腹腔无金属标记纱布瘤CT诊断、误诊分析及文献复习

The Diagnosis and Misdiagnosis of CT for Abdominal Nonmetallic Marked Gossypiboma and Associated Literature Review

目的探讨腹腔无金属标记纱布瘤的CT表现,分析术前误诊原因,以提高对本病的认识。方法回顾性分析经手术及病理证实的4例腹腔无金属标记纱布瘤患者的临床资料,均行CT平扫、增强扫描,并行多平面重组(MPR)图像处理,复习相关文献。结果本组无金属标记纱布遗留腹腔时间为3个月～8年。1例术前误诊为小肠肿瘤,2例术前误诊为胃肠道间质瘤,1例误诊为乙状结肠炎症。其中小肠与肿块相互包绕2例,小肠穿孔、纱布包块嵌入小肠内1例;小肠、乙状结肠穿孔合并阑尾炎、双侧输卵管积脓1例。结论纱布瘤是少见的医源性异物肉芽肿,CT是重要诊断手段之一,特别是无金属标记纱布瘤误诊率高,仔细分析其影像征象,减少误诊,提高术前诊断率,具有重要的诊断意义。

Objective To investigate the CT features of abdominal nonmetallic marked gossypiboma and analyze the causes of misdiagnosis in order to improve the understanding of the disease. Methods The clinical data of 4 cases of abdominal nonmetallic marked gossypiboma confirmed by surgery and pathology were analyzed retrospectively, including data of MSCT scan, enhanced scan and multiplanar reconstruction （MPR） images. The related literatures were reviewed. Results The duration of the nonmetallic marked gauze leaveding in peritoneal cavity ranged from 3 months to 8 years. One case was misdiagnosed as ileal tumor before operation, two cases as gastrointestinal stromal tumor, and one case as sigmoiditis. Among them, small intestine and mass wrapped each other in two cases, small bowel perforation and gauze imbedded in small intestine in one case, and the perforation of small intestine and the sigmoid colon and appendicitis combined with bilateral pyosalpinx in one case. Conclusions The gossypiboma is a uncommon iatrogenic foreign body granuloma. CT is one of the important diagnostic methods, it would play an important role to reduce the misdiagnosis rate and improve the preoperative diagnostic rate by analyzing the imaging features carefully.