画像診断が有用であった小腸軸捻の1例

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  • A CASE OF SMALL BOWEL VOLVULUS DETECTED BY DIAGNOSTIC IMAGING, WHICH WAS USEFUL

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An 83-year old woman was emeregently admitted to the hospital because of increasing low abdominal intermittent pain and fullness, which had occurred sometimes. There were no chracteristic findings in a plain abdominal X-ray film and ultrasonography. Abdominal CT demonstrated whirling mesentery adjacent to the mass with a calcification placed centrally, and a whirl-like pattern of the small bowel loops. In reviewing sagittal views of MRI, the patient was diagnosed as having a small bowel volvulus. A conservartive therapy was performed because no ischemic nor edematous changes were seen in the intestinal wall. But, whirl-like pattern did not disappear on CT even 10 days after the conservative therapy. and detorsion had to be performed operatively at laparotomy, it was found that the volvulus was twisted by 720° clockwise rotation around the mesenterium about 70cm from Treitz ligament to the ileo-cecal part. Abdominal CT and MRI are considered to be useful in the early diagnosis of small bowel volvulus. In this case, emergently operations were not necessarily needed under no inflammatory signs in the intestinal mucosa, even if a typical whirl-like pattern was demonstrated.

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