64排螺旋CT诊断成人急性小肠逆套肠套叠的体会

Understanding about diagnosis of acute small bowel retrograde intussusception in adults by means of 64-slice-spinal CT

目的进一步探讨MSCT在诊断成人急性小肠套叠中的作用。方法一既往有腹部手术史的46岁女性患者在平片发现急性机械性小肠梗阻后即行腹部64排MSCT扫描(平扫+3期增强)。对照手术所见分析其CT影像表现。结果患者加做腹部MSCT可立即作出空肠-空肠肠套叠的诊断,并可确定有严重肠梗阻;未见小肠肿瘤及其他肠道器质性异常,而病人有腹部手术史,可推断肠粘连为引起肠套叠的原因,且为手术证实;增强动态扫描可直观地观察肠系膜上动脉供血的肠道均有供血,而肠壁黏膜皱襞呈菊花瓣状及多环状增强,说明肠套叠处有静脉淤血现象;本例小肠套叠经手术证明是逆套,CT显示肠套叠影像近端套入部与套鞘之间的间隙仅有少量气体,而此间隙的中部、远侧部明显扩大,积气积液,这可视为小肠逆行套叠的重要征象。结论MSCT是诊断成人小肠套叠很好的方法,除过去文献上已提到的作用(包括对套叠部血运观察的优势)外,其对判断是顺套还是逆套的作用应引起重视。

Objective To have a further study of the value of MSCT in diagnosing acute small bowel retrograde intussusception in adults by means of 64-slice-spinal CT. Methods A 46-year-old female patient with the history of abdominal operation was found having acute mechanical small bowel obstruction through plain X-ray radiograph. 64-slice MSCT was performed afterwards （plain scan ＋ 3 stage contrast scans）. Hence, evidence is provided for operation. Results Using the technique of MSCT for the patient can promptly approach the diagnosis of jejuno-jejunal intussusception with severe bowel obstruction; no small bowel tumor or other organic lesion found in this case. With the patient who has the history of abdominal operations, MSCT can predict the reason of adhesion causing bowel intussusception, and provide the evidence for operation; whereas MSCT with contrast media offers a further investigation of the blood supply to the bowels through SMA, and observation of blood circulation through the intussuscepting site, which represents venous congestion of intussusception. This case is a retrograde small bowel intussusception and confirmed with operation evidence. A greater amount of gas and fluid is accumulated between the dilated space of middle-distal portion of intussusceptum and intussuscipiens. Nevertheless, less gas at the proximal portion and that can be an important sign for retrograde intussusception. Conclusion MSCT is a good choice of examination for diagnosis of adult＇s intussusception. As the literature mentioned the advantages of MSCT for observing the circulation of intussusceptum and whether the diagnosis is antegrade or retrograde intussusception is also essential.