Blane C E, Elhalaby E, Coran A G
Department of Radiology, University of Michigan, Ann Arbor 48109.
Pediatr Radiol. 1994;24(3):164-6. doi: 10.1007/BF02012178.
The enterocolitis following a pull-through in Hirschsprung's disease can be life-threatening and difficult to distinguish clinically from gastroenteritis and post-operative complications. We reviewed retrospectively the abdominal radiographs in our series to identify specific radiographic characteristics of this syndrome in this population. A total of 55 episodes of enterocolitis with an abdominal series at presentation were located in the files of 43 patients following pull-through surgery for Hirschsprung's disease. There were 15 abdominal series with other complications of Hirschsprung's disease and surgery (seven cases of small bowel obstruction, one of fistula, one of abscess, six of severe constipation) and 71 surveillance follow-up studies. Radiographs were evaluated for bowel dilatation, air-fluid levels, intestinal cut-off sign, speculation, and pneumatosis. The intestinal cut-off sign with two or more air-fluid levels had sensitivity of 68% and specificity of 83%, with a positive predictive value of 0.71 and overall accuracy of 77%. Our review of enterocolitis following pull-through in children with Hirschsprung's disease concludes that the constellation of an intestinal cut-off sign and at least two air-fluid levels on the abdominal series strongly suggests the diagnosis.
先天性巨结肠症拖出术后发生的小肠结肠炎可能危及生命，临床上很难与肠胃炎及术后并发症相区分。我们回顾性分析了本系列病例的腹部X光片，以确定该综合征在这一群体中的特定影像学特征。在先天性巨结肠症拖出术后的43例患者档案中，共找到55例出现小肠结肠炎且就诊时拍摄过腹部X光片的病例。另有15例腹部X光片显示先天性巨结肠症及手术的其他并发症（7例小肠梗阻、1例瘘管、1例脓肿、6例严重便秘），以及71例监测随访研究。对X光片评估肠管扩张、气液平面、肠管截断征、肠壁积气及肠壁间积气。出现两个或更多气液平面的肠管截断征，其敏感度为68%，特异度为83%，阳性预测值为0.71，总体准确率为77%。我们对先天性巨结肠症患儿拖出术后小肠结肠炎的回顾分析得出结论，腹部X光片上出现肠管截断征及至少两个气液平面强烈提示该诊断。
