Scaglione M, Romano L, Pinto A, Forner A L, De Lutio di Castelguidone E, Giovine S, Pinto F, Grassi R
Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Napoli.
Radiol Med. 2000 Mar;99(3):165-8.
Colonic diverticula are saccules made of colonic mucosa and submucosa that herniate from the colonic lumen through the muscular layer of the wall where straight vessels penetrate. Diverticula are localized in the sigmoid colon in 95% of cases. Bacteria pooling in the lumen may cause lumen erosion and eventually perforation. CT is a useful technique in this condition because it can demonstrate intra- and/or extramural inflammation. Aim of this retrospective study was to assess the capabilities of contrast-enhanced helical Computed Tomography (CT) in sigmoid diverticulitis, especially relative to selection of the appropriate treatment.
We retrospectively reviewed the findings of 41 patients referred to our emergency department for diverticulitis. CT scans were performed 65 seconds after i.v. injection of nonionic contrast material (3 mL/s, 120 mL in all) administered by a CT-power injector. The following 7 CT findings were considered at least suggestive of acute diverticulitis: focal wall thickening, intramural abscess, inflammatory changes in the sigmoid mesentery root, pericolic fat inflammation or pericolic abscess formation, fistula, peritonitis. CT results were compared with surgical and physical findings.
Based on CT findings, diverticulitis was classified as mild (25 patients) or severe (15 patients). In mild diverticulitis we found: focal sigmoid wall thickening (6 patients), intramural abscess (3 patients), sigmoid mesentery root thickening (5 patients), edema fluid (8 patients) and phlegmon (3 patients). In severe diverticulitis we found: sigmoid mesentery abscess (6 patients), fistula (5 patients) and peritonitis (4 patients). CT findings were questionable in 1 case and thus we could not exclude a perforated carcinoma.
Contrast-enhanced helical CT is the imaging modality of choice in assessing mild or severe acute diverticulitis because it provides useful information for appropriate treatment planning in the emergency setting. This technique is most useful in questionable cases and in patients with suspected severe diverticulitis where a choice must be made between different treatment options.
结肠憩室是由结肠黏膜和黏膜下层构成的囊袋，通过肠壁肌层中直血管穿入处从结肠腔疝出。95%的病例中憩室位于乙状结肠。憩室内细菌聚集可导致肠腔糜烂并最终穿孔。CT在此种情况下是一种有用的技术，因为它能够显示壁内和/或壁外炎症。这项回顾性研究的目的是评估对比增强螺旋计算机断层扫描（CT）在乙状结肠憩室炎中的应用能力，尤其是相对于选择合适治疗方法方面。
我们回顾性分析了41例因憩室炎转诊至我院急诊科患者的检查结果。通过CT高压注射器静脉注射非离子型对比剂（3 mL/s，共120 mL）65秒后进行CT扫描。以下7项CT表现至少提示急性憩室炎：局灶性肠壁增厚、壁内脓肿、乙状结肠系膜根部炎症改变、结肠周围脂肪炎症或结肠周围脓肿形成、瘘管、腹膜炎。将CT结果与手术及体格检查结果进行比较。
根据CT表现，憩室炎分为轻度（25例患者）或重度（15例患者）。在轻度憩室炎中我们发现：乙状结肠局灶性肠壁增厚（6例患者）、壁内脓肿（3例患者）、乙状结肠系膜根部增厚（5例患者）、水肿液（8例患者）和蜂窝织炎（3例患者）。在重度憩室炎中我们发现：乙状结肠系膜脓肿（6例患者）、瘘管（5例患者）和腹膜炎（4例患者）。1例患者的CT表现存在疑问，因此我们无法排除穿孔性癌。
对比增强螺旋CT是评估轻度或重度急性憩室炎的首选成像方式，因为它为急诊情况下的恰当治疗方案制定提供了有用信息。这项技术在存在疑问的病例以及疑似重度憩室炎且必须在不同治疗方案之间做出选择的患者中最为有用。
