Download PDF
Ultraschall Med 2002; 23(1): 13-21
DOI: 10.1055/s-2002-20070
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Nichttraumatisches akutes Abdomen: Ultraschalldiagnostik der Erkrankungen des Gastro-Intestinaltraktes

Ultrasound Examination of Non-Traumatic Acute AbdomenJ.-Y.  Meuwly1 , C.  Felley2 , H.  Vuilleumier3 , P.  Schnyder1 , U.  Hewig1
  • 1Radiologische Abteilung
  • 2Gastroenterologische Abteilung
  • 3Chirurgische Abteilung, Waadtländer Universitätsspital (CHUV), Lausanne, Schweiz
Further Information

Publication History

17. 7. 2001

26. 9. 2001

Publication Date:
13 August 2002 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Der Ultraschall des Abdomens ist bei akuten Bauchschmerzen eine Untersuchungsmethode der ersten Wahl. Ohne Strahlenbelastung, einfach durchführbar, nicht kostenintensiv und realisierbar am Patientenbett hat er außerdem den Vorteil, durch den direkten Patientenkontakt gezielt die schmerzhafte Region zu untersuchen. Die diagnostischen und therapeutischen Möglichkeiten des Ultraschalls sind groß. Es gibt jedoch auch Grenzen der Anwendbarkeit, deren Kenntnis von Bedeutung ist, um Fehldiagnosen zu vermeiden und sich nicht in falscher Sicherheit zu wähnen. Das Ziel dieser Übersichtsarbeit ist das Vorstellen und die Diskussion der echographischen Untersuchung bei akuten nichttraumatischen Abdomenschmerzen mit Ursachen im Zusammenhang mit Magen-Darmerkrankungen.

Abstract

Amongst all imaging procedures available for the exploration of an acute non traumatic abdomen, ultrasound comprises the first line technology. Non ionising, easily accessible, cheap and usable at the bedside, this imaging technique also has the advantage of close contact with the patient, which may help to focus the exploration on painful regions. Moreover, ultrasound has not only diagnostic capabilities, but also therapeutic ones. Nevertheless, sonography has limitations, which have to be known in order to avoid misdiagnosis or inadequate reassurance. The aim of this review is to present and discuss the most recent opinions about ultrasound diagnosis of acute non-traumatic abdomen related to digestive system diseases.

Schlüsselwörter

Akutes Abdomen - Bauchschmerzen - Magen-Darmerkrankungen - Notfall - Ultraschall

Key words

Abdomen, Acute - Abdominal Pain - Emergencies - Digestive System Diseases - Ultrasonography

