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相關文獻
- Pitfalls in CT Evaluation of Blunt Abdominal Injury
- Blunt Abdominal Trauma with Retroperitoneal Teratoma Rupture: A Case Report and Computed Tomography Diagnosis
- Delayed Intestinal Stenosis after Blunt Abdominal Trauma: Report of a Case
- The Value and Role of Computed Tomography in Blunt Injury of the Abdomen
- Unilateral Adrenal Hemorrhage after Blunt Abdominal Injury: A Case Report and Literature Review
- Chronic Colonic Obstruction after Blunt Abdominal Trauma--A Case Report
- CT Diagnosis of Non-solid Organ Injury in Patients with Blunt Abdominal Trauma
- Delayed Perforation of the Colon after Blunt Abdominal Injury: Two Case Reports with Reviews
- 骨盆骨折病患合併腹部鈍傷之診斷
- Delayed Presentation of Duodenal Perforation after a Blunt Abdominal Injury--A Case Report
頁籤選單縮合
題名 | Pitfalls in CT Evaluation of Blunt Abdominal Injury=腹部鈍傷電腦斷層診斷之盲點 |
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作者 | 鄭莉莉; 蔡明哲; 吳明和; 俞芹英; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 26:4 民82.07-08 |
頁次 | 頁1879-1885 |
分類號 | 416.16 |
關鍵詞 | 腹部鈍傷; 電腦斷層診斷; Blunt abdominal injury; Computed tomography; |
語文 | 英文(English) |
中文摘要 | 我們研究電腦斷層攝影在腹部鈍傷手術前診斷的重要性,特別強調電腦斷層攝影診斷的盲點。研究中包括60位腹部鈍傷的病人,先後接受電腦斷層攝影檢查和剖腹探查。對於17例脾臟傷害和12例腎臟傷害,電腦斷層攝影皆能正確診斷。12例肝臟傷害中,2例未能診出。最常誤診的是胰臟,中空臟器及腸系膜損傷。10例胰臟挫傷,以及3例胰臟裂傷中的1例,未能診出。中空臟器穿孔,8例中有2例,腸系膜損傷,16例中有11例,未能診出。2例大型後腹腔血腫誤診為併有腹腔內病灶。1例膀脫破裂及1例中空藏器穿孔,由於掃描未能涵蓋骨盆腔而誤失診斷。另有1例總膽管截斷也未能診出。我們的結論為:(1)早期胰臟損傷是電腦斷層攝影對腹部鈍傷診斷上的一個死角;(2)中空臟器及腸系膜傷害亦為電腦斷層攝影檢查的盲點;(3)當病人懷疑有骨盆腔傷害或是有不明原因的腹腔血腫時,電腦斷層攝影檢查應涵蓋骨盆腔掃描;(4)大型後腹腔血腫易誤為併有腹腔內出血,對此應提高警覺。 |
英文摘要 | The role of computed tomography in preoperative diagnosis of blunt abdominal injury (BAI) was studied. Pitfalls in CT diagnosis were emphasized. Included were 60 BAI patients in whom both preoperative CT and exploratory laparotomy had been performed. CT interpretation was correct in all 17 cases of splenic injuries and in all 12 cases of renal injuries. Two out of 11 hepatic injuries were missed. Most of the misdiagnosis was in pancreatic, hollow organ and mesenteric injuries. CT was unable to disclose the ten patients with pancreatic contusion, and the one with pancreatic laceration. They had been scanned shortly after trauma. Two hollow organ perforation were missed out of the 8 cases, 11 out of 16 mesenteric serosal injuries were missed. Two large retroperitoneal hematoma were misinterpreted as intraperitoneal lesion. Inadequate scanning, without including the pelvic region, missed one bladder rupture and one hollow organ perforation. The single case of common bile duct (CBD) transection was not suspected in the preoperative CT scan. The conclusion: 1) CT is not reliable in detecting an early phase pancreatic injury; 2) misdiagnosis in hollow organ and/or mesenteric injuries is one of the common pitfalls in CT interpretation of blunt abdominal injury; 3) CT scan to include the pelvic region is recommended in patients with unexplained hemoperitoneum or high clinical suspicion of pelvic injuries; and 4) large retroperitoneal hematoma often combine a small amount of intraperitoneal fluid or mimicking intraperitoneal fluid and diagnosis of intraperitoneal lesion under such circumstances should be done with great care. |
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