絞扼性腸閉塞診断における造影CTの有用性
【背景】絞扼性腸閉塞の本態は消化管の虚血であるため，診断には造影CTが重要である。しかし，どのような所見が有用であるか明らかではない。【方法】術前に造影CTが施行された壊死性絞扼性腸閉塞21例と非壊死性絞扼性腸閉塞33例を対象に造影CT所見を検討した。【結果】70％以上の頻度で認められたものはbeak sign，flower bouquet sign，腸管壁の肥厚，腸間膜混濁であった。beak sign，腸管壁の肥厚，腸間膜混濁は非壊死性に限っても高い頻度で同定された。造影低下は壊死性では52％に同定されたが，非壊死性では6％と発現頻度が低かった。【考察】腸管壊死をきたす前に絞扼性腸閉塞を造影...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 37; no. 4; pp. 581 - 585 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
2017
Japanese Society for Abdominal Emergency Medicine |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.37.581 |
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| Abstract | 【背景】絞扼性腸閉塞の本態は消化管の虚血であるため，診断には造影CTが重要である。しかし，どのような所見が有用であるか明らかではない。【方法】術前に造影CTが施行された壊死性絞扼性腸閉塞21例と非壊死性絞扼性腸閉塞33例を対象に造影CT所見を検討した。【結果】70％以上の頻度で認められたものはbeak sign，flower bouquet sign，腸管壁の肥厚，腸間膜混濁であった。beak sign，腸管壁の肥厚，腸間膜混濁は非壊死性に限っても高い頻度で同定された。造影低下は壊死性では52％に同定されたが，非壊死性では6％と発現頻度が低かった。【考察】腸管壊死をきたす前に絞扼性腸閉塞を造影CTで診断するために有用な所見はbeak sign，腸管壁の肥厚，腸間膜混濁であり，造影低下の発現頻度は低いことに注意が必要である。 |
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| AbstractList | 【Background】Since the pathogenesis of bowel strangulation (BS) involves bowel ischemia, contrast-enhanced computed tomography (CECT) is important for the diagnosis of BS. However, which CECT findings are most useful for an accurate diagnosis remain unclear. 【Method】The characteristics of 21 patients with necrotic BS and 33 patients with non-necrotic BS were examined. 【Results】A beak sign, a thick intestinal wall, and mesenteric edema were observed in over 70% of the patients with both necrotic and non-necrotic BS. Hypo-enhancement of the bowel wall was observed in 71% of the patients with necrotic BS and 18% of the patients with non-necrotic BS. 【Discussion】For the early diagnosis of BS, greater importance should be placed on the presence of a beak sign, thick intestinal wall, and mesenteric edema, with hypo-enhancement of the bowel wall being a lesser consideration.
【背景】絞扼性腸閉塞の本態は消化管の虚血であるため，診断には造影CTが重要である。しかし，どのような所見が有用であるか明らかではない。【方法】術前に造影CTが施行された壊死性絞扼性腸閉塞21例と非壊死性絞扼性腸閉塞33例を対象に造影CT所見を検討した。【結果】70％以上の頻度で認められたものはbeak sign，flower bouquet sign，腸管壁の肥厚，腸間膜混濁であった。beak sign，腸管壁の肥厚，腸間膜混濁は非壊死性に限っても高い頻度で同定された。造影低下は壊死性では52％に同定されたが，非壊死性では6％と発現頻度が低かった。【考察】腸管壊死をきたす前に絞扼性腸閉塞を造影CTで診断するために有用な所見はbeak sign，腸管壁の肥厚，腸間膜混濁であり，造影低下の発現頻度は低いことに注意が必要である。 【背景】絞扼性腸閉塞の本態は消化管の虚血であるため，診断には造影CTが重要である。しかし，どのような所見が有用であるか明らかではない。【方法】術前に造影CTが施行された壊死性絞扼性腸閉塞21例と非壊死性絞扼性腸閉塞33例を対象に造影CT所見を検討した。【結果】70％以上の頻度で認められたものはbeak sign，flower bouquet sign，腸管壁の肥厚，腸間膜混濁であった。beak sign，腸管壁の肥厚，腸間膜混濁は非壊死性に限っても高い頻度で同定された。造影低下は壊死性では52％に同定されたが，非壊死性では6％と発現頻度が低かった。【考察】腸管壊死をきたす前に絞扼性腸閉塞を造影CTで診断するために有用な所見はbeak sign，腸管壁の肥厚，腸間膜混濁であり，造影低下の発現頻度は低いことに注意が必要である。 |
| Author | 武田, 幸樹 太田, 惠一朗 松本, 智司 堀田, 正啓 原, 敬介 松田, 明久 小泉, 岐博 高橋, 吾郎 青木, 悠人 進士, 誠一 横山, 康行 岩井, 琢磨 山田, 岳史 内田, 英二 |
| Author_FL | Uchida Eiji Hara Keisuke Ota Keiichiro Hotta Masahiro Matsuda Akihisa Yamada Takeshi Takahashi Goro Takeda Koki Yokoyama Yasuyuki Shinji Seiichi Aoki Yuto Koizumi Michihiro Iwai Takuma Matsumoto Satoshi |
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| References | 1) 山田岳史，古川清憲，佐々木順平，ほか：イレウスの原因，分類，疫学，病態生理．消外2010；33：1527-1533 2) 山田岳史，管 隼人，松本智司，ほか：機械的イレウス 複雑性または絞扼性イレウス 絞扼性イレウス 早期診断の重要性．外科2012；74：250-254 9) Hayakawa K, Tanikake M, Yoshida S, et al: CT findings of small bowel strangulation: the importance of contrast enhancement. Emerg Radiol 2013; 20: 3-9. 14) Geffroy Y, Boulay-Coletta I, Jullès MC, et al: Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction. Radiology 2014; 270: 159-167. 4) 山田岳史，菅 隼人，松本智司，ほか：病態に基づいた造影CTによる絞扼性イレウスの早期診断．日腹部救急医会誌2015；35：403-407 12) Schwenter F, Poletti PA, Platon A, et al: Clinicoradiological score for predicting the risk of strangulated small bowel obstruction. Br J Surg 2010; 97: 1119-1125. 