Yeung Kwok-Wan, Chang Ming-Sung, Hsiao Chao-Peng, Huang Jee-Fu
Department of Radiology, Foo-Yin University Hospital, 5, Chung San Road, Tung Kang, Ping Tung, 928 Taiwan, ROC.
Clin Imaging. 2004 Sep-Oct;28(5):329-33. doi: 10.1016/S0899-7071(03)00204-3.
The purpose of this study is to review the computed tomography (CT) appearance of gastrointestinal tract (GI) perforation. Forty-two patients with 10 cases of proximal GI perforation and 32 cases of distal GI perforation were evaluated based on the CT findings of extraluminal air (which was subdivided into the CT-falciform ligament sign crossing the midline and scattered pockets of air), bowel wall thickening (>8 mm in gastroduodenal wall, >3 mm in the small bowel wall, >6 mm in the caliber of the appendix and >5 mm in the colonic wall), associated abscess formation, ascites and adjacent fat stranding. The results were compared using Fisher's Exact Test. Detection of extraluminal air in the upright plain films and CT was analyzed by Z test. Our results showed that CT-falciform ligament sign was more frequent in the proximal GI perforation, while pockets of extraluminal air (excluding the cases accompanying CT-falciform ligament sign), bowel wall thickening and fat stranding were found in higher incidence in distal GI perforation (P<.05). CT detected extraluminal air in more cases than the upright plain films did (69% vs. 19%; Z=4.62>Z(0.01)=2.326). We concluded that CT is a good imaging tool to differentiate the various GI perforations.
本研究的目的是回顾胃肠道（GI）穿孔的计算机断层扫描（CT）表现。基于腔外气体的CT表现（分为穿过中线的CT镰状韧带征和散在的气体腔）、肠壁增厚（胃十二指肠壁>8mm，小肠壁>3mm，阑尾管径>6mm，结肠壁>5mm）、相关脓肿形成、腹水和邻近脂肪条索，对42例患者（10例近端GI穿孔和32例远端GI穿孔）进行了评估。使用Fisher精确检验比较结果。通过Z检验分析立位平片和CT中腔外气体的检测情况。我们的结果显示，CT镰状韧带征在近端GI穿孔中更常见，而腔外气体腔（不包括伴有CT镰状韧带征的病例）、肠壁增厚和脂肪条索在远端GI穿孔中的发生率更高（P<0.05）。CT检测到腔外气体的病例比立位平片更多（69%对19%；Z=4.62>Z(0.01)=2.326）。我们得出结论，CT是鉴别各种GI穿孔的良好成像工具。
