Ferstl F J, Obert R
Radiologisch-Nuklearmedizinisches Zentrum am St. Theresienkrankenhaus Nürnberg.
Rofo. 2004 Feb;176(2):246-51. doi: 10.1055/s-2004-817635.
Small bowel diverticulitis is a rare cause of an acute abdomen. Originating from acquired diverticula of the jejunum, less often of the ileum, or Meckel diverticulum, the symptoms are nonspecific, simulating other acute inflammatory disorders, such as appendicitis, cholecystitis or colonic diverticulitis. The diagnosis of small bowel diverticulitis is solely based on radiologic findings, with computed tomography (CT) regarded as the method of choice. In recent years, a number of case reports have described the spectrum of the CT features in acute small bowel diverticulitis and its dependence on the severity of the inflammatory process. Typical findings are an inflamed diverticulum, inflammatory mesenteric infiltration, extraluminal gas collection and mural edema of adjacent small bowel loops with resultant separation of bowel loops. An enterolith is rarely found in an inflamed diverticulum. Complications include abscesses, fistulae, small bowel obstruction and free perforation with peritonitis. Small bowel diverticulitis can be a diagnostic problem if it involves the terminal ileum or Meckel's diverticulum. For preoperative confirmation of the presumed diagnosis of small bowel diverticulitis on CT, an enteroclysis for acquired diverticula or a technetium scan for Meckel's diverticulum should be performed. We present the CT findings in three patients of acute small bowel diverticulitis, two affecting the jejunum and one a Meckel's diverticulum.
小肠憩室炎是急腹症的罕见病因。它起源于空肠后天性憩室,回肠或梅克尔憩室较少见,其症状不具有特异性,可模拟其他急性炎症性疾病,如阑尾炎、胆囊炎或结肠憩室炎。小肠憩室炎的诊断完全基于影像学检查结果,计算机断层扫描(CT)被视为首选方法。近年来,一些病例报告描述了急性小肠憩室炎的CT特征谱及其与炎症过程严重程度的相关性。典型表现为发炎的憩室、炎性肠系膜浸润、腔外气体积聚以及相邻小肠肠袢壁水肿,导致肠袢分离。发炎的憩室内很少发现肠石。并发症包括脓肿、瘘管、小肠梗阻和伴有腹膜炎的游离穿孔。如果小肠憩室炎累及回肠末端或梅克尔憩室,可能会成为诊断难题。为在术前通过CT确诊小肠憩室炎的推测诊断,对于后天性憩室应进行小肠灌肠造影,对于梅克尔憩室应进行锝扫描。我们展示了3例急性小肠憩室炎患者的CT表现,其中2例累及空肠,1例累及梅克尔憩室。