Computed Tomography and Diagnostic Peritoneal Lavage Findings in Diagnosis of Blunt Small Bowel Perforation

腹部鈍傷致小腸破裂在電腦斷層掃描和診斷性腹膜灌洗術之特徵

鄭垂軒(Chui-Husan Cheng) ； 陳維恭(Wei-Kung Chen) ； 王毓駿(Yu-Chun Wang) ； 黃獻宏(Hsien-Hung Huang) ； 蔡家碩(Jia-Shuo Henry Tsai) ； 梁偉成(Wai-Shing Leung)

《Journal of Emergency Medicine, Taiwan》 10卷3期 (2008/09) Pp. 73-80

摘要

目的：術前診斷鈍傷致小腸破裂有其困難之處。目前診斷工具雖以電腦斷層掃描或診斷性腹膜灌洗術為主，但很少有研究同時探討這兩種檢查。因此本研究以同時接受上述兩種檢查的病人為研究對象，來探討小腸破裂的特徵。
方法：本研究對象選自某創傷中心因腹部鈍傷接受電腦斷層掃描和診斷性腹膜灌洗術的病人；並以敏感度、特異度、陽性及陰性預測值，來評估哪些特徵可診斷小腸破裂。
結果：研究期間2年共收集40位病人，其中3位小腸破裂。斷層掃描影像中，若游離空氣出現在增厚小腸壁附近，診斷小腸破裂的敏感度為66.7%、特異度為100%、陽性預測值為100%及陰性預測值為97.4%；來源不明腹水的敏感度為66.7%、特異度為97.3%、陽性預測值為66.7%及陰性預測值為97.3%；腸壁增厚的敏感度、特異度、陽性及陰性預測值均為100%。診斷性腹膜灌洗術的指標中，若amylase≥175 IU時，敏感度、特異度、陽性及陰性預測值均為100%。
結論：充分了解電腦斷層掃描和診斷性腹膜灌洗術之特徵將有助於診斷小腸破裂。

關鍵字

小腸 ； 穿孔 ； 鈍傷 ； 創傷 ； 電腦斷層掃描 ； 診斷性腹膜灌洗術

並列摘要

Background: Preoperative diagnosis of blunt small bowel perforation remains difficult. The purpose of this study was to determine the key diagnostic findings of computed tomography and diagnostic peritoneal lavage in detecting blunt small bowel perforation.
Methods: A retrospective study was conducted from January 2004 to December 2005 in a level one trauma center. We collected data from patients hospitalized with blunt trauma who had received both a computed tomography (CT) scan and diagnostic peritoneal lavage to evaluate suspected intra-abdominal injury. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of various signs were analyzed to determine their usefulness in predicting small bowel perforation.
Results: Data from a total of 40 patients hospitalized with blunt trauma, including 3 with small bowel perforation, were analyzed. Intraperitoneal free air adjacent to the injured bowel on CT imaging had a sensitivity of 66.7%, specificity of 100%, PPV of 100%, and NPV of 97.4% in detecting small bowel perforation; free fluid without a definite origin had a diagnostic sensitivity of 66.7%, specificity of 97.3%, PPV of 66.7%, and NPV of 97.3%; both bowel wall thickening and a lavage amylase level ≥175 IU had values of 100% for the sensitivity, specificity, PPV, and NPV.
Conclusion: CT and diagnostic peritoneal lavage had high accuracy rates in detecting blunt small bowel perforation. However, a complete understanding of the radiologic signs and lavage findings may help the physician correctly identify blunt small bowel perforation.

並列關鍵字

small bowel ； perforation ； blunt injury ； trauma ； computed tomography ； diagnostic peritoneal lavage