspointofrepresentativepatientstodescribetheCTap-torsionasitwouldappearonaxialCTimages.Lg.=large,Sm.=small.ReceivedOctober20,2000;acceptedafterrevisio