小儿美克尔憩室及其合并症的CT表现

CT characteristic findings of Meckel＇s diverticulum and its complications in children

目的 探讨儿童美克尔憩室合并症的CT表现及诊断价值.方法 回顾性分析25例经手术及病理证实的儿童美克尔憩窒患者的临床及CT资料,25例均行CT平扫及增强扪描.结果 （1）直接征象：5例未发现明确憩室;20例于脐周或右下腹见憩室影,其中平扫呈含液管形表现9例,增强后均呈环形强化.憩室平扪呈实性结节样表现11例,增强后4例不强化,7例强化,其中3例呈均匀强化,4例呈不均匀强化.（2）间接征象：肠梗阻表现8例,憩室周围脂肪层肿胀、模糊9例,憩窒周边游离气体影3例,邻近肠系膜和（或）网膜增厚异常强化8例,腹水4例,继发肠套叠呈＂同心圆＂征1例.（3）CT分型：合并憩室炎和（或）出血型20例;合并小肠梗阻和（或）肠套叠型8例,其中索带压迫粘连7例,肠套叠1例;合并穿孔周围炎症型3例.结论 儿童美克尔憩室出现合并症后具有特征性CT表现,CT 可以清楚地显示其形态、内部成分和周边结构.

Objective To investigate the CT manifestations of Meckel＇s diverticulum and its complications in children. Methods Retrospective analysis of Clinical and CT findings in 25 cases with pathologically proved Meckel＇s diverticulum. The unenhanced and contrast-enhanced CT were obtained in all patients. Results （1）The direct signs： the diverticulum cannot be shown in 5 cases; the diverticulums were found around the navel or in lower right abdomen in 20 cases. The blind-ending fluid-filled or gas-filled structures were found in 9 cases, with heterogeneous ring-enhancement. The tubercle-like structures were detected in 11 cases, which showed no enhancement in 4 cases, and homogeneous enhancement in 3 cases,and heterogeneous enhancement in 4 cases. （2） The indirect signs included intestine obstruction in 8 cases,swelling fat layer surrounding the diverticulum in 9 cases, free gas around the diverticulum in 3 cases,thickened mesentery in 8 cases, ascites in 4 cases, and intussusception due to inverted Meckel＇s diverticulum with ＂target sign＂ in 1 case. （3） CT classification： with diverticulitis or diverticular bleeding in 20 eases; with intestine obstruction or intussusception in 8 cases; bands-caused obstruction in 7 cases;intussusception in 1 case; with perforation in 3 cases. Conclusion Meckel＇s diverticulum and its complications have typical CT findings, and CT can clearly demonstrate diverticulum＇s shape, margin,internal components and surroundiug tissues.