Ghahremani G G, Meyers M A
Am J Roentgenol Radium Ther Nucl Med. 1975 Sep;125(1):21-34. doi: 10.2214/ajr.125.1.21.
In approximately 80 per cent of cases the gallbladder is closely applied to the superior medial aspect of the right colic flexure. This intimate anatomic relationship provides pathways for direct extension of both inflammatory and neoplastic lesions of the gallbladder to involve the adjacent colon. The resultant secondary colonic abnormalities noted in 15 patients have been analyzed and correlated with surgical-pathologic findings. In acute cholecystitis, barium enema examination shows evidence of indentation by an enlarged gallbladder, spasm and mucosal edema in the anterior hepatic flexure. Chronic cholecystitis results in involvement of the adjacent colon by fibrous adhesions and inflammatory reaction. These may further lead to the development of pseudotumors simulating primary carcinoma of the colon. Similar findings including cholecysto-colic fistulae may be the initial manifestations of carcinoma of the gallbladder. The spectrum of pathologic-roentgenographic alterations in the cholecysto-colic interface is described and illustrated. Recognition of these features is of critical importance for the correct interpretation of barium enema findings and the subsequent management of patients with gallbladder disorders.
在大约80%的病例中，胆囊紧密贴附于右结肠曲的上内侧。这种密切的解剖关系为胆囊的炎症和肿瘤性病变直接蔓延至相邻结肠提供了途径。对15例患者出现的继发性结肠异常进行了分析，并与手术病理结果相关联。在急性胆囊炎中，钡剂灌肠检查显示有增大的胆囊造成的压迹、肝曲前部的痉挛和黏膜水肿。慢性胆囊炎会导致相邻结肠受到纤维粘连和炎症反应的累及。这些情况可能进一步导致模拟结肠癌的假肿瘤形成。包括胆囊结肠瘘在内的类似表现可能是胆囊癌的首发症状。本文描述并举例说明了胆囊结肠界面的病理X线改变范围。认识这些特征对于正确解读钡剂灌肠检查结果以及后续胆囊疾病患者的治疗至关重要。
