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Duodenal Rupture Due to Blunt Abdominal Trauma: Evaluation with Plain Film and Computed Tomography
腹部鈍傷導致十二指腸破裂：傳統X光片及電腦斷層的診斷
摘要
十四例因腹部鈍傷而導致十二指腸破裂經開刀證實的病人。其中，10例做腹部電腦斷層檢查(computed tomography, CT) 4例做上腸胃道檢查(upper GI series)。腹部X光片(plain abdominal films)顯示，後腹腔氣腫(retro-peritoneal emphysema)導致4例右腎和1例腰大肌邊緣被空氣之對比顯示出來。79%的病人，有非特異發現(non-specific findings)，它們包括：9例右邊腰大肌邊緣模糊，7例右邊腎臟邊緣不清楚，及7例腰椎側彎。CT顯示8例(80%)可在右邊腎旁部(right anterior pararenal space)發現液體存留，有意義的是其中6例(60%)在右前腎旁和／或右前腎周圍(right anterior pararenal or/and perirenal space)可見氣體存積，只有1例沿著右腰大肌分佈。上腸胃道檢查(Upper GI series) 4例中，有3例可見造影劑從破裂的十二指腸滲出。對於因十二指腸破裂導致空氣和液體滲出在腹膜後的檢查，電腦斷層比傳統腹部X光片更靈敏。因為用傳統腹部X光片診斷，經常會把它們誤為大便中所含的物質與氣體。
並列摘要
We studied retrospectively 14 patients with surgically proved duodenal rupture due to blunt abdominal trauma. Among them, plain abdominal films were taken in all cases, abdominal computed tomography (CT) in 10 cases and upper GI series in 4 cases. Plain abdominal films revealed retroperitoneal emphysema outlining the right kidney in 4 cases and along the right psoas muscle in 1 case. Other non-specific findings suggestive of duodenal rupture were demostrated in 79% of the patients. These included obliteration of right psoas muscle margin (9 cases), right renal outline (7 cases) or scoliosis of lumbar spine (7 cases). Using CT, 8 cases (80%) could clearly demostrate fluid collection at right anterior pararenal space and among them, 6 cases (60%) showed gaseous collection at the right anterior pararenal or/and perirenal space and one case showed gaseous collection along right psoas margin. Three out of 4cases of upper GI series could demostrate extravasation of contrast agent through the perforated duodenum. CT scanning was more sensitive in detecting retroperitoneal gas and fluid extravasated from perforated duodenum which were often being missed or misinterpreted as superimposed fecal gaseous materials on their plain films.
延伸閱讀
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