Paparo Francesco, Denegri Andrea, Revelli Matteo, Puppo Cristina, Garello Isabella, Bacigalupo Lorenzo, Garlaschi Alessandro, Rollandi Ludovica, Fornaro Rosario
Ann Ital Chir. 2014 May-Jun;85(3):271-81.
In patients who had previously undergone ileocolic resection due to Crohn's disease (CD) complications, anastomotic recurrence is a frequent event, which may lead to further surgical interventions. Optical colonoscopy with retrograde ileoscopy is currently the reference standard technique to confirm the clinical suspicion of anastomotic recurrence; however, the ileal side of ileocolic anastomoses may not be assessed due to technical complexities in approximately 1/3 of cases. Moreover, endoscopy allows for an investigation limited to the mucosal surface without demonstrating trans-mural involvement and/or penetrating complications (i.e. fistulas and abscesses). Imaging plays an important role in the assessment of both ileocolic and entero-enteric anastomoses in patients with CD. Conventional radiological methods (i.e. small bowel enteroclysis and small bowel follow through) can effectively depict the presence of aphthous ulcers and other mild and subtle mucosal abnormalities, but they are not precise for the diagnosis of transmural and extramural disease. CT - and MR- enterography accurately demonstrate both the extent of bowel wall involvement and the presence of penetrating complications. The main cross-sectional imaging findings observed in CD (including anastomotic recurrence) are small bowel wall thickening with bilaminar or trilaminar stratification, hyperdensity and oedema of the mesenteric fat, engorged mesenteric vasa recta ("comb sign"), sub-mucosal fibro-fatty infiltration and mesenteric adenopathy. Ultrasonography performed after distension of small bowel loops with anechoic contrast agents (Small Intestine Contrast Ultrasonography - SICUS -) is a non-invasive imaging technique which can detect early inflammatory alterations of the anastomosis. On the other hand ultrasonography is an operator-dependent technique and it lacks of a large anatomic field of view.
Computed Tomography enterography, Crohn's disease, Ileocolic anastomosis, Magnetic Resonance Imaging.
在因克罗恩病（CD）并发症而先前接受过回结肠切除术的患者中，吻合口复发是常见事件，这可能导致进一步的手术干预。光学结肠镜检查联合逆行回肠镜检查是目前用于确认吻合口复发临床怀疑的参考标准技术；然而，由于技术复杂性，约1/3的病例中回结肠吻合口的回肠侧可能无法评估。此外，内镜检查仅能对黏膜表面进行检查，无法显示透壁受累和/或穿透性并发症（即瘘管和脓肿）。影像学在CD患者回结肠和肠-肠吻合口的评估中起着重要作用。传统放射学方法（即小肠灌肠造影和小肠钡剂造影）可有效显示阿弗他溃疡和其他轻度及细微黏膜异常的存在，但对于透壁和壁外疾病的诊断并不精确。CT和MR小肠造影能准确显示肠壁受累程度和穿透性并发症的存在。CD（包括吻合口复发）中观察到的主要横断面影像学表现为小肠壁增厚伴双层或三层分层、肠系膜脂肪高密度和水肿、肠系膜直小血管增粗（“梳征”）、黏膜下纤维脂肪浸润和肠系膜淋巴结肿大。用无回声造影剂扩张小肠肠袢后进行的超声检查（小肠对比超声检查-SICUS-）是一种非侵入性成像技术，可检测吻合口的早期炎症改变。另一方面，超声检查是一种依赖操作者的技术，且缺乏大的解剖视野。
计算机断层扫描小肠造影、克罗恩病、回结肠吻合术、磁共振成像