Literatur

  • 1 Stone R. Acute abdominal pain.  Lippincotts Prim Care Pract. 1998;  2 341-357
    PubMedGoogle Scholar
  • 2 Hawthorn I. Abdominal pain as a cause of acute admission to hospital.  J R Coll Surg Edimb. 1992;  37 389-393
    PubMedGoogle Scholar
  • 3 Carrico C, Fenton L, Taylor G, DiFiore J, Soprano J V. Impact of sonography on the diagnosis and treatment of acute lower abdominal pain in children and young adults.  Am J Roentgenol. 1999;  172 513-516
    PubMedGoogle Scholar
  • 4 Heistermann H P, Joosten U, Krawzak H W, Hohlbach G. Effect of intestinal ultrasound on choice of surgical procedure in acute abdominal pain.  Ultraschall Med. 1995;  16 288-292
    PubMedGoogle Scholar
  • 5 Pohl D, Golub R, Schwartz G, Stein H. Appendiceal ultrasonography performed by nonradiologists: does it help in the diagnostic process?.  J Ultrasound Med. 1998;  17 217-221
    PubMedGoogle Scholar
  • 6 Caterino S, Cavallini M, Meli C, Murante G, Schiffino L, Lotito S. et al . Acute abdominal pain in emergency surgery. Clinical epidemiologic study of 450 patients.  Ann Ital Chir. 1997;  68 817-818
    PubMedGoogle Scholar
  • 7 Irvin T. Abdominal pain: a surgical audit of 1190 emergency admissions.  Br J Surg. 1989;  76 1121-1125
    CrossrefPubMedGoogle Scholar
  • 8 Zielke A, Hasse C, Sitter H, Rothmund M. Influence of ultrasound on clinical decision making in acute appendicitis: a prospective study.  European Journal of Surgery. 1998;  164 201-209
    CrossrefPubMedGoogle Scholar
  • 9 Chen S, Wang H, Hsu H, Huang P, Lin F. Accuracy of ED sonography in the diagnosis of the acute appendicitis.  Am J Emerg Med. 2000;  18 449-452
    CrossrefPubMedGoogle Scholar
  • 10 Rettenbacher T, Hollerweger A, Macheiner P, Gritzmann N. Akute Appendicitis: Sensitivität und Spezifität der einzelnen Ultraschallzeichen.  Ultraschall in Med. 2000;  2 l S60
    PubMedGoogle Scholar
  • 11 Franke C, Bohner H, Yang Q, Ohmann C, Roher H. Ultrasonography for diagnosis of acute appendicitis: results of a prospective multicenter trial. Acute Abdominal Study Group.  World J Surg. 1999;  23 141-146
    CrossrefPubMedGoogle Scholar
  • 12 Karakas S, Guelfguat M, Leonidas J, Springer S, Singh S. Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging.  Pediatric Radiolgy. 2000;  30 94-98
    PubMedGoogle Scholar
  • 13 Lehmann D, Uebel P, Weiss H, Fiedler L, Bersch W. Detectability of the normal and acutely inflamed appendix in patients with right sided abdominal pain.  Ultraschall in Med. 2000;  2 l 101-106
    PubMedGoogle Scholar
  • 14 Vermeulen B, Morabia A, Unger P, Goehring C, Grangier C, Skljarov I. et al . Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate - a randomized trial.  Radiology. 1999;  210 639-643
    PubMedGoogle Scholar
  • 15 Zielke A, Hasse C, Bandorski T, Sitter H, Wachsmuth P, Grobholz R. et al . Diagnostic ultrasound of acute colonic diverticulitis by surgical residents.  Surgical Endoscopy. 1997;  11 1194-1197
    CrossrefPubMedGoogle Scholar
  • 16 Eggesbo H, Jacobsen T, Kolmannskog F, Bay D, Nygaard K. Diagnosis of acute left-sided colonic diverticulitis by three radiological modalities.  Acta Radiologica. 1998;  39 315-321
    PubMedGoogle Scholar
  • 17 Pradel J, Adell J, Taourel P, Djafari M, Monnin-Delhom E, Bruel J. Acute colonic diverticulitis: prospective comparative evaluation with US and CT.  Radiology. 1997;  205 503-512
    CrossrefPubMedGoogle Scholar
  • 18 Franco D, Roudie J. Gallstones and their complications.  Rev Prat. 2000;  50 2117-2122
    PubMedGoogle Scholar
