华法林过量引起自发性小肠壁内血肿的CT表现及其临床价值

Spontaneous Intramural Hematoma of Small Bowel Secondary to Excessive Warfarin Therapy:CT Manifestations and Its Clinical Value

目的探讨华法林过量引起自发性小肠壁内血肿的MSCT表现及其诊断价值。方法回顾性分析经临床确诊的6例自发性小肠壁内血肿的MSCT表现,其中5例行全腹增强CT扫描。结果 6例均出现单发弥漫性肠壁环形增厚,其中空、回肠各3例;3例表现为肠壁全层密度增高,另3例表现为肠壁黏膜下层密度增高;增强扫描可见"靶征";1例出现小肠肠壁积气;6例均伴有肠腔狭窄、腹腔积血,均出现受累小肠周围及相应肠系膜区密度增高,其中3例并发肠梗阻。结论对于正在接受华法林抗凝治疗的患者,突发腹痛伴凝血功能异常,且有典型的CT表现,应高度警惕自发性小肠壁内血肿的可能。早期诊断对患者的治疗及预后有很重要的临床意义。

Objective To investigate the MSCT features of spontaneous intramural hematoma of small bowel caused by excessive warfarin therapy, and to discuss the value of MSCT in its diagnosis. Methods A total of 6 patients with sponta- neous intramural hematoma of small bowel caused by excessive warfarin therapy were included in this study. Plain MSCT was employed in all 6 patients, and 5 of them received contrast-enhanced CT scan of the whole abdomen. The clinical data were retrospectively analyzed. Results Single, diffused annular thickening of bowl wall, involving jejunum （ n = 3 ） and ileum （ n = 3 ）, was seen in all 6 patients. The density of whole layer of intestinal wall was increased in 3 patients, while increased density of submucous layer was seen in other 3 patients. ＂Target sign＂ could be observed on enhanced CT scan; intestinal wall pneumatosis was detected in one patient ; stenosis of intestinal lumen and hemoperitoneum were found in all 6 patients, among them small bowel obstruction was present in 3. Conclusion When a patient, who is receiving warfarin therapy, develops sudden abdominal pain with abnormal coagulation function and has typical CT manifestations, spontaneous intramural hematoma of small bowel should be strongly considered. Early diagnosis is very important for the treatment and prognosis.