胆石性肠梗阻的影像学诊断

Imaging Diagnosis of Gallstone Ileus

目的探讨胆石性肠梗阻的影像诊断价值。资料与方法回顾性分析7例经手术或内镜证实的胆石性肠梗阻患者的影像资料及临床表现,影像检查包括立卧位腹部平片7例,消化道碘水造影1例,CT检查6例,MRI检查2例。结果7例患者皆有程度不等的肠梗阻表现。6例CT检查见肠腔内异位结石,7例腹部平片中2例显示肠腔内异位结石,MRI检查的2例均见肠腔内异位结石,1例消化道造影示十二指肠充盈缺损,误为肿瘤性病变。腹部平片2例见胆囊区积气,6例CT见胆囊积气、胆囊窝结构紊乱,其中2例胆囊与十二指肠内气体相通,1例MRI显示胆囊与十二指肠间有高信号液体相通。结论胆石性肠梗阻影像检查中腹部平片除明确肠梗阻外,仔细寻找肠内阳性结石会对诊断有帮助,CT与MRI均能明确诊断,价值相仿。

Objective To evaluate the imaging diagnostic value of gallstone ileus.Materials and Methods The image findings of 7 patients with gallstone ileus confirmed by surgery were retrospectively reviewed.Imaging examinations included abdominal plain film in 7 cases,G I barium in 1 case,abdominal CT in 6 cases,and MR imaging in 2 cases.Results Signs of ileus were found in all cases.Ectopic stones were seen on CT images,abdominal plain film and MR images in 6,2 and 2 cases respectively.One case with filling defect in duodenum was demonstrated on G I and misdiagnose as tumor.Gas inside the gallladder were showed on abdominal plain in 2 cases.CT scanning showed gallbladder gas in 6 cases,among them,biliary enteric fistula were seen in 2 cases.MR imaging demonstrated biliary enteric in 1 case.Conclusion Abdominal plain film can demonstrate not only bowel obstruction,but also ectopic stones within the jejunum.CT and MRI can display the gas and fluid fistula between the gallbladder and duodenum,which should be the best tool in the diagnosis of gallstone ileus.