  • 19 Berger M, Vander Elden J, Ligmer J, de Kort H, Prins A, Bohnen M. Abdominal symptoms: do they predict gallstones?.  Scand J Gastroenterol. 2000;  35 70-76
    CrossrefPubMedGoogle Scholar
  • 20 Hessler P, Hill D, Detorie F. High accuracy sonographic recognition of gallstones.  Am J Roentgenol. 1981;  136 517-520
    PubMedGoogle Scholar
  • 21 Laing F, Federle M, Jeffrey R. Ultrasonic evaluation of patients with acute right upper quadrant pain.  Radiology. 1981;  140 449-455
    PubMedGoogle Scholar
  • 22 Cooperberg P, Burhenne H. Real time ultrasonography: Diagnostic technique of choice in calculous gallbladder.  New Engl J Med. 1980;  302 1277-1279
    PubMedGoogle Scholar
  • 23 Bree R. Further observations on the usefulness of the sonographic Murphy sign in the evaluation of suspected acute cholecystitis.  J Clin Ultrasound. 1995;  23 169-172
    PubMedGoogle Scholar
  • 24 Ralls P, Colletti P, Lapin S, Chandrasoma P, Boswell W, Ngo C. et al . Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs.  Radiology. 1985;  155 767-771
    CrossrefPubMedGoogle Scholar
  • 25 Croce F, Montali G, Solbiati L, Marinoni G. Ultrasonography in acute cholecystitis.  Br J Radiol. 1981;  54 927-931
    PubMedGoogle Scholar
  • 26 Maresca G, de Gaetano A, Mirk P. et al . Sonographic patterns of the gallbladder in acute viral hepatitis.  J Clin Ultrasound. 1984;  12 141-146
    PubMedGoogle Scholar
  • 27 Kaftori J, Pery M, Green J. Thickness of the gallbladder wall in patients with hypoalbuminemia: A sonographic study of patients on peritoneal dialysis.  Am J Roentgenol. 1987;  148 1117-1118
    PubMedGoogle Scholar
  • 28 Shaler W, Leopold G, Scheible F. Sonography of the thickened gallbladder wall: A nonspecific finding.  Am J Roentgenol. 1981;  136 337-339
    PubMedGoogle Scholar
  • 29 Saigh J, Williams S, Cawley K. et al . Varices: A cause of focal gallbladder wall thickening.  J Ultrasound Med. 1985;  4 371-373
    PubMedGoogle Scholar
  • 30 Cello J P. AIDS-Related biliary tract discase.  Gastrointest Endosc Clin N Am. 1998;  8 963
    PubMedGoogle Scholar
  • 31 Draghi F, Ferrozzi G, Calliada F, Slocia M, Madonia L, Campani R. Power Doppler ultrasound of gallbladder wall vascularization in inflammation: clinical applications.  Eur Radiol. 2000;  10 1587-1590
    CrossrefPubMedGoogle Scholar
  • 32 Bloom R, Libson E, Lebensart P. et al . The ultrasound spectrum of emphysematous cholecystitis.  J Clin Ultrasound. 1989;  17 251-256
    CrossrefPubMedGoogle Scholar
  • 33 Kane R. Ultrasonographic diagnosis of gangrenous cholecystitis and emphysema of the gallbladder.  Radiology. 1980;  134 191-194
    PubMedGoogle Scholar
  • 34 Simeone J, Brink J, Mueller P. et al . The sonographic diagnosis of acute gangrenous cholecystitis: Importance of the Murphy sign.  Am J Roentgenol. 1989;  152 2890
    PubMedGoogle Scholar
  • 35 Sowa M, Pamilo M, Paivansalo M. et al . Ultrasonography in acute gallbladder perforation.  Acta Radiol. 1989;  29 41-43
    PubMedGoogle Scholar
  • 36 McGahan J, Lindfors K. Percutaneous cholecystotomy: an alternative to surgical cholecystectomy for acute cholecystitis.  Radiology. 1989;  173 481-485
    CrossrefPubMedGoogle Scholar
  • 37 Granlund A, Karlson B M, Elvin A, Rasmussen I. Ultrasound-guided percutaneous cholecystostomy in high-risk surgical patients.  Langenbecks Arch Surg. 2001;  386 212-217
    CrossrefPubMedGoogle Scholar
  • 38 Kalliafas S, Ziegler D W, Flancbaum L, Choban P S. Acute acalculous cholecystitis: incidence, risk factors, diagnosis, and outcome.  Am Surg. 1998;  64 471-475
    PubMedGoogle Scholar
