Matsuki M, Narabayashi I, Inoue Y, Yamasaki K
Department of Radiology, Osaka Medical College, Takatsuki, Japan.
Radiat Med. 1997 May-Jun;15(3):181-3.
Small bowel volvulus is usually secondary to conditions such as malrotation, congenital bands, postoperative adhesions, and internal hernias. Primary small bowel volvulus in an adult is rare, and only 14 cases had been reported in Japan as of 1994. Preoperative diagnosis is difficult, because clinical examinations and plain films are of limited diagnostic value. In our cases, CT showed signs of small bowel volvulus such as a U-shaped configuration or radial distribution of distended and fluid-filled loops of the small bowel converging toward the point of torsion, tightly twisted mesentery around the point of torsion (whirl sign), fusiform tapering loop (triangular sign in the cross section or beak sign in the longitudinal section), and signs of bowel ischemia or infarct such as attached mesenteric fluid and blurred mesenteric folds. CT enabled us to diagnose not only small bowel volvulus but also bowel ischemia or infarct.
小肠扭转通常继发于诸如肠旋转不良、先天性束带、术后粘连和内疝等情况。成人原发性小肠扭转罕见，截至1994年在日本仅报道过14例。术前诊断困难，因为临床检查和平片的诊断价值有限。在我们的病例中，CT显示小肠扭转的征象，如U形结构或扩张且充满液体的小肠袢呈放射状分布并向扭转点汇聚、扭转点周围系膜紧密扭转（漩涡征）、梭形逐渐变细的肠袢（横断面上的三角形征或纵断面上的鸟嘴征），以及肠缺血或梗死的征象，如附着的肠系膜积液和模糊的肠系膜皱襞。CT不仅能诊断小肠扭转，还能诊断肠缺血或梗死。
