Jacob S E, Lee S H, Hill J
Department of Surgery, Manchester Royal Infirmary, Manchester, UK.
Colorectal Dis. 2008 Sep;10(7):729-31. doi: 10.1111/j.1463-1318.2007.01415.x. Epub 2007 Nov 12.
Imaging the colon in suspected acute large bowel obstruction (LBO) is traditionally carried out with a supine abdominal X-ray (AXR) and erect chest X-ray. If there is no clinical or radiological evidence to suggest a perforation, then an unprepared barium or water-soluble contrast enema (CE) can be performed to confirm the presence of and demonstrate the site of obstruction. The advent of modern, fast multidetector CT (MDCT) scanners has changed management strategies for acute abdominal conditions including suspected LBO in all groups of patients especially the elderly, infirm and those on ITU/HDU.
A retrospective case note analysis was carried over a 7-year period in a single centre. The study criteria involved investigation of suspected LBO with CE, CT and MDCT.
It showed a reduction in the number of contrast enemas performed.
MDCT was shown to be more accurate in the diagnosis of LBO, is usually available on a 24-h basis, and in many institutions has replaced the urgent CE in this group of patients. This also has the advantage of excluding incidental findings and in staging malignant disease.
传统上，对于疑似急性大肠梗阻（LBO）的患者，通过仰卧位腹部X线平片（AXR）和立位胸部X线平片对结肠进行成像。如果没有临床或放射学证据提示穿孔，那么可以进行未做肠道准备的钡剂或水溶性造影剂灌肠（CE）以确认梗阻的存在并显示梗阻部位。现代快速多层螺旋CT（MDCT）扫描仪的出现改变了对包括疑似LBO在内的急性腹部疾病的管理策略，尤其是在老年、体弱以及重症监护病房/高依赖病房的患者中。
在单一中心对7年期间的病例记录进行回顾性分析。研究标准包括用CE、CT和MDCT对疑似LBO进行检查。
结果显示进行造影剂灌肠的次数有所减少。
MDCT在LBO的诊断中显示出更高的准确性，通常24小时均可进行检查，并且在许多机构中已取代了对这类患者进行的紧急CE检查。这还有助于排除偶然发现以及对恶性疾病进行分期。
