BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
小肠梗阻(SBO)是临床常见的急腹症,若未能及时诊断和处理,可能引发严重并发症,甚至死亡。特别是在老年患者中,由于生理机能下降,肠坏死的发生率较高。本文回顾了小肠梗阻的诊断方法、影像学检查及治疗进展,重点讨论了CT、X线、超声和MR...小肠梗阻(SBO)是临床常见的急腹症,若未能及时诊断和处理,可能引发严重并发症,甚至死亡。特别是在老年患者中,由于生理机能下降,肠坏死的发生率较高。本文回顾了小肠梗阻的诊断方法、影像学检查及治疗进展,重点讨论了CT、X线、超声和MRI等影像学手段在诊断中的应用,特别是如何通过影像学特征预测肠缺血和坏死。此外,文章还探讨了生物标志物(如乳酸、D-二聚体、PCT和I-FABP)在肠缺血诊断中的潜力。手术治疗和保守治疗的适应症及决策依据也得到了详细分析。尽管现有诊疗方案已取得一定成效,但对于早期肠绞窄和缺血的识别仍存在挑战,未来需要更多多中心研究优化诊断和治疗策略。Small bowel obstruction (SBO) is a common acute abdominal condition, which, if not diagnosed and managed promptly, may lead to severe complications, including death. This risk is particularly higher in elderly patients due to diminished physiological function and increased likelihood of bowel necrosis. This review discusses the diagnostic methods, imaging techniques, and therapeutic advances in SBO, with a focus on the use of CT, X-ray, ultrasound, and MRI in diagnosis, particularly in predicting bowel ischemia and necrosis through imaging features. Furthermore, the potential of serum biomarkers such as lactate, D-dimer, procalcitonin (PCT), and intestinal fatty acid-binding protein (I-FABP) in diagnosing bowel ischemia is explored. The indications for and decision-making processes surrounding both surgical and conservative treatments are also analyzed. While current diagnosis and treatment strategies have shown effectiveness, early identification of bowel strangulation and ischemia remains a challenge, highlighting the need for more multicenter studies to optimize diagnosis and treatment strategies.展开更多
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
文摘小肠梗阻(SBO)是临床常见的急腹症,若未能及时诊断和处理,可能引发严重并发症,甚至死亡。特别是在老年患者中,由于生理机能下降,肠坏死的发生率较高。本文回顾了小肠梗阻的诊断方法、影像学检查及治疗进展,重点讨论了CT、X线、超声和MRI等影像学手段在诊断中的应用,特别是如何通过影像学特征预测肠缺血和坏死。此外,文章还探讨了生物标志物(如乳酸、D-二聚体、PCT和I-FABP)在肠缺血诊断中的潜力。手术治疗和保守治疗的适应症及决策依据也得到了详细分析。尽管现有诊疗方案已取得一定成效,但对于早期肠绞窄和缺血的识别仍存在挑战,未来需要更多多中心研究优化诊断和治疗策略。Small bowel obstruction (SBO) is a common acute abdominal condition, which, if not diagnosed and managed promptly, may lead to severe complications, including death. This risk is particularly higher in elderly patients due to diminished physiological function and increased likelihood of bowel necrosis. This review discusses the diagnostic methods, imaging techniques, and therapeutic advances in SBO, with a focus on the use of CT, X-ray, ultrasound, and MRI in diagnosis, particularly in predicting bowel ischemia and necrosis through imaging features. Furthermore, the potential of serum biomarkers such as lactate, D-dimer, procalcitonin (PCT), and intestinal fatty acid-binding protein (I-FABP) in diagnosing bowel ischemia is explored. The indications for and decision-making processes surrounding both surgical and conservative treatments are also analyzed. While current diagnosis and treatment strategies have shown effectiveness, early identification of bowel strangulation and ischemia remains a challenge, highlighting the need for more multicenter studies to optimize diagnosis and treatment strategies.
文摘目的研究无痛胃肠镜检查后肠麻痹的影响因素,构建人工神经网络(artificial neural network,ANN)预测模型,并验证其预测价值。方法选取2019年6月至2023年6月在浙江大学医学院附属第二医院临平院区进行无痛胃肠镜检查的500例患者为研究对象,采用随机数字表法将其按照7∶3的比例分配为训练集350例、测试集150例。根据训练集术后是否发生肠麻痹再将其分为无肠麻痹组(308例)和肠麻痹组(42例)。比较两组患者临床资料差异;采用多因素逐步Logistic回归模型分析无痛胃肠镜检查后肠麻痹的影响因素;构建ANN预测模型,并绘制受试者工作特征(receiver operating charcteristic,ROC)曲线,通过曲线下面积(area under the cure,AUC)比较多因素逐步Logistic回归模型与ANN预测模型对术后肠麻痹的预测价值。结果与无肠麻痹组相比,肠麻痹组患者中男性、身体质量指数(BMI)≤18.5 kg/m^(2)、吸烟、糖尿病、术后低钾血症的各项指标构成比均有所升高(均P<0.05);多因素逐步Logistic回归模型显示,性别、BMI、吸烟、糖尿病、术后低钾血症均是无痛胃肠镜检查后肠麻痹的影响因素(均P<0.05);选择多因素逐步Logistic回归模型得出的5个因素,并依此建立ANN预测模型,该模型为3层5-4-2结构。训练集的灵敏度、特异度、错误率分别为88.1%、52.9%、22.5%,测试集的灵敏度、特异度、错误率分别为90.5%、71.1%、27.6%,各种影响因素权重分别为糖尿病17.1%、术后低钾血症13.3%、BMI 11.5%、性别8.1%、吸烟7.6%。ROC曲线显示,多因素逐步Logistic回归模型、ANN预测模型预测术后肠麻痹的AUC分别为0.810、0.880,这提示ANN预测模型的预测价值高于多因素逐步Logistic回归模型。结论男性、BMI过低、吸烟、糖尿病、术后低钾血症是无痛胃肠镜检查后肠麻痹的影响因素,本研究构建的ANN预测模型可以准确预测术后肠麻痹的发生风险,为识别高危人群、采取早期干预措施提供依据。
