儿童十二指肠壁内血肿的临床及影像特征

Clinical and imaging features of intramural duodenal hematoma in children

目的:探讨儿童十二指肠壁内血肿的临床及影像特征,提高诊断准确率,减少不必要手术。方法:回顾性分析2011年8月-2021年3月我院经手术或临床确诊且临床及影像资料完整的11例儿童十二指肠壁内血肿病例。10例行X线检查,3例行上消化道造影检查,11例行上腹部CT平扫及增强扫描检查。结果:10例X线均未见气腹。3例上消化道造影显示十二指肠不全性梗阻。11例上腹部CT平扫显示沿十二指肠走行囊性病灶,范围3.3~9.4 cm(中位值4.6 cm),囊壁增厚,厚度1.9~6.9 mm(中位值3.4 mm),囊内密度不均匀,中央为稍高密度-融冰征,增强扫描囊壁轻微强化2例。其他影像学改变包括腹腔积液10例,肝内外胆管稍扩张4例,胰腺损伤1例,肝挫伤1例,车祸伤致肺挫裂伤、创伤性左侧膈疝、骨盆、四肢长骨骨折1例。结论:影像检查是诊断儿童十二指肠壁内血肿的最重要手段。CT增强扫描能清晰显示十二指肠血肿的位置、范围及其他实质性器官损伤,为临床诊断及治疗提供依据。

Objective:To explore the clinical and imaging features of intramural duodenal hematoma in children,improve the diagnostic accuracy and reduce unnecessary surgery.Methods:Eleven children with intramural duodenal hematoma with complete clinical and imaging data diagnosed surgically and/or clinically in our hospital from August 2011 to March 2021 were analyzed retrospectively.X-ray examinations were performed in 10 cases,upper gastrointestinal radiography in 3 cases and plain and enhanced CT scanning of the upper abdomen were performed in 1l cases.Results:No pneumoperitoneum was found in 10 X-ray examinations.Upper gastrointestinal angiography showed duodenal incomplete obstruction in 3 cases.CT showed cystic lesions along with the duodenum in 11 cases,ranging from 3.3~9.4 cm,with a median size of 4.6 cm.The cyst walls were thick,with a thickness of 1.9~6.9 mm and a median thickness of 3.4 mm.The density in the capsules was uneven,and the centers were higher density-ice melting sign.There were 2 cases of cyst wall mild enhancement,10 cases of ascites,4 cases of slight dilatation of intrahepatic and extrahepatic bile ducts,1 case of pancreatic injury with peripheral blur,and 1 case of liver contusion.One case of traffic accident injury complicated with pulmonary contusion and laceration,traumatic left diaphragmatic hernia,pelvic and limb long bone fracture.Conclusions:Imaging examination was the most important means to diagnose intramural duodenal hematoma in children.Contrast-enhanced CT scan could clearly show the location and size of intramural duodenal hematoma and other substantive organ injuries which was important for clinical diagnosis and treatment.