小肠憩室的多层螺旋CT表现及误诊因素分析

Multislice spiral computed tomography performance and misdiagnosis factor analysis of small intestine diverticulum

目的探讨多层螺旋CT(MSCT)在小肠憩室中的诊断价值,并且分析小肠憩室的常见误诊原因。方法选取2015年1月~2017年12月我院门诊及住院患者行上腹部CT平扫及增强扫描诊断的30例诊断为小肠憩室患者以及25例初始诊断非小肠憩室而最终诊断为小肠憩室的患者,分析最终确诊为小肠憩室的患者的MSCT表现以及初始诊断非小肠憩室患者的误诊原因。结果 55例患者最终确诊为小肠憩室,小肠憩室患者的MSCT多表现为:憩室凸向肠腔内,憩室呈气体或气液混杂密度影,单纯表现为液体密度影较少,憩室多位于十二指肠降段或降段与水平段的交界处,单纯位于水平段者较少,小肠憩室多合并胆囊结石、食管裂孔疝等消化道疾病;小肠憩室在临床中较易误诊为肠梗阻、肠出血、穿孔、腹股沟斜疝、阑尾炎,主要原因与小肠憩室的单一临床表现、解剖部位有关。结论 MSCT对于小肠憩室的诊断具有较高价值,但临床上较易将小肠憩室诊断为其他疾病,因此应注意鉴别诊断。

Objective To evaluate the diagnostic value of multislice spiral computed tomography（MSCT） in small bowel diverticulum and to analyze the common misdiagnosis reasons of small bowel diverticulum.Methods From January2015 to December 2017,30 patients from outpatient clinics and hospitalization diagnosed as small intestine diverticulum by plain and enhanced CT scans on upper abdomen and 25 patients who were initially diagnosed as non-small bowel diverticulum but eventually proved were enrolled in our hospital in order to analyze the MSCT performance and the misdiagnosis reasons of these patients.Results The final definite diagnosis of small bowel diverticulum was in 55 patients mostly presenting with protrusion to the enteric cavity and gas or gas-liquid mixed density.The simple manifestation was less liquid density shadow.The diverticulum frequently located at the descending segment and the junction between the descending segment and the horizontal segment of duodenum,with little chance to be in horizontal segment.The small intestine diverticulum was mostly complicated with gastrointestinal diseases such as gallbladder stones and esophageal hiatal hernia,etc.The small intestine diverticulum in clinical practice was more likely to be misdiagnosed as intestinal obstruction,intestinal hemorrhage and perforation,inguinal hernia,appendicitis,which were mainly associated with single clinical manifestation and anatomic site of the small intestine diverticulum.Conclusion MSCT has a high value for the diagnosis of small bowel diverticulum,but it is easy to diagnose small bowel diverticulum as other diseases in the clinic.Therefore,attention should be paid to differential diagnosis.