Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 333 Taoyuan, Taiwan, China.
World J Gastroenterol. 2011 Jan 21;17(3):379-84. doi: 10.3748/wjg.v17.i3.379.
To study the computed tomography (CT) signs in facilitating early diagnosis of necrotic stercoral colitis (NSC).
Ten patients with surgically and pathologically confirmed NSC were recruited from the Clinico-Pathologic-Radiologic conference at Chang Gung Memorial Hospital, Taoyuan, Taiwan. Their CT images and medical records were reviewed retrospectively to correlate CT findings with clinical presentation.
All these ten elderly patients with a mean age of 77.1 years presented with acute abdomen at our Emergency Room. Nine of them were with systemic medical disease and 8 with chronic constipation. Seven were with leukocytosis, two with low-grade fever, two with peritoneal sign, and three with hypotensive shock. Only one patient was with radiographic detected abnormal gas. Except the crux of fecal impaction, the frequency of the CT signs of NSC were, proximal colon dilatation (20%), colon wall thickening (60%), dense mucosa (62.5%), mucosal sloughing (10%), perfusion defect (70%), pericolonic stranding (80%), abnormal gas (50%) with pneumo-mesocolon (40%) in them, pericolonic abscess (20%). The most sensitive signs in decreasing order were pericolonic stranding, perfusion defect, dense mucosal, detecting about 80%, 70%, and 62.5% of the cases, respectively.
Awareness of NSC and familiarity with the CT diagnostic signs enable the differential diagnosis between NSC and benign stool impaction.
研究计算机断层扫描（CT）征象在促进坏疽性粪石性结肠炎（NSC）早期诊断中的作用。
从中国台湾长庚纪念医院临床病理放射科联合会诊中招募了 10 名经手术和病理证实的 NSC 患者。回顾性分析他们的 CT 图像和病历，将 CT 表现与临床表现进行相关性分析。
这 10 名老年患者平均年龄为 77.1 岁，均因急性腹痛至我院急诊就诊。其中 9 例患有系统性内科疾病，8 例患有慢性便秘。7 例白细胞增多，2 例低热，2 例有腹膜征象，3 例低血压休克。仅有 1 例患者放射检查发现异常气体。除粪石嵌塞的核心外，NSC 的 CT 征象频率如下：近端结肠扩张（20%）、结肠壁增厚（60%）、黏膜致密（62.5%）、黏膜脱落（10%）、灌注缺损（70%）、结肠旁条索状影（80%）、异常气体（50%）伴气腹-结肠系膜（40%），结肠旁脓肿（20%）。依次为结肠旁条索状影、灌注缺损、黏膜致密，分别检出 80%、70%和 62.5%的病例。
对 NSC 的认识和对 CT 诊断征象的熟悉，有助于鉴别 NSC 与良性粪便嵌塞。
