CT diagnosis of intestinal volvulus
ZHAO Wen-liang, WANG Ji-long, WU Ren-min, WANG Zhi-chen, ZHUANG Qi-xin.
Department of Radiology, Fengjing Hospital of Jinshan District, Shanghai 201501, China
【Ａｂｓｔｒａｃｔ】 Objective To discuss the manifestations of intestinal volvulus and evaluate the role of CT in diagnosing the disease. Methods CT findings in 11 cases of intestinal volvulus proved by operation were retrospectively analyzed.8 cases were scanned with plain CT and 3 cases were scaned with plain CT following with enhanced CT. Results “whirl”sign was seen in 6 cases and “target”sign in 4 cases, dilatation of bowl loops fulled with gas and lipuid in 9 cases, seroperitoneum appeared in 6 cases, emphysema of the intestinum wall detected in 1 case. Conclusion “whirl”sign is the main evidence which can be relied on to diagnose intestinal volvulus. “target”sign and emphysema of bowel wall are the reliable signs which meaning ischemia of intestinum due to intestinal volvulus.
【Ｋｅｙ ｗｏｒｄｓ】 Ｉntestinal volvulus; Tomography, X-ray computed
肠扭转是绞窄性肠梗阻的常见病因之一，是一种严重的急腹症。肠扭转的死亡率较高,术前正确诊断具有重要的临床意义[1]。笔者回顾分析了11例经手术病理证实肠扭转的CT表现，旨在提高对此疾病各种CT征象的认识和术前诊断的准确性。
资料与方法
一、临床资料
搜集2000年1月-2007年10月,有完整CT检查资料的肠扭转病例共11例(3例小肠扭转病例资料由上海市第六人民医院放射科提供),所有病例经手术证实。其中男10例,女1例,年龄20～72岁,平均55岁。全部病人均有不同程度的腹痛,停止排便排气，病程在1～10天。体检腹部压痛相对固定。临床因腹痛原因不明,疑似肠梗阻,行CT检查。
二、检查方法
采用Elscint 1900,GE Prospeed FⅡ和Siemens 16层CT机型。检查前无肠道准备,8例平扫，3例先平扫后,再行增强扫描。增强者静脉注射含碘非离子型剂；碘浓度30gI/100ml;注射速率3-4ml/s;总量100ml。范围从膈顶至耻骨联合水平,行全腹扫描.患者取卧位,层厚10mm～2mm,其中2例做多平面重建。常规采用腹窗观察,窗宽40Hu，窗位200Hu，调节窗位观察网系膜结构。
结果
一、手术所见
手术证实的肠扭转中,小肠扭转9例,乙状结肠扭转2例。180°肠扭转1例、360°肠扭转8例、720°肠扭转2例。 术中发现局部肠坏死4例， 2例内疝；1例为整个小肠由原胆道空肠吻合处近空肠系膜裂孔处嵌入扭转,另1例为乙状结肠扭转且穿过网膜组织形成内疝。
二、CT征象
“漩涡征”6例(图1-4),肠壁水肿增厚“靶征”4例(图5),肠壁积气1例（图6）,腹腔积液6例, 肠腔扩张；肠腔内积液积液9例,小肠肠曲蜷曲呈“花瓣状”1例（图7）, 1例为大跨度肠曲（图8）。
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