lemon2008 发表于 2011-8-15 20:12:02

小肠扭转(Small-Intestinal Volvulus)CT病例


腹部CT增强扫描显示肠系膜血管旋涡征(mesenteric vessel whirl sign )(箭头),肠系膜上动脉围绕肠系膜上静脉呈360度顺时针旋转包围。此影像学表现称为“旋涡征”,肠管绕着一个固定的梗阻点旋转,提示肠扭转。
    A 67-year-old man presented to the emergency department with acute abdominal pain, which had started 3 hours earlier. On physical examination, the abdomen was distended and tender to palpation. The levels of serum lipase and lactate were within normal limits, as were the white-cell count and hematocrit. The abdominal pain persisted and progressed in severity even after the administration of analgesic drugs. Abdominal computed tomography with intravenous contrast material revealed twisting of mesenteric pedicles (arrows), with the superior mesenteric artery encircled by the superior mesenteric vein in a 360-degree clockwise rotation. This radiologic finding is known as the “whirl sign,” which occurs when bowel loops rotate around a fixed point of obstruction, suggesting intestinal volvulus. An emergency laparotomy was performed, which confirmed the diagnosis of small-bowel volvulus. A jejunal diverticulum with an adhesion band located 40 cm below the ligament of Treitz was identified as the cause of this volvulus. The patient underwent reduction of the volvulus and resection of the jejunal diverticulum. He subsequently made a full recovery.

Ming-Yuan Hong, M.D.
Chih-Hsien Chi, M.D.
National Cheng Kung University Hospital, Tainan, Taiwan
chich@mail.ncku.edu.tw原文链接:http://www.nejm.org/doi/full/10.1056/NEJMicm0806895#figure=f1

lemon2008 发表于 2011-8-15 20:15:18

CT上,扩张肠段至正常肠腔的移行点未发现有其它病因时,可确认为粘连性肠梗阻。
肠闭襻(closed loop)时,在横断面CT图像上闭襻的肠曲可构成"U"型或"C"型,在箝闭的肠段内可见放射状肠系膜血管向扭结部位集中。肠扭转处可显示“鸟喙征-beak sign”或“旋涡征-whirl sign”。
绞窄性肠梗阻的发病率各家报告不一,由粘连,内、外疝引起的肠梗阻中5%-42%可并发。CT的诊断征象有:高CT值的环形增厚肠壁;“靶征-target sign”;肠系膜血管充血或出血;肠壁积气(pnematosis intestinalis);

wangbingliang 发表于 2011-8-16 06:56:16

典型病例,谢谢分享。

飞鹰行动 发表于 2011-8-16 16:13:37

谢谢,分享。
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