14例乙状结肠扭转多层螺旋CT诊断临床观察

Clinical significance of multislice CT in diagnosis of 14 cases of sigmoid volvulus

[背景]探讨多层螺旋CT(MSCT)在乙状结肠扭转(SV)诊断中的临床意义.[病例报告]回顾性分析经外科手术证实的14例SV患者的临床资料,总结SV的MSCT特征.14例中手术复位治疗12例,2例外科手术中发现扭转的结肠缺血、坏死,进一步给行坏死肠段切除及腹壁造瘘术;所有患者术后恢复良好.MSCT检查结果均可见不同程度的结肠扩张、积气及气-液平面表现,扩张的乙状结肠肠壁菲薄,无法判断肠壁强化程度;均有鸟嘴征表现,5例有漩涡征表现,其中4例伴有少量腹腔或盆腔积液,外科手术证实为血性积液.[讨论]SV在MSCT检查中主要表现为结肠严重扩张、积气,鸟嘴征及漩涡征,亦表现为气-液平面或腹腔、盆腔积液.MSCT检查对SV的诊断具有临床意义.

BACKGROUND To investigate the clinical significance of multislice CT（MSCT）in the diagnosis of sigmoid volvulus（SV）.CASE REPORTS Clinical data of 14 patients with SV and MSCT characteristics of SV verified by surgery were retrospectively analyzed.Out of 14 patients with SV,12 patients were underwent by surgical reduction treatment,and 2patients were received by further bowel resection and abdominal fistula treatment because of ischemia and necrosis at the twisted colons,and all patients had good postoperative recovery.Main characteristics of MSCT included severe expansion and pneumatosis in the colon,as well as bird beak and whirlpool presentations.All 14 patients in the cohort showed different degrees of colon expansion,pneumatosis and gas-liquid surface presentation.MSCT showed very thin colon wall at the expanded sigmoid and the degree of strengthening of the colon wall could not be judged.Bird beak presentation was observed in all 14 patients and whirlpool presentation was observed in five patients,including four patients with small amounts of abdominal or pelvic fluid confirmed by surgery to be ischemic.DISCUSSION The main performances of SV in MSCT included severe colon expansion and pneumatosis,bird beak and whirlpool presentation,as well as possible gas-liquid surface or abdominal/pelvic fluid accumulation,and MSCT examination has important value for the diagnosis of SV.