Camera Luigi, Calabrese Milena, Mainenti Pier Paolo, Masone Stefania, Vecchio Walter Del, Persico Giovanni, Salvatore Marco
Luigi Camera, Milena Calabrese, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
World J Radiol. 2012 Oct 28;4(10):439-42. doi: 10.4329/wjr.v4.i10.439.
Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile, intra-peritoneal, colonic segments. Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments. We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain. Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac. The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography (CT). CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon. At surgery, a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed. However, a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and overlooked in the pre-operative CT. Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.
结肠扭转是大肠梗阻相对少见的原因，通常累及活动的、位于腹膜内的结肠段。先天性或后天性解剖变异可能与结肠扭转风险增加有关，结肠扭转偶尔也可累及腹膜后段。我们报告一例54岁女性患者，因突发痉挛性腹痛到我院进行腹部平片系列检查。立位片和仰卧位片均显示急性结肠梗阻征象，考虑为横结肠经小网膜囊内疝所致。因此，该患者接受了多排螺旋CT增强扫描。CT表现最初被认为与推测的内疝诊断相符，但进一步评估和冠状面重建清晰显示存在结肠扭转，可能是由胃后结肠引起。手术中发现升结肠扭转，不得不进行右半结肠切除术。然而，剖腹手术时还发现了未旋转的中肠，十二指肠空肠曲位于右侧，结肠位于左侧，术前CT检查时被忽略。因此，对CT图像进行了回顾性评估，发现了一些肠旋转不良的CT征象。
