儿童小肠机械性梗阻的CT诊断

CT diagnosis of small bowel obstruction in children

目的 探讨CT检查对儿童小肠机械性梗阻的诊断价值。方法 分析 31例手术确诊为小肠机械性梗阻患者的腹部X线平片与CT表现。年龄 9个月至 14岁 ,男 17例 ,女 14例。急性小肠梗阻 2 9例 ,慢性小肠梗阻 2例。其中 7例有腹部手术史。结果 腹部X线平片与CT准确显示梗阻程度分别为 19例和 2 9例。CT准确显示梗阻病因 18例 ,包括小肠石 4例 ,肠套叠 5例 ,腹腔局部感染渗出粘连 6例 ,腔内型肠重复畸形 1例 ,先天性脐疝 1例 ,先天性肠旋转不良 1例。本组 7例有腹部手术史者全部为粘连性梗阻 ,结合手术史 ,CT准确判断病因 2 5例。腹部X线平片与CT假阴性诊断分别为 4例和 2例。结论 CT对发现肠绞窄和肠壁积气的敏感性较腹平片高。CT显示狭窄移行段的形态有助于判断病因 ,对梗阻病因的判断CT明显优于腹部X线平片。

Objective To evaluate CT in the diagnosis of small bowel obstruction in children. Methods Thirty one cases with small bowel obstruction manifestations on CT and plain radiograph were analysed. The age ranged from 9 months to 14 years, male 17 cases, female 14 cases. There were 29 acute small bowel obstructions, and 2 chronic obstruction. Seven cases had history of previous abdominal operation. Results Corred diagnosis was made in 19 cases and 29 cases respectively by plain film and CT. The accurate etiologic diagnosis could be made by CT in 18 cases, including small bowell stone 4 cases, intussusception, 5 localized infection and adhesion 6 intraluminal bowel duplication, 1 congenital umbilical hernia, congenital malrotation of the intestine 1 case.Combined with history of abdominal operation the accurate CT etiologic diagnosis increased to 25 cases.There were 4 CT false negative cases and 2 plain film false negative cases. Conclusion The CT is obviously superior to plain radiograph in detecting strangulation and gas in bowel wall,better dilineating the transitional segment of bowel stenosis thereby demonstrating the case of obstruction which is very helpful for clinical management.