Danse E M, Kartheuser A, Paterson H M, Laterre P-F
Department of Radiology, St-Luc University Hospital, Brussels, Belgium.
JBR-BTR. 2009 Jul-Aug;92(4):202-6.
To describe the small bowel wall changes observed with color Doppler sonography in acute mesenteric ischemia with comparison with its outcome.
We reviewed the sonographic findings of 21 patients with a final diagnosis of acute mesenteric ischemia (12 acute arterial forms and 9 acute venous forms). These examinations included identification of non peristaltic thin-walled fluid-filled intestinal loops (with or without pneumatosis), thickened intestinal wall (> 3 mm) (noted as stratified or not), and preserved or absent mural flow assessed with color Doppler. Sonographic findings were compared with the surgical data (n = 16) or with the clinical outcome (n = 5).
In acute arterial ischemia, non-peristaltic thin-walled intestinal loops were detected with sonography in five cases, with visualization of pneumatosis in one. Bowel infarction was diagnosed in four of these five patients including one patient with pneumatosis. Thickened bowel loops were sonographically detected in four cases, of which 3 required resection. Conservative therapy was performed in the remaining case having preserved wall stratification and mural flow with color Doppler. In acute venous ischemia, thickened bowel loops were detected with sonography in six cases. Conservative therapy was performed in three cases for whom preserved mural flow was noted. Stratification was present in two of these three cases.
In acute arterial ischemia, intestinal resection is frequently required when non-peristaltic, thin-walled, fluid-filled loops are detected with sonography. In arterial and venous ischemia, absence of wall stratification and mural flow are frequently associated with ischemia requiring surgery.
描述彩色多普勒超声观察到的急性肠系膜缺血时小肠壁的变化，并与预后进行比较。
我们回顾了最终诊断为急性肠系膜缺血的21例患者的超声检查结果（12例急性动脉型和9例急性静脉型）。这些检查包括识别无蠕动的薄壁充满液体的肠袢（有无积气）、增厚的肠壁（>3mm）（记录为有无分层）以及用彩色多普勒评估肠壁血流是否存在。超声检查结果与手术数据（n = 16）或临床预后（n = 5）进行比较。
在急性动脉缺血中，超声检查发现5例有无蠕动的薄壁肠袢，其中1例可见积气。这5例患者中有4例被诊断为肠梗死，包括1例有积气的患者。超声检查发现4例肠袢增厚，其中3例需要切除。其余1例肠壁分层和彩色多普勒显示肠壁血流存在，进行了保守治疗。在急性静脉缺血中，超声检查发现6例肠袢增厚。3例肠壁血流存在的患者进行了保守治疗。这3例中有2例存在分层。
在急性动脉缺血中，超声检查发现无蠕动、薄壁、充满液体的肠袢时，常需要进行肠切除。在动脉和静脉缺血中，肠壁无分层和肠壁血流缺失常与需要手术的缺血相关。
