Catalano O
Istituto di Scienze Radiologiche, Università degli Studi di Napoli Federico II.
Minerva Chir. 1998 Sep;53(9):719-26.
The diagnostic procedures proposed in the evaluation of sigmoidovesical fistulas complicating diverticulitis are various and their effectiveness is still not well established.
Personal experience is based on 14 cases of colovesical fistulas secondary to sigmoid diverticulitis. Several diagnostic tools were employed: plain abdominal film (10 cases), large bowel enema (12), urography (3), cystography (2), sonography (4), and CT (5). The semeiotics of these fistulas were distinguished in direct, indirect, secondary, and related to the underlying disease.
The fistulous tract itself was recognized in 100% of the cases with sonography, in 75% with enema, in 60% with CT, in 33% with urography, and in none with cystography. Vesical gas was visible in 100% of the cases with sonography and CT, and in 40% with plain radiographs. Diffusion of contrast medium was present in 91% of the cases with enema, in 60% with CT, and in 33% with urography. Focal thickening and/or irregularity of the bladder wall was evident with cystography and urography in 67% of the cases, with CT in 60%, with sonography in 50%, with enema in 8%. Diverticulosis/diverticulitis was recognizable in 100% of the cases with CT, in 91% with enema, in 25% with sonography. A paravesical abscess was recognizable in 40% of the cases with CT, in 25% with sonography, in 8% with enema.
The radiourological procedures, though of limited use in our series, have a poor effectiveness. Large bowel enema and, specially, CT confirm as the method with greatest accuracy in the evaluation of these fistulas. The sonographic examination, according to personal preliminary experiences, is a valuable diagnostic alternative. Sonography and CT allow analysis of the perivisceral structures and, if compared with barium enema, provide a larger number of information on diverticulitis, which is essentially an extraluminal disease, and its complications.
在评估并发憩室炎的乙状结肠膀胱瘘时所提出的诊断程序多种多样，但其有效性仍未得到充分证实。
个人经验基于14例继发于乙状结肠憩室炎的结肠膀胱瘘病例。采用了多种诊断工具：腹部平片（10例）、大肠灌肠造影（12例）、尿路造影（3例）、膀胱造影（2例）、超声检查（4例）和CT（5例）。这些瘘的症状学分为直接、间接、继发以及与基础疾病相关的。
超声检查在100%的病例中识别出瘘管，灌肠造影为75%，CT为60%，尿路造影为33%，膀胱造影未识别出。超声检查和CT在100%的病例中可见膀胱内气体，腹部平片为40%。灌肠造影在91%的病例中出现造影剂外渗，CT为60%，尿路造影为33%。膀胱造影和尿路造影在67%的病例中显示膀胱壁局灶性增厚和/或不规则，CT为60%，超声检查为50%，灌肠造影为8%。CT在100%的病例中可识别憩室病/憩室炎，灌肠造影为91%，超声检查为25%。CT在40%的病例中可识别膀胱旁脓肿，超声检查为25%，灌肠造影为8%。
放射学检查程序在我们的系列病例中虽然应用有限，但有效性较差。大肠灌肠造影，特别是CT，被确认为评估这些瘘的最准确方法。根据个人初步经验，超声检查是一种有价值的诊断选择。超声检查和CT能够分析膀胱周围结构，并且与钡剂灌肠造影相比，能提供更多关于憩室炎（本质上是一种腔外疾病）及其并发症的信息。
