Cherukuri R, Levine M S, Maki D D, Rubesin S E, Laufer I, Rosato E F
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
AJR Am J Roentgenol. 1998 Dec;171(6):1577-82. doi: 10.2214/ajr.171.6.9843291.
The purpose of this study was to determine the usefulness of contrast-enhanced radiography of the Hartmann's pouch for evaluating postoperative abnormalities.
We performed a retrospective study of 84 patients with a Hartmann's pouch who underwent contrast-enhanced radiography of the pouch during a recent 7-year period. Sixty-four patients underwent single-contrast barium studies of the pouch, 17 underwent studies with a water-soluble contrast medium, and three underwent both types of studies. The radiographic studies were reviewed to determine the types and frequency of abnormalities involving the pouch. Medical records were also reviewed to determine clinical presentation and course.
Abnormalities of the Hartmann's pouch were detected on contrast-enhanced radiography in 16 (19%) of the 84 patients. Of the 70 patients who underwent routine contrast-enhanced radiography of the pouch, 11 (16%) had abnormalities, including diversion colitis in three, leaks in two, adhesions in two, recurrent carcinoma in two, ulcerative colitis involving the pouch in one, and a stricture in one. In both patients with clinically silent leaks, the contrast-enhanced radiography was performed 3 months or more after creation of the pouch. Of the remaining 14 patients who underwent contrast-enhanced radiography because of suspected complications involving the pouch, five (36%) had abnormalities revealed, including leaks in two, fistulas in two, and recurrent carcinoma in one.
Contrast-enhanced radiography of the Hartmann's pouch revealed abnormalities of the pouch in 19% of patients, including leaks or fistulas, diversion colitis, adhesions, strictures, and recurrent tumor. Because two patients had clinically silent leaks that were detected during the late postoperative period, it may be prudent to perform these studies with a water-soluble contrast medium to avoid the problems associated with extravasation of barium into the extra- or intraperitoneal spaces.
本研究的目的是确定哈特曼袋造影增强检查在评估术后异常情况中的实用性。
我们对84例有哈特曼袋的患者进行了一项回顾性研究，这些患者在最近7年期间接受了袋造影增强检查。64例患者接受了袋的单对比钡剂检查，17例接受了水溶性造影剂检查，3例接受了两种类型的检查。对影像学检查进行回顾，以确定涉及袋的异常类型和频率。还查阅了病历以确定临床表现和病程。
84例患者中，16例（19%）在造影增强检查中发现哈特曼袋异常。在70例接受袋常规造影增强检查的患者中，11例（16%）有异常，包括3例的改道性结肠炎、2例的渗漏、2例的粘连、2例的复发性癌、1例累及袋的溃疡性结肠炎和1例狭窄。在2例临床无症状渗漏的患者中，造影增强检查是在袋形成后3个月或更长时间进行的。在其余14例因怀疑袋并发症而接受造影增强检查的患者中，5例（36%）发现有异常，包括2例渗漏、2例瘘管和1例复发性癌。
哈特曼袋造影增强检查在19%的患者中发现了袋的异常，包括渗漏或瘘管、改道性结肠炎、粘连、狭窄和复发性肿瘤。由于2例患者在术后晚期发现了临床无症状渗漏，使用水溶性造影剂进行这些检查可能较为谨慎，以避免钡剂外渗到腹膜外或腹膜内间隙相关的问题。
