복부둔상에 의한 소장천공에서 시간경과에 따른 CT와 임상소견의 분석

강영준; 이용석; 백용해; 최원용; 곽범석; 김연대; 박영진; 김홍용

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자료유형: 학술저널

저자정보: 강영준 (동국대학교) 이용석 (동국대학교) 백용해 (동국대학교) 최원용 (동국대학교) 곽범석 (동국대학교) 김연대 (동국대학교) 박영진 (동국대학교) 김홍용 (동국대학교)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research 대한외과학회지 Vol.75 No.4

발행연도: 2008.10

수록면: 228 - 234 (7page)

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연구주제

📖

연구배경

🔬

연구방법

🏆

연구결과

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Purpose: The high mortality and morbidity rates associated with traumatic rupture of the small bowel have been attributed to the clinical difficulty of establishing an early diagnosis. CT scan is the most widely used tool for the diagnosis of blunt abdominal trauma, but its accuracy in diagnosing small bowel perforation is still controversial. This study was conducted to determine the overall and time-dependent diagnostic value of abdominal CT and the clinical findings of small bowel perforation.
Methods: The clinical data and CT images of 21 patients with small bowel perforation after blunt trauma were retrospectively analyzed. The patients were divided into the early and late elapsed time groups based on the elapsed time of 8 hours from the initial trauma to the time of evaluation.
Results: Any changes of the vital signs, including hypotension, tachycardia or fever, were observed in only half of the patients. Signs of peritonitis were evident in 7/11 of the early lapse group and in 10/10 of the late lapse group. The most common CT finding of small bowel perforation was free peritoneal air (17 of 21 patients), followed by segmental bowel wall thickening (15/21), high density ascites (14/21), an intermesentric fluid collection (13/21) and mesentic fat obliteration (11/21). Extraluminal air and segmental bowel wall thickening were detected more frequently in the late lapse group (P=0.03 and 0.01, respectively). In the one patient, bowel perforation was not evident at the initial evaluation according to the clinical findings and CT, but the follow-up CT exam showed specific findings for bowel perforation.
Conclusion: CT scanning is a sensitive and effective modality for the evaluation of small bowel perforation, but this is less sensitive during the earlier post traumatic period. Therefore, careful clinical and radiological follow up is necessary for suspected cases, and even when an initial evaluation shows negative findings for bowel injury.

#Blunt abdominal trauma #Small bowel perforation #CT #복부둔상 #소장천공 #전산화단층촬영

참고문헌 (24)

참고문헌 신청

1. [학술지(정기간행물)] - Wisner DH / 1990 / Blunt intestinal injury. Keys to diagnosis and management / Arch Surg 125 : 1319 ~ 1322

2. [학술지(정기간행물)] - Allen GS / 1998 / Hollow visceral injury and blunt trauma / J Trauma 45 : 69 ~ 75

3. [학술지(정기간행물)] - Fakhry SM / 2000 / Relatively short diagnostic delays (＜8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience / J Trauma 48 : 408 ~ 414

4. [학술지(정기간행물)] - Fakhry SM / 2003 / Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial / J Trauma 54 : 295 ~ 306

5. [학술지(정기간행물)] - Levine CD / 1997 / CT findings of bowel and mesenteric injury / J Comput Assist Tomogr 21 : 974 ~ 979

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