MSCT诊断胃肠道异物及穿孔

MSCT diagnosis of gastrointestinal foreign bodies and perforations

目的探讨MSCT诊断胃肠道异物及异物致胃肠道穿孔的价值。方法回顾性分析30例胃肠道异物(其中17例致胃肠道穿孔)的MSCT及临床资料,观察异物位置、形态、密度及胃肠道穿孔的MSCT表现。结果 30例胃肠道异物MSCT均可显示。异物以牙签多见(12/30,40.00%),其次为鱼骨(5/30,16.67%)、枣核(3/30,10.00%)以及鸡骨(2/30,6.67%)等;异物存留于小肠15例(15/30,50.00%)、胃部7例(7/30,23.33%)、结肠6例(6/30,20.00%)、回盲部2例(2/30,6.67%)。腹部X线平片可显示11例(11/30,36.67%)高密度异物。牙签、鱼骨等长条状尖锐物致胃肠道穿孔14例(14/17,82.35%),穿孔局部见肠壁水肿、周围渗出,可见异物"跨壁征"及局部小气泡影。结论 MSCT可全面显示胃肠道异物的位置、形态及伴发改变,对胃肠道穿孔有重要诊断价值。

Objective To observe the value of MSCT in diagnosis of gastrointestinal foreign bodies and the resulting gastrointestinal perforations. Methods MSCT and clinical data of 30 patients with gastrointestinal foreign bodies, including 17 with gastrointestinal perforations were reviewed retrospectively. The location, morphology, density of foreign bodies, and the performances of gastrointestinal perforations were observed. Results All gastrointestinal foreign bodies could be displayed by MSCT in 30 patients. Toothpicks were the most common type of foreign bodies （12/30, 40.00%）, followed by fish bones （5/30, 16.67%）, jujube nuclei （3/30, 10.00%）, chicken bones （2/30, 6.67%） and so on. Foreign bodies were found in small intestine in 15 patients （15/30, 50.00%）, in stomach in 7 （7/30, 23.33%）, in colon in 6 （6/30, 20.00%） and in ileocecus in 2 patients （2/30, 6.67%）. High density foreign bodies were demonstrated on abdominal X-ray films in 11 patients （11/30, 36.7%）. Gastrointestinal perforations caused by toothpicks, fishbones and other sharp objects were observed in 14 patients （14/17, 82.35%）. Intestinal wall edema, peripheral exudation, foreign bodies ＂cross through the intestinal wall＂ and the surrounding small bubbles were found in perforation site or nearby. Conclusion MSCT can comprehensively display the location, shape and associated changes of gastrointestinal foreign bodies, with important diagnostic value for gastrointestinal perforations.