Scaglione Mariano, de Lutio di Castelguidone Elisabetta, Scialpi Michele, Merola Stefanella, Diettrich Andrea Irma, Lombardo Patrizia, Romano Luigia, Grassi Roberto
Department of Radiology, "A. Cardarelli" Hospital, Via G. Merliani 31, 80127 Naples, Italy.
Eur J Radiol. 2004 Apr;50(1):67-73. doi: 10.1016/j.ejrad.2003.11.016.
The CT diagnosis of bowel and mesenteric injuries is difficult and warrants optimal technique and skilled interpretation. We retrospectively reviewed 36 consecutive patients with blunt traumatic injuries to the bowel and mesentery at our regional level I trauma center during the past 3 years. Physical examination, laboratory, Computed tomographic (CT), and intraoperative findings were compared. Surgically proven bowel injuries (13 cases) occurred in the duodenum (three cases), ileum (two cases), jejunum (two cases), colon (three cases), and stomach (three cases). CT findings considered specific of bowel rupture were observed in 5/13 patients including: extraluminal oral contrast or luminal content extravasation (four cases) and discontinuity of hollow viscus wall (one case). In the remaining 8/13 CT findings considered suggestive of bowel injury consisted of: pneumoperitoneum (six), gas bubbles close to the injured hollow viscus (three), thickened (>4-5mm) bowel wall (five), bowel wall hematoma (three), intraperitoneal fluid of unknown source (three). Mesenteric injury (23 cases) were surgically observed at the level of the mesenteric vessels (17 cases), legament of Treitz (two cases), gastro-duodenal artery (one case), transverse (one case) and sigmoid mesocolon (one case). CT finding considered specific of mesenteric laceration was active extravasation of contrast material from the mesenteric vessels (10 cases). CT findings suggestive of mesenteric injury (13 cases) consisted of: mesenteric hematoma (five) and/or high attenuation fluid collections, within the mesenteric root (eight) and folds (four). Helical CT is sensitive in the identification of bowel and mesenteric injury after blunt trauma providing a wide spectrum of findings. However, CT cannot be used as the sole indicator in cases with isolated thichened bowel wall, mesenteric hematoma, bowel hematoma, pneumoperitoneum or gas bubbles. Persistent, active extravasation of intravenous constrast medium from the mesenteric vessels, in isolation or associated with further injuries, requires immediate exploration and repair; disruption of bowel wall and extravasation of oral contrast are definite signs of bowel rupture. Close clinical observation, monitoring, and surgical expertise are mandatory for appropriate management.
肠道和肠系膜损伤的CT诊断具有挑战性，需要采用最佳技术并由经验丰富的医生进行解读。我们回顾性分析了过去3年在我们地区一级创伤中心连续收治的36例钝性创伤致肠道和肠系膜损伤的患者。对比了体格检查、实验室检查、计算机断层扫描（CT）及术中所见。手术证实的肠道损伤（13例）发生于十二指肠（3例）、回肠（2例）、空肠（2例）、结肠（3例）和胃（3例）。13例患者中有5例出现了被认为是肠道破裂特异性的CT表现，包括：肠腔外口服对比剂或肠腔内内容物外渗（4例）及中空脏器壁连续性中断（1例）。其余8例被认为提示肠道损伤的CT表现包括：气腹（6例）、靠近受损中空脏器的气泡（3例）、肠壁增厚（>4 - 5mm）（5例）、肠壁血肿（3例）、不明来源的腹腔内积液（3例）。手术观察到肠系膜损伤（23例）发生于肠系膜血管水平（17例）、Treitz韧带（2例）、胃十二指肠动脉（1例）、横结肠系膜（1例）和乙状结肠系膜（1例）。被认为是肠系膜撕裂特异性的CT表现为对比剂从肠系膜血管主动外渗（10例）。提示肠系膜损伤的CT表现（13例）包括：肠系膜血肿（5例）和/或肠系膜根部（8例）及肠襻（4例）内的高密度液体聚集。螺旋CT对钝性创伤后肠道和肠系膜损伤的识别很敏感，可发现多种表现。然而，对于孤立的肠壁增厚、肠系膜血肿、肠血肿、气腹或气泡的病例，CT不能作为唯一的诊断指标。肠系膜血管持续、主动的静脉对比剂外渗，无论单独出现还是伴有其他损伤，均需立即进行探查和修复；肠壁中断和口服对比剂外渗是肠道破裂的确切征象。密切的临床观察、监测及手术专业知识对于恰当的处理至关重要。
