Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, Manhasset, NY, USA.
Abdom Radiol (NY). 2017 Nov;42(11):2597-2608. doi: 10.1007/s00261-017-1180-x.
Large bowel perforation is an abdominal emergency that results from a wide range of etiologies. Computed tomography is the most reliable modality in detecting the site of large bowel perforation. The diagnosis is made by identifying direct CT findings such as extraluminal gas or contrast and discontinuity along the bowel wall. Indirect CT findings can help support the diagnosis, and include bowel wall thickening, pericolic fat stranding, abnormal bowel wall enhancement, abscess, and a feculent collection adjacent to the bowel. Common etiologies that cause large bowel perforation are colon cancer, foreign body aspiration, stercoral colitis, diverticulitis, ischemia, inflammatory and infectious colitides, and various iatrogenic causes. Recognizing a large bowel perforation on CT can be difficult at times, and there are various entities that may be misinterpreted as a colonic perforation. The purpose of this article is to outline the MDCT technique used for evaluation of suspected colorectal perforation, discuss relevant imaging findings, review common etiologies, and point out potential pitfalls in making the diagnosis of large bowel perforation.
大肠穿孔是一种腹部急症，可由多种病因引起。计算机断层扫描（CT）是检测大肠穿孔部位的最可靠方法。通过识别直接 CT 表现，如肠外气体或对比剂以及肠壁连续性中断，可做出诊断。间接 CT 表现有助于支持诊断，包括肠壁增厚、结肠旁脂肪条索、肠壁异常强化、脓肿和邻近肠管的粪便积聚。导致大肠穿孔的常见病因有结肠癌、异物吸入、粪性结肠炎、憩室炎、缺血、炎症性和感染性结肠炎以及各种医源性原因。有时在 CT 上识别大肠穿孔较为困难，有多种病变可能被误诊为结肠穿孔。本文旨在概述用于评估疑似结直肠穿孔的 MDCT 技术，讨论相关的影像学表现，回顾常见病因，并指出诊断大肠穿孔的潜在陷阱。
