INTESTINAL INJURIES MISSED BY COMPUTED-TOMOGRAPHY
INTESTINAL INJURIES MISSED BY COMPUTED-TOMOGRAPHY
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DOI：
10.1097/00005373-199001000-00001
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发表时间：
1990-01-01
影响因子：
--
通讯作者：
OAKES, DD
中科院分区：
文献类型：
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作者：
SHERCK, JP;OAKES, DD
仅通过体格检查和常规实验室检查往往难以诊断孤立性肠道损伤。在1980年到1988年间，确定了10名肠道损伤患者，他们在手术前都进行了计算机断层扫描（CT）。这些扫描的初步结果都未被认为对肠道损伤具有诊断性。所有患者在受伤后2小时到3天内接受了剖腹手术，没有患者因肠道损伤漏诊而死亡。对扫描结果的回顾性分析显示，有2例可诊断为肠道穿孔，伴有游离的腹腔内气体或渗出的造影剂。其余8例扫描结果有提示损伤的迹象。然而，另外6名患者有类似的提示性表现却没有肠道损伤的证据。1名十二指肠损伤漏诊的患者未使用胃肠道造影剂。肠道创伤的计算机断层扫描结果可能很细微或不具特异性，在解读时需要最佳的技术和谨慎态度。这种损伤的及时治疗仍然依赖于临床医生高度的怀疑意识以及由经验丰富的外科医生进行的系列检查。
Isolated intestinal injuries are frequently difficult to diagnose using only physical examination and routine laboratory studies. Between 1980 and 1988, ten patients were identified who had intestinal injuries and had computed tomographic (CT) scans before operation. For none of these scans was the initial reading considered diagnostic of intestinal injury. All patients came to laparotomy from 2 hours to 3 days following injury, and no patient died because of missed intestinal injury. Retrospective review of the scans revealed two to be diagnostic of intestinal perforation with free intraperitoneal air or extravasated contrast. The remaining eight scans had findings suggestive of injury. However, six additional patients had similar suggestive findings and had no evidence of intestinal injury. One patient with missed duodenal injury had not been given gastrointestinal contrast. Computed tomographic findings of intestinal trauma may be subtle or nonspecific and require optimal technique and care in interpretation. The timely treatment of this injury continues to rely on a high index of clinical suspicion and serial examinations by an experienced surgeon.