| Intestinal contents can not run smoothly through the intestinal tract,known as ileus (intestinal obstruction), which is a common disease insurgery. Imaging studies are important means of diagnosis of acute intestinalobstruction．The traditional diagnostic methods as the preferred are still X-rayorthostatic abdominal plain films. In recent years, with the development of CT(computer tomography), it plays an increasingly important role in the diagnosisof acute intestinal obstruction. According to the basic reason for the occurrenceof acute intestinal obstruction， it can be divided into three categories:mechanical intestinal obstruction、dynamic intestinal obstruction and bloodsupply intestinal obstruction, in which the incidence of mechanical intestinalobstruction is the highest. CT scan can show the morphological changes of theintestinal wall，which the traditional X-ray examination can not display, and, ithas strong qualitative and localizing diagnostic value for various types of acuteintestinal obstruction. For the patients of acute intestinal obstruction whohave no improvement through conventional decompression, sausage and othersymptomatic treatment and required surgical treatment, CT examination canprovide adequate preoperative information, in order to facilitate clinicians toconduct a detailed preoperative evaluation. The early diagnosis of acuteintestinal obstruction is not only a clinical difficulty, and also a hot topic in thestudy. This article aims to find the qualitative、localizing diagnostic value aswell as the value of assessment of the degree in acute intestinal obstruction. Itis a retrospective study on the patients who had a clear diagnosis of acuteintestinal obstruction by surgery and treated in the Gastrointestinal Surgery Department of our hospital from January2010to January2012, all patientshave undergone X-ray abdominal plain film in standing position and CT scan,within48hours since admitted to hospital. Two physicians analyze thediagnostic value in judgment、location、cause and degree of acute intestinalobstruction by retrospectively studying the performance of CT,X-rayabdominal plain film and abdominal ultrasonography by blinded method.Results:64patients, CT examination made clearly diagnosis of acute intestinalobstruction were53cases, the sensitivity was82.8%(53/64), the X-rayabdominal plain film confirmed the diagnosis of acute intestinal obstructionwere45cases, the sensitivity was70.3%(45/64), abdominal ultrasonographyconfirmed the diagnosis of acute intestinal obstruction were39cases, thesensitivity was60.9%(39/64). In the diagnosis of the location of acuteintestinal obstruction,surgical findings were the gold standards. The highintestinal obstruction (the site of obstruction in the stomach and duodenum andupper jejunum) were eight cases，and the low intestinal obstruction (the site ofobstruction in the ileum, ileocecal junction, colon or rectum)were56cases in64cases. the accuracy rate in location of CT scan was62.5%(40/64),two casesof high intestinal obstruction and38cases of low intestinalobstruction,including2cases (5%)of gastroduodenal obstruction,20cases(50%)of small intestinal obstruction,10cases (25%) of colon obstruction,3cases (7.5%)of ileocecal obstruction, and5cases(12.5%) of rectalobstruction.And the accuracy rate in location of X-ray abdominal plain filmwas15.6%(10/64), all for the low intestinal obstruction, of which9cases ofsmall bowel obstruction (90%), only1patient (10%) was diagnosed as colonicobstruction; Abdominal ultrasonography check through indirect imaging suchas a large number of product gas effusion, intra-abdominal free fluid areas,obstruction of proximal intestinal motility actively. Subject to the restrictions ofthe product gas effusion in the intestine, the accuracy rate in location of abdominal ultrasonography was only14.1%(9/64), all for the low intestinalobstruction, the site of obstruction in the colon.There was statisticallysignificant (P <0.05)by comparing the three methods, as well as comparing theCT examination and X-ray abdominal plain film, CT scan and abdominalultrasonography examination (P <0.05).In determining the cause of acuteintestinal obstruction, the surgical findings or postoperative pathology were thegold standards,56cases of mechanical intestinal obstruction, and8cases ofdynamic obstruction.In mechanical intestinal obstruction,there were34casesof tumors (25cases of colorectal cancer, one case of small intestinal stromaltumors, one case of kidney rupture,7cases of abdominal metastatic carcinoma),7cases of postoperative adhesions,6cases of intra-abdominal (outside) hernia,1case of intussusception,1case of volvulus,3cases of fecal obstruction,4cases of other rare diseases.In dynamic intestinal obstruction,there were2casesof appendicitis,1case of cecitis,2cases of peritonitis,1case of pelvic abscess,1case of pancreas abscess,1case of lesser omental cyst. The accuracy rate inthe judgement of the cause of acute intestinal obstruction of CT scan was45.3%(29/64).Among them, mechanical intestinal obstruction was25cases(86.2%), and dynamic intestinal obstruction was4cases (13.8%).25cases ofmechanical intestinal obstruction include19cases of tumors、1case ofpostoperative adhesion、2cases of abdominal hernia、one case of inguinalhernia、one case of intussusception and1cases of fecal obstruction.4cases ofdynamic intestinal obstruction include1case of pelvic abscess,1case of thelesser omental cyst,1case of pancreatic abscess,1case of appendicitis. Theaccuracy rate in the judgement of the cause of acute intestinal obstruction ofX-ray abdominal plain film was0%(0/64), that is, no one cases diagnosed thecause of acute intestinal obstruction.The accuracy rate in the judgement of thecause of acute intestinal obstruction of Abdominal ultrasonography was21.9%(14/64), including9cases of tumor,2cases of abdominal hernia,1case of pancreatic abscess,1case of inguinal hernia,1case of incisional hernia. Therewere statistically significant (P <0.05) by comparing CT scan and X-rayabdominal plain film, CT scan and abdominal ultrasonography examination,abdominal plain film examination and abdominal ultrasonography examination.The surgery of the64patients:22cases of colonic resection (including lefthemicolectomy, right hemicolectomy, sigmoid resection, subtotal hysterectomyof colon)，4cases of simple colostomy,10cases of bowel resection andanastomosis,9cases of enterolysis performed,11cases of ileocecal resection,simple laparoscopy or exploratory laparotomy surgery were2cases. Of which15cases were strangulated intestinal obstruction confirmed by surgery,10patients underwent bowel resection and anastomosis,5patients underwententerolysis surgery. CT examination considering strangulation were10cases,X-ray abdominal plain film tconsidering strangulation were2cases, abdominalultrasonography examination considering strangulation were6cases.Therewere statistically significant difference (P <0.05) by comparing the threemethods, the CT examination and X-ray abdominal plain film examination,butthe CT examination and abdominal ultrasonography had no statisticallysignificant difference (P>0.05) between them. Conclusion:1.In diagnosis ofacute intestinal obstruction，CT examination is better than X-ray abdominalplain film and abdominal ultrasonography.2,In the diagnosis of location ofacute intestinal obstruction, CT scan is superior to X-ray abdominal plain filmand ultrasonography.3, in the qualitative diagnosis of acute intestinalobstruction, CT scan is superior to X-ray abdominal plain film andultrasonography.4, in the judgment of the extent of acute intestinal obstruction,CT scan is superior to X-ray abdominal plain film examination.5, CT shouldbe used as one of the routine examination of patients with acute intestinalobstruction. |
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