结核性腹膜炎并发肠穿孔的CT特征分析(附七例报告)

CT features of patients with tuberculous peritonitis combined with intestinal perforation(with seven cases)

搜集7例结核性腹膜炎并发肠穿孔患者的CT扫描资料，分析腹膜、大网膜、肠系膜及腹膜后间隙及腹腔实质脏器的CT表现特征。结核性腹膜炎并发肠穿孔患者的CT主要表现：（1）巨大包裹性积液、积气脓肿5例。（2）膈下游离气体1例。（3）肠管周围及腹腔内多发小气泡影7例。（4）并发肠梗阻4例。（5）较高密度少量游离腹腔积液7例。（6）腹膜、网膜增厚7例。（7）肠系膜呈“污迹”状改变7例。（8）并发继发性肺结核6例，并发血行播散性肺结核1例，并发结核性胸膜炎6例。（9）继发肾盂积液6例。因此，结核性腹膜炎并发肠穿孔CT扫描主要表现除少量腹腔积液、腹膜增厚、大网膜及肠系膜受累外，出现膈下游离气体时即提示急性穿孔；腹腔内出现巨大包裹性气一液平脓肿，且肠周围、器官间隙、网膜及系膜区出现多发小气泡影时则提示慢性穿孔。CT扫描能为结核性腹膜炎并发肠穿孔的诊断提供重要信息。

The abdominal CT scans of seven patients with tuberculous peritonitis combined with intestinal perforation were retrospectively reviewed. We analyzed the CT features of the patients, including peritoneum, omentum, mesentery, retroperitoneal space, and abdominal parenchymal viscera. The main features in the abdominal CT scans of tuberculous peritonitis combined with intestinal perforation appeared as follows. （1） Large encapsulated effusion and gas abscess were found in five cases. （2） One case of free gas under the diaphragm was identified. （3） Multiple small bubbles surrounding the bowels and abdominal cavity were present in seven cases. （4） Intestinal obstruction was found in four cases. （5） Small amount of free ascites with high density were identified in seven cases. （6） Peritoneum and retinal thickening were found in seven eases. （7） The mesentery of seven cases showed a ＂smudge＂ change. （8） Secondary pulmonary tuberculosis were identified in six cases, combined hematogenous disseminated pulmonary tuberculosis happened in one patient and combined tuberculous pleurisy were found in two cases. （9） Six cases were found with combined secondary hydronephrosis. Therefore, the CT scan features of tuberculous peritonitis combined with intestinal perforation may appear as a small amount of free ascites, peritoneal thickening, omental and mesenteric involvement. Acute perforation is indicated when free gas under the diaphragm occurs. In addition, chronic perforation is indicated when large encapsulated effusion and gas abscesses appear in the abdominal cavity and surrounding the bowels, multiple small bubbles appear in the omentum and mesentery. CT scan can provide important information for the diagnosis of tuberculous peritonitis combined with intestinal perforation.