Furukawa A, Sakoda M, Yamasaki M, Kono N, Tanaka T, Nitta N, Kanasaki S, Imoto K, Takahashi M, Murata K, Sakamoto T, Tani T
Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho Otsu, Shiga 520-2192, Japan.
Abdom Imaging. 2005 Sep-Oct;30(5):524-34. doi: 10.1007/s00261-004-0289-x.
Gastrointestinal tract perforation is an emergent condition that requires prompt surgery. Diagnosis largely depends on imaging examinations, and correct diagnosis of the presence, level, and cause of perforation is essential for appropriate management and surgical planning. Plain radiography remains the first imaging study and may be followed by intraluminal contrast examination; however, the high clinical efficacy of computed tomographic examination in this field has been well recognized. The advent of spiral and multidetector-row computed tomographic scanners has enabled examination of the entire abdomen in a single breath-hold by using thin-slice sections that allow precise assessment of pathology in the alimentary tract. Extraluminal air that is too small to be detected by conventional radiography can be demonstrated by computed tomography. Indirect findings of bowel perforation such as phlegmon, abscess, peritoneal fluid, or an extraluminal foreign body can also be demonstrated. Gastrointestinal mural pathology and associated adjacent inflammation are precisely assessed with thin-section images and multiplanar reformations that aid in the assessment of the site and cause of perforation.
胃肠道穿孔是一种需要立即进行手术的急症。诊断很大程度上依赖于影像学检查，正确诊断穿孔的存在、部位及原因对于恰当的处理和手术规划至关重要。腹部平片仍然是首选的影像学检查，随后可能会进行腔内对比检查；然而，计算机断层扫描检查在该领域的高临床效能已得到充分认可。螺旋和多层螺旋计算机断层扫描仪的出现，使得通过使用薄层扫描在一次屏气过程中对整个腹部进行检查成为可能，这些薄层扫描能够精确评估消化道的病变情况。计算机断层扫描能够显示常规放射摄影无法检测到的少量腹腔积气。肠道穿孔的间接征象，如蜂窝织炎、脓肿、腹腔积液或腔外异物也能够被显示出来。利用薄层图像和多平面重建可以精确评估胃肠道壁的病变及相关的邻近炎症，这有助于评估穿孔的部位和原因。
