Ghekiere Olivier, Lesnik Alvian, Hoa Denis, Laffargue Guillaume, Uriot Claire, Taourel Patrice
Department of Radiology, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France.
J Comput Assist Tomogr. 2007 Mar-Apr;31(2):169-76. doi: 10.1097/01.rct.0000237809.11123.8e.
To identify computed tomographic features with a high predictive value to differentiate gastroduodenal ulcer perforations from other causes of perforations in patients with a non-traumatic-free pneumoperitoneum.
Computed tomographic scans of 81 patients with a non-traumatic-free pneumoperitoneum were reviewed for direct visualization of the perforation site and indirect findings of the perforation, including the presence, amount, and localization of air and ascites in the peritoneal cavity, mural thickness of the gastrointestinal tract, perigastrointestinal fat stranding, intestinal ischemia, fecal peritonitis, abscess, and portomesenteric venous gas.
The perforation site was directly visualized in 16 (41%) of 39 patients with gastroduodenal ulcer perforation and in 5 (12%) of 42 patients with other causes of perforation. The findings with a positive predictive value of more than 90% for gastroduodenal ulcer perforation were the presence of local fluid between the duodenum and the pancreatic head and the combination of local gastroduodenal wall thickening and fat stranding. The presence of abscess in the peritoneal cavity or fecal peritonitis, portomesenteric gas, or bowel ischemia findings had a positive predictive value of 100% for the diagnosis of other perforations.
Indirect computed tomographic findings are helpful for differentiating gastroduodenal ulcer perforation from other causes of perforations.
识别具有高预测价值的计算机断层扫描特征，以区分非创伤性气腹患者的胃十二指肠溃疡穿孔与其他原因导致的穿孔。
回顾了81例非创伤性气腹患者的计算机断层扫描，以直接观察穿孔部位及穿孔的间接表现，包括腹腔内气体和腹水的存在、量及定位、胃肠道壁厚度、胃肠道周围脂肪条索状改变、肠缺血、粪性腹膜炎、脓肿及门静脉肠系膜静脉积气。
39例胃十二指肠溃疡穿孔患者中有16例（41%）直接观察到穿孔部位，42例其他原因导致穿孔的患者中有5例（12%）直接观察到穿孔部位。对胃十二指肠溃疡穿孔阳性预测值超过90%的表现为十二指肠与胰头之间存在局部液体以及局部胃十二指肠壁增厚与脂肪条索状改变并存。腹腔内存在脓肿或粪性腹膜炎、门静脉肠系膜积气或肠缺血表现对诊断其他穿孔的阳性预测值为100%。
计算机断层扫描间接表现有助于区分胃十二指肠溃疡穿孔与其他原因导致的穿孔。
