Levine M S, Kam L W, Rubesin S E, Ekberg O
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
Radiology. 1990 Oct;177(1):141-4. doi: 10.1148/radiology.177.1.2399313.
The authors retrospectively studied 43 patients suspected of having internal hemorrhoids at double-contrast barium enema examination. At endoscopy, 24 patients (56%) had internal hemorrhoids, four (9%) had other pathologic lesions in the rectum without evidence of hemorrhoids, and 15 (35%) had no reported abnormalities in the rectum. Internal hemorrhoids were found at endoscopy in 10 of 20 patients (50%) with lobulated folds extending 3 cm or less from the anorectal junction and 10 of 13 patients (77%) with multiple submucosal nodules. However, no patients with these characteristic radiographic findings were found to have other pathologic lesions in the rectum that had been mistaken for hemorrhoids at barium enema examination. Conversely, three of four patients with lobulated folds extending more than 3 cm from the anorectal junction and one of six patients with solitary nodules had proctitis or rectal neoplasms. Thus, specific criteria are suggested for the diagnosis of internal hemorrhoids on double-contrast barium enema examinations. Suspected hemorrhoids that do not fulfill these criteria should be evaluated endoscopically to rule out other more serious pathologic lesions in the rectum.
作者回顾性研究了43例在双重对比钡灌肠检查中疑似患有内痔的患者。在内镜检查中，24例患者（56%）患有内痔，4例（9%）在直肠有其他病理病变但无痔疮证据，15例（35%）在直肠未报告有异常。在内镜检查中，20例有从肛门直肠交界处延伸3厘米或更短的分叶状皱襞的患者中有10例（50%）发现内痔，13例有多个黏膜下结节的患者中有10例（77%）发现内痔。然而，在钡灌肠检查中，没有发现有这些特征性影像学表现的患者在直肠有被误诊为痔疮的其他病理病变。相反，4例从肛门直肠交界处延伸超过3厘米的分叶状皱襞的患者中有3例，6例有孤立结节的患者中有1例患有直肠炎或直肠肿瘤。因此，建议在双重对比钡灌肠检查中诊断内痔有特定标准。不符合这些标准的疑似痔疮患者应接受内镜检查以排除直肠其他更严重的病理病变。
