右下腹部痛(Right Lower Quadrant Pain)シリーズ15 RESIDENT COURSE 解答 【症例 RR 71】

盲腸癌.Cecal cancer.



小腸が拡張している.右側結腸(A:上行結腸,C:盲腸)は図10までで,図4〜図9の↑は不整に強く造影され,辺縁も不整で,悪性腫瘍を強く示唆する.図6から回腸末端(TI)が始まるが,図8〜図12で拡張を示し,盲腸癌による腸閉塞と診断できる.図10の1〜図5の6は虫垂で,低濃度の内容物でやや拡張し,根部での閉塞を意味する.内視鏡検査で盲腸癌と診断され手術となった.病理:well differentiated adenocarcinoma.Stage IIIb






文献考察:大腸閉塞とPseudo-obstructionのCT診断は精度が高い
Abdom Imaging. 1998 Mar-Apr;23(2):141-6.
Prospective evaluation of colonic obstruction with computed tomography.
Frager D, Rovno HD, Baer JW, Bashist B, Friedman M.

BACKGROUND: To determine whether computed tomography (CT) can satisfactorily diagnose and evaluate patients with suspected colonic obstruction. METHODS: Seventy-five patients with suspected colonic obstruction were evaluated prospectively by CT and compared with the gold standards of surgery and/or endoscopy in 65 patients, clinical course in nine, and contrast enema (CE) in one. A limited comparison between CT and CE (26) patients was also made in those patients who had both studies. RESULTS: CT successfully diagnosed colonic obstruction in 45 of 47 patients (96% sensitivity). Pseudo-obstruction was correctly diagnosed in 26 of 28 patients (93% specificity). CT correctly localized the point of obstruction in 44 of 47 patients (94%). CE successfully diagnosed obstruction in only 20 of 25 patients (80% sensitivity). CONCLUSION: In this study, CT proved to be a satisfactory modality in evaluating patients with suspected colonic obstruction. CT may in certain circumstances be preferable to the traditional CE in evaluating these patients.PMID: 9516501
  【参照症例】   1. 右下腹部痛シリーズ7 【症例 RR 32】

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