Lu C-Y, Xu M, Lin J, Chen Y, Gao Y, Wang Z-F, Zhao Z-W, Song J-J, Que H-F, Ji J-J
Department of Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, 289 Kuocang Road, Lishui, Zhejiang 32300, China.
Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 32300, China.
Clin Radiol. 2018 Feb;73(2):218.e1-218.e7. doi: 10.1016/j.crad.2017.08.007. Epub 2017 Dec 15.
To review the clinical and multidetector computed tomography (MDCT) features of adhesive internal hernias (IHs) and to ascertain specific MDCT criteria to assist in the diagnosis of adhesive IHs and the early detection of intestinal strangulation.
Medical records and preoperative abdominal MDCT findings of 34 patients with surgically confirmed abdominal adhesive IHs were analysed retrospectively.
The specific MDCT features of adhesive IHs included the following: dislocating and clustering of intestinal segments (100%); stretching and crowding of the mesenteric vessels (100%); presence of hernial orifice (88.2%), peritoneal adhesive bands (76.5%); and the fat notch sign (85.3%). In addition, the significant MDCT features indicative of intestinal strangulation compared with those without intestinal strangulation were bowel wall thickening (p=0.009), intramural haemorrhage (p=0.007), and abnormal bowel wall enhancement (p=0.023). Furthermore, bowel obstruction occurred in 17 (50%) patients, and mesenteric whirl was apparent in 8 (23.5%) patients.
This article illustrates the specific MDCT criteria of adhesive IHs. Knowledge of MDCT findings in adhesive IHs and their complications is essential for making the correct diagnosis and may help guide early clinical management.
回顾粘连性内疝（IHs）的临床及多排螺旋计算机断层扫描（MDCT）特征，确定有助于诊断粘连性IHs及早期发现肠绞窄的特定MDCT标准。
回顾性分析34例经手术证实的腹部粘连性IHs患者的病历及术前腹部MDCT表现。
粘连性IHs的特定MDCT特征如下：肠段移位和聚集（100%）；肠系膜血管拉长和拥挤（100%）；疝孔存在（88.2%），腹膜粘连带（76.5%）；以及脂肪切迹征（85.3%）。此外，与无肠绞窄者相比，提示肠绞窄的显著MDCT特征为肠壁增厚（p = 0.009）、壁内出血（p = 0.007）和肠壁强化异常（p = 0.023）。此外，17例（50%）患者发生肠梗阻，8例（23.5%）患者可见肠系膜扭转。
本文阐述了粘连性IHs的特定MDCT标准。了解粘连性IHs的MDCT表现及其并发症对于做出正确诊断至关重要，并可能有助于指导早期临床处理。
