바륨관장법으로 정복된 장중첩증과 정복실패한 장중첩증의 방사

Abstract

The intussusception is one of the most frequent cause of the intestinal obstruction in children. It shows typical clinical pictures and is very important to diagnose early and treat adequately, because it frequently develops to bowel perforation and eventually to peritonitis. Findings of intestinal obstruction and soft tissue mass density are seen on simple abdomen film. Barium enema is widely used, because it is proved to be nor only an excellent tool of diagnosis, but also the treatment of choice for intussusception. 181 cases, which were confirmed to be intussusception, were reviewed retrospectively to identify the differences between radiologic findings of reduced and unreduced intussusceptions by barium enema. 181 cases, which were confirmed to be intussusception, were reviewed retrospectively to identify the differences between radiologic findings of reduced and unreduced intussusceptions by barium enema. The results were as follows. 1. Of 181 cases, 148 cases were reduced and 33 cases were nonreduced barium enema, so the rate reduction was 82%. 2. In simple abdomen film, air-fluid levels were seen in 23 cases(15.5%) of the reduced intussusception and in 18 cases(54.6%) of the nonreduced intussusception, and soft tissue mass densities were seen in 20 cases(13.5%) of the rediced intussusception and in 12 cases(36.4%) of the nonreduced intussusception. So, air-fluid levels and soft tissue mass dinsities were more frequent finding in nonreduced intussusception. 3. The mean value of a ratio of maximal diameter of small bowel in interpedicular distance of L3 vertebral body was 0.93 in the reduced intussusception and 1.25 in the nonreduced intussusception. And, statistically significant correlation exists between the degree of small bowel dilatation and the rate if reduction(P〈0.05). 4. On barium enema, the dissection sign was seen in 33.1% of the reduced intussusception and in 75.8% if the ninreduced intussusception, so the sign is more common finding in nonreduced intussusception(P〈0.05). 5. Morphologic abnormalities of ascending colon were seen in 11.5% of the reduced intussusceptionand in 38.7% if the nonreduced intussusception, so this finding is more common finding in nonreduced intussusception(P〈0.05). So, If air-fluid levels, soft tissue mass densities and marked small bowel dilatation were seen on simple abdomen film, and the dissection sign and morphologic abnormalities were seen on barium enema, it is likely to fail in barium hydrostatic. And then, it is advisable to immediately proceed with manual reduction by surgery, after identifying the location of intussusception only by bariul enema.

;장중첩증은 소아의 장폐색의 가장 흔한 원인 중의 하나로서 특징적인 임상증상을 보이며 천공으로 인한 복막염을 유발할 수 있으므로 조기진단과 치료가 요구되는 급성질환이다. 단순복부촬영사진에는 장폐색의 소견과 종괴의 음영이 나타나며 특히 바륨관장술은 장중첩증의 확진이 가능할 뿐 아니라 치료의 최선책으로 널리 사용되고 있다. 연구자는 장중첩증으로 확진된 181명의 환자들을 후향적으로 분석하여 정복된 장중첩증과 정복에 실패한 장중첩증의 방사선학적 소견을비교한 결과 다음과 같은 결과를 얻었다. 1. 181례 바륨관장법으로 정복된 경우는 148례, 정복되지 않은 경우는 33례로 82%의 정복률을 보였다. 2. 단순복부촬영사진소견상 공기-액체층은 정복된 경우 23례(15.5%), 정복되지 않은 경우는 18례(54.6%)에서 관찰되었고, 종괴음영은 정복된 경우 20례(13.5%), 정복되지 않는 경우는 12례(36.4%)로 정복이 되지 않은 장중첩 중에서 공기-액체 음영상과 종괴음영이 더 많이 발전되었다. 3. 소장의 최대 직경을 제삼 요추의 척추경간거리로 나눈 비의 평균치는 정복된 경우 약 0.93, 그리고 정복 안된 경우는 약 1.25이었으며, 소장확장의 정도와 정복률간에는 통계적으로 유의한 상관관계가 있었다(P〈0.05). 4. 바륨관장사진 소견상 dissection sign은 정복된 경우에 33.1%에서 보였고, 정복 실패한 경우 75.8%에서 보여 정복 안된 경우에 더 흔한 소견이었다(P<0.05). 따라서 단순복부촬영 소견상 공기-액체상의 종괴가 보이고 소장확장이 심하며 바륨관장소견상 dissection sign과 상행결장의 형태학적 이상이 보이면 바륨관장에 의한 정복이 실패할 가능성이 높으므로 무리한 관장을 시행하지 말고 감입부만을 확인한 후 개복하여 도수정복을 하는 것이 바람직하다고 하겠다.