CT在大网膜扭转术前诊断中的应用价值

Application Value of CT in Preoperative Diagnosis of Omental Torsion

目的总结大网膜扭转的临床表现及CT检查的影像学特点,以期减少大网膜扭转的误诊、漏诊率。方法回顾性分析笔者所在医院1998～2014年期间收治的16例大网膜扭转（继发性15例,原发性1例）及同期收治的286例急性阑尾炎（排除肝下、腹膜后等异位阑尾）患者的临床资料。结果大网膜扭转有转移性右下腹痛表现者11例,4例无明显转移性右下腹痛者,发病即以脐周偏右压痛、反跳痛为主,另1例表现为左侧腹股沟区包块伴疼痛,脐周持续性疼痛。16例患者术前均行腹部螺旋CT检查,13例发现脐周及以下平面见团块状软组织密度增高影,偏离麦氏点位置。1例腹股沟嵌顿疝合并大网膜扭转漏诊。结论大网膜扭转以转移性右下腹痛或右下腹痛为主,脐周偏右压痛、反跳痛,易与阑尾炎相混淆;腹部螺旋CT检查是术前诊断和鉴别大网膜扭转的有效手段。

Objective To summarize the clinical features and imaging features of CT in the omental torsion, and in order to reduce the misdiagnosis and missed diagnosis rate of imaging features. Methods The data of 16 cases of omental torsion （secondary 15 cases, primary 1 case） and 286 cases of acute appendicitis （eliminated the subhepatic and retroperitoneal ectopic appendix） in our hospital from 1998 to 2014 were retrospectively analyzed. Results Eleven cases of omental torsion suffered from the shifting pain in right lower quadrant. No obvious shifting abdominal pain was observed in other 4 cases whose main manifestations were abdominal tenderness and rebound tenderness around umbilicus. The patient of the remaining 1 case had enclosed mass in the area of left groin with pain and suffered from continuous periumbilical pain. Abdominal spiral CT examination was performed in 16 patients before operation. Increased signal intensity of globular soft tissue, which deviating from McBumey＇s point, was found at level of distal umbilicus by preoperative spiral CT in 13 cases. One case of omental torsion associated with ncarcerated inguinal hernia was missed. Conclusions Omental torsion manifests chiefly shifting pain in right lower quadrant, abdominal tenderness, and rebound tenderness around umbilicus. It is easily confused with appendicitis. Abdominal spiral CT should be chosen as a preferred means in preoperative diagnosis of omental torsion.