儿童肠旋转不良伴中肠扭转的影像学表现

The imaging performance of malrotation of intestine with midgut volvulus in child

目的:探讨X线与CT对儿童肠旋转不良伴中肠扭转(volvulus in intestinal malrotation,VIM)的诊断价值。方法:回顾性分析经手术证实的肠旋转不良伴中肠扭转15例。8例行腹部立卧位平片检查;15例均行上消化道造影,其中10例新生儿采用76%泛影葡胺造影,6例行钡灌肠;4例行CT检查,2例行增强CT扫描。结果:①腹部立卧位平片表现:4例见"双泡征"或"三泡征",小肠内不含气或含气较少;1例见空、回肠换位征;②上消化道造影:十二指肠完全梗阻5例;十二指肠不完全梗阻10例,见"螺旋征"。③钡灌肠:回盲部位于右上腹3例,中上腹2例,左上腹1例。④4例CT显示肠系膜根部类团块影,3例见典型"漩涡征";1例新生儿CT扫描肠系膜血管及"漩涡征"显示不清。结论:上消化道造影对肠旋转不良伴中肠扭转的诊断具有重要价值,"螺旋征"是其典型表现;新生儿采用泛影葡胺上消化道造影取得良好效果。CT对非新生儿诊断具有重要价值,"漩涡征"伴肠系膜根部SMA、SMV正常排列迷失及相伴肠袢走行异常为VIM典型CT表现。

Objective： To study the X - ray and CT manifestations of volvulus in intestinal malrntafion （VIM） so as to recognize the characteristics of VIM. Methods：The imaging findings in 15 surgically - proved cases （3 day - 12 years） were retrospectively analyzed. There were 9 males and 6 female. All the 15cases underwent upper gastrointestinal radiography with 10 cases of newborns using 76% diatrizoate contrast,8 of 15 underwent erect position and supine abdominal plain film examination, 6 of 15 underwent barium enema and 4 of 15 underwent CT scan with 2 of 4 underwent enhanced CT scan. Results： （1）The finding of X - ray plan ： showing double bubble sign or triple bubble sign in 4 cases with no contain gas or gas - less In the small intestine, and showing Jejunal or ileal transposition sign in 1 case. （2） The finding of upper gastrointestinal radiography ： showing complete duodenal obstruction in 5 cases, and incomplete duodenal obstruction in 10 cases with ＂spiral sign＂. （3）The finding of barium enema： 3 cases of Ileocecal in the right upper quadrant, 2 cases in the upper abdomen, and 1 case in left upper abdomen. （4） The characteristic CT appearance： edematous mesenteric folds was found in 4 cases,3 of 4 with typical ＂whirl sign＂, and 1 case of neonatal enhanced CT scans did not show the mesenteric and ＂whirl sign＂ clearly. Conclusion ： Upper gastrointestinal radiography is proved to be very valuable on diagnose of VIM, and its characteristic finding of VIM is ＂spiral sign＂. Newhorns with diatrizoate contrast upper gastrointestinal tract to achieve good results. CT scan is proved to be very valuable on diagnose of VIM of non - neonatal, the predominant ＂whirl sign＂ with the abnormal arrangement of superior mesenteric artery and veins at the mesenteric root was a characteristic CT finding of VIM.