Seitz K, Merz M
Innere Abteilung, Kreiskrankenhaus Sigmaringen.
Ultraschall Med. 1998 Dec;19(6):242-9. doi: 10.1055/s-2007-1000499.
Bowel obstruction is an acute alarming situation with limited diagnostic conditions. Therapeutic decisions must be taken in time. Diagnostic differentiation between incomplete or complete bowel obstruction, intestinal obstruction and paralytic ileus is often uncertain and the underlying cause difficult to detect. Besides plain films in acute abdomen the ultrasound examination presents important additional informations: 1st Dilated intestinal loops and gas caps correlate with the characteristic x-ray finding, i.e. erected dilated intestinal loops with fluid levels. The location of the obstruction is defined in small bowel obstruction by differentiation between jejunum (with Kerckring folds) and ileum (without Kerckring folds). In large bowel obstruction the caecum is dilated and a collapse of the distal colon is detectable. 2nd Additional sonographical findings are: oedema of the intestinal walls, hyperpendulum peristalsis or absence of peristalsis, sedimentation of intestinal contents, pearlstring-like lined up gas bubbles under the ventral intestinal walls, and concomitant ascites. Duplex sonographical studies of the intestinal peristalsis may help to differentiate between mechanical obstruction and paralytic ileus. 3rd In bowel obstruction stenoses can be detected as a result of tumour, Crohn's disease diverticulitis, invagination, strangulated hernias or gall stone ileus. Intestinal adhesions cannot be found by ultrasound. Small and large bowel is dilated in paralytic ileus. Numerous causes like acute pancreatitis, ureteral colic, free gastrointestnal perforation and so on can be diagnosed. 4th In ileus of vascular disorder early diagnosis is high important, but inspite of colour flow imaging diagnostic possibilities are limited. 5th Sonographical diagnosis is of special interest when the x-ray plain films is "empty". The lack of massive fluid collection and meteorism allows an optimal ultrasound examination. In this early phase disorders of peristalsis and intestinal walls are reliably found, and it is easier to find the cause of bowel obstruction. In this way the definitive diagnosis can be arrived at earlier, because it still takes up to 6 hours to obtain the classical x-ray finding. There is a rule that the earlier ultrasound is done, the more findings one will get.
肠梗阻是一种诊断条件有限的急性警示情况。必须及时做出治疗决策。不完全性或完全性肠梗阻、机械性肠梗阻和麻痹性肠梗阻之间的诊断鉴别往往不明确，且潜在病因难以检测。除了腹部平片外，超声检查还能提供重要的额外信息：1. 扩张的肠袢和气帽与特征性的X线表现相关，即直立扩张的肠袢伴有液平面。在小肠梗阻中，通过区分空肠（有克尔克林皱襞）和回肠（无克尔克林皱襞）来确定梗阻部位。在大肠梗阻中，盲肠扩张，可检测到远端结肠塌陷。2. 其他超声检查结果包括：肠壁水肿、蠕动亢进或无蠕动、肠内容物沉降、腹侧肠壁下呈珍珠串状排列的气泡以及伴有腹水。对肠道蠕动进行双功超声研究可能有助于区分机械性梗阻和麻痹性肠梗阻。3. 在肠梗阻中，可检测到由肿瘤、克罗恩病、憩室炎、肠套叠、绞窄性疝或胆石性肠梗阻导致的狭窄。超声无法发现肠粘连。麻痹性肠梗阻时小肠和大肠均扩张。可诊断出许多病因，如急性胰腺炎、输尿管绞痛、胃肠道游离穿孔等。4. 在血管性疾病导致的肠梗阻中，早期诊断非常重要，但尽管有彩色血流成像，诊断可能性仍然有限。5. 当X线平片显示“阴性”时，超声诊断特别有意义。缺乏大量液体积聚和肠积气可进行最佳超声检查。在此早期阶段，可可靠地发现蠕动和肠壁的异常，更容易找到肠梗阻的病因。这样就能更早地做出明确诊断，因为获得经典的X线表现仍需长达6小时。有一条规律是，超声检查进行得越早，发现的结果就越多。
