Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Center for Ultrasound Research and Education (CURE) at Massachusetts General Hospital, Boston, Massachusetts; Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Center for Ultrasound Research and Education (CURE) at Massachusetts General Hospital, Boston, Massachusetts.
J Emerg Med. 2021 May;60(5):e119-e124. doi: 10.1016/j.jemermed.2020.11.019. Epub 2021 Jan 7.
Patients with anorectal complaints commonly present to the emergency department (ED). In patients with prior history of pelvic radiation and those with risk factors for sexually transmitted infections, proctitis is frequently on the differential diagnosis. Computed tomography (CT) scans are frequently done in patients with atypical presentations and those with broader differential diagnoses. Although in cases with suspected uncomplicated proctitis, conducting a point-of-care transperineal ultrasound (TPUS) may provide sufficient data to confirm the diagnosis and ascertain a safe plan for outpatient management, thus limiting the need for CT scan, a frequent flow-limiting step in the ED.
In this article, we present a brief case series of patients presenting to the ED with anorectal complaints in whom TPUS revealed circumferential symmetric rectal wall edema and pericolonic stranding suggestive of proctitis. History and subsequent imaging further supported these diagnoses; we also briefly detail the patients' clinical course and outcomes. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We propose the use of TPUS as the screening imaging for anorectal pathologies and those with suspected proctitis to increase its use among emergency physicians. We review the main sonographic features of proctitis alongside reports from clinical cases, as well as the potential advantages of TPUS as a first-line imaging modality as compared with CT or magnetic resonance imaging. Although the complexities of anorectal anatomy can make TPUS a more difficult ultrasound modality to master, integrating TPUS into clinical practice will prove beneficial to both physician and patient.
有肛肠疾病的患者通常会到急诊部（ED）就诊。对于有盆腔放疗史的患者和有性传播感染风险因素的患者，直肠炎通常是鉴别诊断的一部分。对于非典型表现和鉴别诊断范围较广的患者，常进行计算机断层扫描（CT）检查。尽管对于疑似单纯性直肠炎的患者，进行床边经会阴超声（TPUS）检查可能提供足够的数据来确认诊断，并确定安全的门诊管理计划，从而避免 CT 扫描，这是 ED 中经常限制流程的步骤。
本文介绍了一组简要的病例系列，这些患者因肛肠疾病到 ED 就诊，TPUS 显示直肠壁环状对称肿胀和周围结肠束状，提示直肠炎。病史和后续影像学进一步支持这些诊断；我们还简要详细介绍了患者的临床过程和结果。
为什么急诊医生应该了解这个？：我们建议将 TPUS 用作肛肠疾病和疑似直肠炎的筛查影像学检查，以增加急诊医生对其的使用。我们回顾了直肠炎的主要超声特征以及临床病例报告，以及与 CT 或磁共振成像相比，TPUS 作为一线影像学检查方法的潜在优势。尽管肛肠解剖结构的复杂性使得 TPUS 成为一种更难掌握的超声模式，但将 TPUS 纳入临床实践将对医生和患者都有益。
