粪石性结肠炎：CT 影像学表现及临床危险因素。

Stercoral colitis: CT imaging findings and clinical risk factors.

机构信息

Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA.

Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA.

出版信息

Abdom Radiol (NY). 2023 Oct;48(10):3050-3062. doi: 10.1007/s00261-023-03974-2. Epub 2023 Jun 27.

DOI:10.1007/s00261-023-03974-2

PMID:37369923

Abstract

PURPOSE

To describe and update stercoral colitis clinical risk factors, relative frequency, location, and CT imaging features correlated with surgical and pathological results.

METHODS

CT reports over a 5-year period (05/2017-05/2022) at a single medical center were searched. Main inclusion criteria were luminal distention with formed stool, wall thickening, and surrounding inflammation. Positive cases were graded as mild (early or developing stercoral colitis) versus moderate-to-severe based on CT findings. Medical records were reviewed for risk factors and outcome data in moderate-to-severe cases. P-values were tabulated for comparison.

RESULTS

545 total cases (71 (60, 82) years, 278 males) were identified on CT, including 452 mild (82.9%) and 93 moderate-to-severe cases (17%, 67 (55, 79) years, 48 females). Twenty cases showed evidence of perforation (3.7% total cohort, 22% moderate-to-severe cohort). Diagnosis as an incidental finding was frequent (46.0% of mild cases). Most cases involved the rectum (97.6% of mild cohort and 69% of moderate-to-severe cohort). The sigmoid was involved in 31% of moderate-to-severe cases, but 95% of the perforated subcohort (19/20, 13/20 without rectal involvement). Among the moderate-to-severe cohort, perforation was associated with slightly increased wall thickness (6.4 vs. 5.7 mm, p = 0.03), opioid use (50 vs. 23%, p = 0.04), and disease-specific mortality (11 vs. 0%, p =0.04). Perforation was less associated with major neurocognitive disorders (20 vs. 60%, p = 0.003), institutionalized status (5 vs. 38%, p = 0.005), and a prescribed bowel regimen (30 vs. 63%, p = 0.01).

CONCLUSION

Stercoral colitis may be under-reported. Perforation tends to favor sigmoid involvement and a less traditional patient cohort.

摘要

目的

描述和更新粪石性结肠炎的临床危险因素、相对频率、位置和与手术及病理结果相关的 CT 影像学特征。

方法

对一家医疗中心 5 年来（2017 年 5 月至 2022 年 5 月）的 CT 报告进行了检索。主要纳入标准为肠腔扩张伴成形粪便、肠壁增厚和周围炎症。根据 CT 发现，将阳性病例分为轻度（早期或进展性粪石性结肠炎）和中重度。对中重度病例的危险因素和结局数据进行了病历回顾。对数据进行了制表和比较。

结果

在 CT 上共发现 545 例（71（60，82）岁，278 名男性），其中 452 例为轻度（82.9%），93 例为中重度（17%，67（55，79）岁，48 名女性）。20 例有穿孔证据（总队列的 3.7%，中重度队列的 22%）。偶然发现的诊断很常见（轻度病例的 46.0%）。大多数病例累及直肠（轻度组的 97.6%，中重度组的 69%）。乙状结肠受累占中重度组的 31%，但穿孔亚组的 95%（19/20，无直肠受累的 13/20）。在中重度组中，穿孔与肠壁厚度略有增加相关（6.4 毫米比 5.7 毫米，p = 0.03）、阿片类药物使用（50%比 23%，p = 0.04）和疾病特异性死亡率（11%比 0%，p = 0.04）。穿孔与主要神经认知障碍（20%比 60%，p = 0.003）、机构化状态（5%比 38%，p = 0.005）和规定的肠道方案（30%比 63%，p = 0.01）的相关性较低。