Labs J D, Sarr M G, Fishman E K, Siegelman S S, Cameron J L
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
Am J Surg. 1988 Feb;155(2):331-6. doi: 10.1016/s0002-9610(88)80726-8.
We have evaluated the diagnostic role of computerized tomography in 42 patients suspected clinically of having a complication of acute diverticulitis (abscess, colovesical fistula, or both). Diverticular abscesses were confirmed at operation in 10 patients. All 10 patients were diagnosed preoperatively on computerized tomography by the triad of diverticula, a segmentally thickened colon, and extravisceral fluid collection with (6 patients) or without (4 patients) associated gas. Contrast enema study suggested the presence of a diverticular abscess in only two of eight patients studied. Colovesical fistulas were confirmed in 12 patients. Eleven of 12 were diagnosed preoperatively on computerized tomography by the triad of air in the bladder, thickened colon adjacent to an area of thickened bladder, and the presence of colonic diverticula. Contrast enema examinations demonstrated the fistula in only three of eight patients studied. The remaining 20 patients proved to have uncomplicated acute diverticulitis. Findings on computerized tomography included the presence of a segmentally thickened colon with diverticula but without the findings of an abscess or a colovesical fistula. Computerized tomography correctly visualized acute diverticular complications in 21 of 22 patients and it excluded an abscess or fistula in all 20 patients with uncomplicated acute diverticulitis who were suspected of having a diverticular complication. Computerized tomography is the most sensitive and specific test for diagnosing complications of acute diverticulitis. It should be an early consideration in patients with suspected diverticular abscesses or fistulas so that appropriate therapy is not delayed.
我们评估了计算机断层扫描在42例临床怀疑患有急性憩室炎并发症（脓肿、结肠膀胱瘘或两者皆有）患者中的诊断作用。10例患者术中证实有憩室脓肿。所有10例患者术前通过计算机断层扫描根据憩室、节段性增厚的结肠以及伴有（6例患者）或不伴有（4例患者）相关气体的脏器外液体积聚三联征得以诊断。在接受检查的8例患者中，只有2例经对比灌肠研究提示存在憩室脓肿。12例患者证实有结肠膀胱瘘。12例中的11例术前通过计算机断层扫描根据膀胱内气体、膀胱增厚区域附近增厚的结肠以及结肠憩室的存在三联征得以诊断。在接受检查的8例患者中，只有3例经对比灌肠检查显示有瘘管。其余20例患者被证明患有无并发症的急性憩室炎。计算机断层扫描的表现包括存在伴有憩室的节段性增厚的结肠，但无脓肿或结肠膀胱瘘的表现。计算机断层扫描在22例患者中的21例正确显示了急性憩室并发症，并且在所有20例怀疑有憩室并发症但实际患有无并发症急性憩室炎的患者中排除了脓肿或瘘管。计算机断层扫描是诊断急性憩室炎并发症最敏感和特异的检查。对于怀疑有憩室脓肿或瘘管的患者应尽早考虑进行该项检查，以免延误适当的治疗。
