胆石性肠梗阻的影像诊断

Diagnostic imaging of gallstone ileus

目的研究胆石性肠梗阻影像表现及其诊断价值。方法回顾性分析15例经临床证实的胆石性肠梗阻患者的影像表现及其诊断价值。结果所有病例CT表现均见肠梗阻征象、肠腔内迷走结石(异位结石)及胆囊、胆系积气,2例显示腹腔游离积液,除1例胆囊切除者外另14例均见胆囊变形,胆囊与十二指肠分界不清,4例可见明确显示胆肠瘘。5例同时进行了腹部立卧位X线平片检查,其中1例碘水造影显示机械性肠梗阻、肠腔内充盈缺损、胆肠瘘,1例显示胆管积气,3例显示肠梗阻征象,2例未见异常。7例同时进行了腹部超声检查,均提示胆囊异常,其中3例显示胆系积气。结论胆石性肠梗阻有典型的CT表现,CT是胆石性肠梗阻最佳诊断方法,X线平片及超声可以作为筛查手段。

Objective To study imaging findings of gallstone ileus and to discuss the value on diagnosis. Methods The image findings of 15 patients with gallstone ilens confirmed by clinical information were reviewed retrospectively. Results Signs of ilens, ectopic gallstone, and penumobilia were seen in all cases. The distorted gallbladder was seen in 14 cases except one case with the gallbladder resection. Signs of biliary enteric fistula were seen in 4 cases, and peritoneal fluid was seen in 2 cases. Abdominal plain films were performed in 5 cases in the same time and signs of penumobilia were seen in 1 case. Signs of ilens were seen in 3 cases. GastroenterogTaphy study was performed in 2 cases and signs of biliary enteric fistula were seen in 2 cases, and filling defect of the bowel in 1 case. Abdominal US was performed in 7 cases. Gallbladder abnormalities were seen in 7 cases, and penumobilia in 3 cases. Conclusion Primary result revealed that the CT appearance of gallstone ileus was particularly striking. CT is the best valuable tool for the diagnosis of gallstone ileus, and X-ray plain film and sonography examination are shown to be very good screening examinations.