Multiplanar reformatted CT enterography in acute abdomen

Yıl 2016, Cilt: 8 Sayı: 1, 1 - 5, 01.04.2016

Abdurrahim Dusak Bircan Alan Abdulmenap Güzel Muharrem Çakmak Fatih Taşkesen Cemil Göya Aslan Bilici

Öz

Aim: To investigate the correlation between surgical - histopathological data and CT enterography CTE in patients with acute abdomen due to mecanical ileus. Methods: Ninety one 46 female, 45 male; 44±11 year- old consecutive acute abdomen cases admitted to emergency department and operated in general surgery department with a preoperative diagnoses of mechanical ileus were included in this study. CTE was carried-out using Multi sliced CT 64 detector CT, Philips Brilliance . Subjects were scanned from xiphoid process to symphysis pubis during a single breath-hold. Correlation analyses were done between radiological findings and surgical and histopathological findings. Result: Gastrointestinal tract GIT obstruction finding was evident in 82% of subjects with mecanical ileus and acute abdomen. Sensitivity and specificity of CTE was 85% and 55% respectively in terms of demonstration of etiopathology. 80% of cases had small bowel obstruction and remaining 20% had large bowel obstruction. Bridled ileus, mass, hernia, mesenteric ischemia, perforation, peritonitis carcinomatosa, volvulus, invagination, narrowed anastomosis, torsion, abscess, gossypiboma, gallstone ileus and malrotation were among underlying etiological factors. Statistically significant correlation found between GIT obstruction and findings such as mesenteric stranding, intra abdominal free fluid, string of pearls sign and transition-zone. In contrary, bowel wall thickening, mass lesion, faeces sign, peritoneal nodule, whirl sign, target sign, intra abdominal free air, pneumatosis intestinalis were not statistically significantly correlated with GIT obstruction. Conclusion: CT Entherography is an efficient imaging modality with high diagnostic value in demonstrating the existence and etiopathology of bowel obstruction.

Anahtar Kelimeler

CT enterography, mechanic ileus, acute abdomen, bridle

Akut batında multiplanar reformat BT enterografi

Öz

Amaç: Akut batın ile başvuran, mekanik ileus tanısı alan olgularda, cerrahi - histopatoloji verileri ile BT Enterografi BTE bulgularının korelasyonu araştırıldı. Gerek ve Yöntem: Merkezimiz Acil servisine akut batın ile başvuran ve Genel Cerrahi servisinde mekanik ileus tanısı ile opere edilen ardışık 91 olgu 46 kadın, 45 erkek; yaş: 44±11 çalışmaya alındı. Çok kesitli BT 64 dedektör BT, Philips Brillance ile BTE; ksifoid proçesten ve simfizis pubise kadar, nefes tutturularak tarandı. Radyolojik bulgular; cerrahi ve histopatolojik veriler ile korele edildi. Bulgular: Akut batın ile başvuran ve mekanik ileus tanısı alan olguların %82'inde GIT obstrüksiyonu saptandı. Etyopatolojide BTE'nin sensitivitesi %85 spesifitesi %55 olup olgularda %80 ince barsak, %20 kalın barsak obstrüksiyonu brid ileus, kitle, herni, mezenter iskemi, perforasyon, peritonitis karsinomatoza, volvulus, invajinasyon, anastomoz darlığı, torsiyon, anastomoz darlığı, abse, gossipiboma, safra taşı ileusu ve malrotasyon saptandı. GIT obstrüksiyonu ile mezenterik kirlenme, batın içi serbest sıvı, inci dizisi bulgusu ve geçiş zonu arasında istatistiksel olarak anlamlı korelasyon saptandı. Ancak duvar kalınlaşması, kitle, feçes sign, peritoneal nodül, whirl sign, target sign, batın içi serbest hava ve pneumatosis intestinalis ile anlamlı korelasyon saptanmadı. Sonuç: Akut batın ile başvuran olgularda, GIT obstrüksiyonu varlığı ve etyopatolojisinin belirlenmesinde; BTE etkin, tanı değeri yüksek bir Radyolojik görüntüleme yöntemidir.

Anahtar Kelimeler

BT Enterografi, akut batın, mekanik ileus, brid

Kaynakça

• Aguirre DA, Santosa AC, Casola G, Sirlin CB. Abdominal Wall Hernias: Imaging Features, Complications and Diagnostic Pitfalls at Mul- ti-Dedector Row CT. RadioGraphics 2005; 25: 1501-1520.
• Sagar P M, MacFie J, Sedman P, May J. Intestinal obstruction promotes gut translocation of bac- teria. Dis Colon Rect 1995; 38: 640-644.
• Filippone A, Cianci R, Storto ML. Bowel Obstruc- tion: comparsion between multidedector-row CT axial and coronal planes. Abdom Imaging 2007; 32: 310-316.
• Fukuya T, Hawes D, Lu CC, Chang, PJ, Barloon TJ. CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR 1992; 158: 765-769.
• Menzies D, Ellis H. Intestinal obstruction from adhesions – how big is the problem? Ann R Coll Surg Engl 1990; 72: 60-63.
• Fuchsjäger MH. The small-bowel feces sign. Radiology 2002; 225: 378-379.
• Boudiaf M, Soyer P, Terem C, Pelage JP, Maissait E, Raymer R. CT evalution at small bowel ob- struction. RadioGraphics 2001; 21: 613-624.
• Furukawa A, Yamasaki M, Furuichi K et al. Hel- ical CT in the diagnosis of small bowel obstruc- tion. RadioGraphics 2001; 21: 341-355.
• Miller PA, Mezwa DG, Feczko PJ, Jafri ZH, Mad- razo BL. Imaging Of Abdominal Hernias. Radio- Graphics 1995; 15: 333-347.
• Rao PM, Rhea JT, Novelline RA et al. Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination. Radiology 1997; 202: 139-144.
• Frager D, Baer JW, Medwid SW, et al. Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesion or hernia: efficacy of CT. AJR Am J Roentgenol 1996; 166: 67-71.
• Maglinte DD, Reyes BL, Harmon BH et al. Relia- bility and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR 1996; 167: 1451-1455.
• FukuyaT, Hawes DR, Lu CC, Chang PJ, Barloon TJ. CT diagnosis of small bowel obstruction: efficacy in 60 patients. AJR 1992; 158: 765-769.
• Landwehr P. Emergency radiology of bowel obstructions. Chirurg 2006; 77: 889-897.
• Meigbow AJ, Balthazar EJ, Cho KC, Medwid SW, Birnbaum BA, Noz ME. Bowel Obstruction: Eval- uation with CT. Radiology 1991; 180: 313-318.
• Frager D, Medwid SW, Baer JW, Mollineli B, Friedman M. CT of Small Bowel Obstruction: Value in Establishing the Diagnosis and Deter- mining the Degree and Cause. AJR 1994; 162: 37-41.
• Megibow AJ, Balthazar EJ, Cho KC, Medwid SW, Birnbaum BA, Noz ME. Bowel Obstruction: Eval- uation with CT, Radiology 1991; 180: 313-318.
• Furukawa A, Yamasaki M, Takahashi M, Nitta N, Tanaka T, Kanasaki S et al. CT diagnosis of small bowel obstruction: scaning technique, inter- pretation and role in the diagnosis. Seminars in Ultrasound, CT, MRI 2003; 24: 336-352.
• Attard JA, Mc Laren AR Adesive small bowel ob- struction: epidemiology, biology and prevention Can J Surg 2007; 50: 291-300.