6) Fevang BT, Fevang J, Stangeland L, et al: Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience. Ann surg 2000; 231: 529-537. 13) Sheedy SP, Earnest F 4th, Fletcher JG, et al: CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology 2006; 241: 729-736. 11) Jancelewicz T, Vu LT, Shawo AE, et al: Predicting strangulated small bowel obstruction: an old problem revisited. J Gastrointest Surg 2009; 13: 93-99. 5) 青木悠人，山田岳史，菅 隼人，ほか：造影効果の客観的評価による絞扼性イレウスの診断．日腹部救急医会誌2015；35：201-206 10) Chou CK, Wu RH, Mak CW, et al: Clinical significance of poor CT enhancement of the thickened small-bowel wall in patients with acute abdominal pain. AJR Am J Roentgenol 2006; 186: 491-498. 15) Ohira G, Shuto K, Kono T, et al: Utility of arterial phase of dynamic CT for detection of intestinal ischemia associated with strangulation ileus. World J Radiol 2012; 4: 450-454. 3) Makar RA, Bashir MR, Haystead CM, et al: Diagnostic performance of MDCT in identifying closed loop small bowel obstruction. Abdom Radiol (NY) 2016; 41: 1253-1260. 7) Balthazar EJ, Birnbaum BA, Megibow AJ, et al: Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 1992; 185: 769-775. 8) Balthazar EJ, Liebeskind ME, Macari M: Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology 1997; 205: 519-522. |
| References_xml | – reference: 7) Balthazar EJ, Birnbaum BA, Megibow AJ, et al: Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 1992; 185: 769-775. – reference: 3) Makar RA, Bashir MR, Haystead CM, et al: Diagnostic performance of MDCT in identifying closed loop small bowel obstruction. Abdom Radiol (NY) 2016; 41: 1253-1260. – reference: 4) 山田岳史，菅 隼人，松本智司，ほか：病態に基づいた造影CTによる絞扼性イレウスの早期診断．日腹部救急医会誌2015；35：403-407． – reference: 12) Schwenter F, Poletti PA, Platon A, et al: Clinicoradiological score for predicting the risk of strangulated small bowel obstruction. Br J Surg 2010; 97: 1119-1125. – reference: 2) 山田岳史，管 隼人，松本智司，ほか：機械的イレウス 複雑性または絞扼性イレウス 絞扼性イレウス 早期診断の重要性．外科2012；74：250-254． – reference: 13) Sheedy SP, Earnest F 4th, Fletcher JG, et al: CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology 2006; 241: 729-736. – reference: 11) Jancelewicz T, Vu LT, Shawo AE, et al: Predicting strangulated small bowel obstruction: an old problem revisited. J Gastrointest Surg 2009; 13: 93-99. – reference: 5) 青木悠人，山田岳史，菅 隼人，ほか：造影効果の客観的評価による絞扼性イレウスの診断．日腹部救急医会誌2015；35：201-206． – reference: 6) Fevang BT, Fevang J, Stangeland L, et al: Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience. Ann surg 2000; 231: 529-537. – reference: 1) 山田岳史，古川清憲，佐々木順平，ほか：イレウスの原因，分類，疫学，病態生理．消外2010；33：1527-1533． – reference: 10) Chou CK, Wu RH, Mak CW, et al: Clinical significance of poor CT enhancement of the thickened small-bowel wall in patients with acute abdominal pain. AJR Am J Roentgenol 2006; 186: 491-498. – reference: 15) Ohira G, Shuto K, Kono T, et al: Utility of arterial phase of dynamic CT for detection of intestinal ischemia associated with strangulation ileus. World J Radiol 2012; 4: 450-454. – reference: 9) Hayakawa K, Tanikake M, Yoshida S, et al: CT findings of small bowel strangulation: the importance of contrast enhancement. Emerg Radiol 2013; 20: 3-9. – reference: 8) Balthazar EJ, Liebeskind ME, Macari M: Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology 1997; 205: 519-522. – reference: 14) Geffroy Y, Boulay-Coletta I, Jullès MC, et al: Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction. Radiology 2014; 270: 159-167. |
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| Snippet | 【背景】絞扼性腸閉塞の本態は消化管の虚血であるため，診断には造影CTが重要である。しかし，どのような所見が有用であるか明らかではない。【方法】術前に造影CTが施行された... 【Background】Since the pathogenesis of bowel strangulation (BS) involves bowel ischemia, contrast-enhanced computed tomography (CECT) is important for the... |
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| Title | 絞扼性腸閉塞診断における造影CTの有用性 |
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