急性坏疽性阑尾炎穿孔的CT诊断

CT diagnosis of acute gangrenous appendicitis perforation

目的:观察分析急性坏疽阑尾炎穿孔多排螺旋CT的影像学特征,以期提高诊断和鉴别诊断水平。方法:回顾性搜集2017年1月—2021年6月于苏州高新区人民医院经手术病理证实的20例急性坏疽阑尾炎穿孔患者的临床CT影像资料,对CT表现进行分析与总结。结果:20例急性坏疽穿孔性阑尾炎均出现阑尾外径增粗及周围渗出及腹腔积液,阑尾外径平均为(10.87±4.32)m m;16例腹腔见游离小气泡影;14例阑尾粪石阳性,其中2例粪石部分游离腔外;6例形成阑尾周围脓肿包块;8例阑尾腔内积气;12例盲肠壁增厚;6例回盲部淋巴结肿大(短径> 10 mm);18例小肠不同程度的郁张积气,个别并发严重肠梗阻。结论:MSCT可直观、快捷、有效地诊断急性坏疽性阑尾炎穿孔,有利于临床对急性坏疽性阑尾炎穿孔进行及时诊断和治疗。

Objective To observe and analyze the imaging characteristics of acute gangrenous appendicitis perforated multi-row spiral CT,with a view to improving the level of diagnosis and differential diagnosis.Methods The clinical CT imaging data of 20patients with acute gangrenous appendicitis perforation confirmed by surgical pathology in Suzhou high tech Zone People’s Hospital from January 2017 to Jun 2021 were collected retrospectively,and the CT findings was analyzed and summarized.Results 20 cases of acute gangrenous perforated appendicitis all showed appendix a thickening and surrounding oozing and abdominal fluid partly free of the cavity,the average outer diameter of appendix was(10.87±4.32) mm;Free small air bubbles were seen in 16 cases;14cases of appendiceal fecal calculus were positive,of which 2 cases were partially free from the cavity;6 cases formed abscess clumps around the appendix;8 cases of gas build-up in the appendix cavity;12 cases of thickening of the wall of the blind intestine;6 cases of swelling of the back-blind lymph nodes(short diameter greater than 10mm);18 cases of depression gas in different degrees of the small intestine,with individual and severe intestinal obstruction.Conclusion MSCT can diagnose acute gangrenous appendicitis perforation intuitively,quickly and effectively,which is beneficial to the timely diagnosis and treatment of acute gangrenous appendicitis perforation in clinical practice.