Guingrich J A, Kuhlman J E
Department of Radiology, University of Wisconsin Hospital and Clinics, Madison 53792-3252, USA.
AJR Am J Roentgenol. 1999 Apr;172(4):919-24. doi: 10.2214/ajr.172.4.10587121.
The purpose of this study was to determine the prevalence and spectrum of colonic wall changes in patients with cirrhosis and to determine the association between these colonic wall changes and portal hypertension.
Abdominal CT examinations of 57 patients with cirrhosis were evaluated for colonic abnormalities including bowel wall thickening and pneumatosis. The degree and extent of colonic involvement, other CT features of cirrhosis including ascites and portal hypertension, and clinical symptoms were recorded. A correlation was made with available colonoscopy, exploratory laparotomy, and pathologic results.
Colonic wall abnormalities were seen in 37% (21/57) of the patients with cirrhosis, 25% (14/57) of whom had isolated or predominantly right-sided colonic changes. Abnormal bowel wall thickening (ranging from 6 mm to 3 cm in thickness) was present in 35% of the patients. Pneumatosis was found in 4% of the patients. Of the 18 liver transplant recipients who had CT examinations before and after liver transplantation, colonic changes were seen in 44% preoperatively but in only 6% postoperatively. Isolated right-sided colonic changes and diffuse colonic changes were associated with varices in 93% and 100% of the patients, respectively; with ascites in 93% and 100%, respectively; and with splenomegaly in 83% and 86%, respectively. Specific or focal bowel symptoms were present in only 29% of the patients with colonic changes, whether the changes were diffuse or isolated to the right side.
Thirty-five percent of the patients with severe cirrhosis who underwent CT were shown to have colonic wall thickening; two thirds of these patients had thickening limited predominantly to the right colon. We postulated that predominantly right-sided colonic wall thickening may be related to changes in blood flow and hydrostatic pressures caused by portal hypertension. Many patients with isolated or predominately right-sided colonic wall thickening did not have specific or focal bowel symptoms, and in most patients, the colonic wall thickening resolved after successful liver transplantation, requiring no further testing. On the other hand, we found that pneumatosis or severe diffuse colonic wall thickening may indicate a more serious colonic problem such as ischemia or infection with Clostridium difficile and should prompt further investigation.
本研究旨在确定肝硬化患者结肠壁改变的患病率和范围，并确定这些结肠壁改变与门静脉高压之间的关联。
对57例肝硬化患者的腹部CT检查进行评估，以确定结肠异常情况，包括肠壁增厚和气肿。记录结肠受累的程度和范围、肝硬化的其他CT特征（包括腹水和门静脉高压）以及临床症状。将其与可用的结肠镜检查、剖腹探查和病理结果进行关联分析。
57例肝硬化患者中，37%（21/57）出现结肠壁异常，其中25%（14/57）患者有孤立性或主要为右侧结肠改变。35%的患者存在肠壁异常增厚（厚度范围为6毫米至3厘米）。4%的患者发现有气肿。在18例肝移植受者中，18例在肝移植前后均进行了CT检查，术前44%出现结肠改变，术后仅6%出现结肠改变。孤立性右侧结肠改变和弥漫性结肠改变分别与93%和100%的患者静脉曲张相关；分别与93%和100%的患者腹水相关；分别与83%和86%的患者脾肿大相关。无论结肠改变是弥漫性还是孤立于右侧，仅有29%出现结肠改变的患者有特异性或局限性肠道症状。
接受CT检查的严重肝硬化患者中，35%显示有结肠壁增厚；其中三分之二患者的增厚主要局限于右结肠。我们推测，主要为右侧结肠壁增厚可能与门静脉高压引起的血流和静水压变化有关。许多孤立性或主要为右侧结肠壁增厚的患者没有特异性或局限性肠道症状，且在大多数患者中，成功肝移植后结肠壁增厚消失，无需进一步检查。另一方面，我们发现气肿或严重弥漫性结肠壁增厚可能提示更严重的结肠问题，如缺血或艰难梭菌感染，应促使进一步检查。
