Vinci R, Angelelli G, Stabile Ianora A A, Gaballo A, Rotondo A
Dipartimento di Medicina Interna e Medicina Pubblica, Università degli Studi, Bari.
Radiol Med. 1999 Sep;98(3):157-61.
We investigated CT capabilities in showing vascular complications (ischemia, infarction) secondary to intestinal obstruction.
32 patients with small bowel obstruction, subdivided in two groups, were examined with CT. The first group consisted of 12 patients with small bowel obstruction complicated by ischemic injury. It was due to loop strangulation in 10 cases and loop distension secondary to colon carcinoma in 2 cases. At surgery the loop strangulation was caused by adhesions in 9 cases and by jejunal hernia in 1 case. Vascular complications were segmentary small bowel infarction in 7 cases, colonic infarction in 2 cases and ischemia, which was resolved after loop debridement, in 3 cases. The second group consisted of 20 patients with intestinal occlusion due to adhesions complicated by a closed loop in 4 cases. All patients were examined with(out) i.v. contrast agent administration. Filling of the intestinal loops by oral contrast agent was never performed.
CT identified the vascular injury secondary to intestinal obstruction in 11/12 patients (91%). In one case it was not possible to diagnose mild ischemia, which was found of surgery. CT findings were: loops distention in all the cases; wall thickening in 11 cases with intramural gas in 8 cases and slight contrast enhancement in 1 case; ascites in 2 cases; mesenteric edema in 9 cases; gas at the mesenteric root in 1 case. In the control group, small bowel obstruction was diagnosed with CT in all cases based on the presence of distended loops up to the occlusion site. Parietal alterations above the lesion were never found.
CT is a sensitive tool for diagnosing small bowel obstruction and for assessing the site and cause of obstruction. CT plays a pivotal diagnostic role in vascular complications, giving very important indications for a correct treatment.
我们研究了CT在显示肠梗阻继发血管并发症（缺血、梗死）方面的能力。
32例小肠梗阻患者分为两组，接受CT检查。第一组由12例合并缺血性损伤的小肠梗阻患者组成。其中10例是由于肠袢绞窄，2例是由于结肠癌继发肠袢扩张。手术中，9例肠袢绞窄是由粘连引起，1例是由空肠疝引起。血管并发症包括7例节段性小肠梗死、2例结肠梗死以及3例经肠袢清创后缺血得以缓解的病例。第二组由20例因粘连导致肠梗阻的患者组成，其中4例合并闭袢。所有患者均在未使用（或使用）静脉造影剂的情况下接受检查。从未进行过口服造影剂充盈肠袢的操作。
CT在12例患者中的11例（91%）中识别出了肠梗阻继发的血管损伤。有1例未能诊断出轻度缺血，该情况在手术中发现。CT表现为：所有病例均有肠袢扩张；11例肠壁增厚，其中8例有壁内积气，1例有轻微对比增强；2例有腹水；9例有肠系膜水肿；1例在肠系膜根部有气体。在对照组中，根据扩张肠袢直至梗阻部位的存在情况，所有病例均通过CT诊断出小肠梗阻。病变上方从未发现壁层改变。
CT是诊断小肠梗阻以及评估梗阻部位和原因的敏感工具。CT在血管并发症的诊断中起着关键作用，为正确治疗提供非常重要的指征。