  • 39 Mariat G, Mahul P, Prevt N, de Filippis J P, Cuilleron M, Dubois F. et al . Contribution of ultrasonography and cholescintigraphy to the diagnosis of acute acalculous cholecystitis in intensive care unit patients.  Intensive Care Med. 2000;  26 1658-1663
    CrossrefPubMedGoogle Scholar
  • 40 Helbich T H, Mallek R, Madl C, Wunderbaldinger P, Breitenseher M, Tscholakoff D. et al . Sonomorphology of the gallbladder in critically ill patients. Value of a scoring system and follow-up examinations.  Acta Radiol. 1997;  38 129-134
    PubMedGoogle Scholar
  • 41 Boland G W, Slater G, Lu D S, Eisenberg P, Lee M J, Mueller P R. Prevalence and significance of gallbladder abnormalities seen on sonography in intensive care unit patients.  Am J Roentgenol. 2000;  174 973-977
    PubMedGoogle Scholar
  • 42 Chatziioannou S, Moore W, Ford P, Dhekne R. Hepatobiliary scintigraphy is superior to abdominal ultrasonography in suspected acute cholecystitis.  Surgery. 2000;  127 609-613
    CrossrefPubMedGoogle Scholar
  • 43 Lee K T, Wong S R, Cheng J S, Ker C G, Sheen P C, Liu Y E. Ultrasound-guided percutaneous cholecystostomy as an initial treatment for acute cholecystitis in elderly patients.  Dig Surg. 1998;  15 328-332
    CrossrefPubMedGoogle Scholar
  • 44 Patel M, Miedema B W, James M A, Marshall J B. Percutaneous cholecystostomy is an effective treatment for high-risk patients with acute cholecystitis.  Am Surg. 2000;  66 33-37
    PubMedGoogle Scholar
  • 45 Teplick S, Harshfield D, Brandon J, Broadwater J, Cone J. Percutaneous cholecystotomy in critically ill patients.  Gastrointest Radiol. 1991;  16 154-156
    CrossrefPubMedGoogle Scholar
  • 46 Perret R S, Sloop G D, Borne J A. Common bile duct measurements in an elderly population.  J Ultrasound Med. 2000;  19 727-730, quiz 731
    PubMedGoogle Scholar
  • 47 Schwaighofer B, Steiner E, Lechner G. Standardized sonographic measurement of the width of the extrahepatic bile ducts.  ROFO Fortschr Geb Rontgenstr Nuklearmed. 1989;  150 176-178
    PubMedGoogle Scholar
  • 48 Laing F, Jeffrey R, Wing V. Improved visualization of choledocholithiasis by sonography.  AJR. 1984;  143 949-952
    PubMedGoogle Scholar
  • 49 Laing F, Jeffrey R, Wing V, Nyberg D. Biliary dilatation: Defining the level and cause by real-time US.  Radiology. 1986;  160 39-42
    PubMedGoogle Scholar
  • 50 Steer M. Classification and pathogenesis of pancreatitis.  Surg Clin North Am. 1989;  69 281-299
    PubMedGoogle Scholar
  • 51 Rothlin M. Does every patient with pancreatic disease need ultrasound examination?.  Swiss Surg. 2000;  6 211-215
    PubMedGoogle Scholar
  • 52 Pezzilli R, Billi P, Barakat B, D'Imperio N, Miglio F. Ultrasonographic evaluation of the common bile duct in biliary acute pancreatitis patients: comparison with endoscopic retrograde cholangiopancreatography.  J Ultrasound Med. 1999;  18 391-394
    PubMedGoogle Scholar
  • 53 Pitchumoni C S, Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed?.  Gastroenterol Clin North Am. 1999;  28 615-639
    CrossrefPubMedGoogle Scholar
  • 54 Noone T C, Semelka R C, Woosley J T, Pisano E D. Ultrasound and MR findings in acute Budd-Chiari syndrome with histopathologic correlation.  J Comput Assist Tomogr. 1996;  20 819-822
    CrossrefPubMedGoogle Scholar
  • 55 Steingruber I E, Bodner G, Czermak B, Hochleitner B, Jaschke W. Color-coded doppler sonographic demonstration of intrahepatic venous collaterals in Budd-Chiari syndrome.  Ultraschall Med. 2001;  22 55-59
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Chawla Y, Kumar S, Dhiman R K, Suri S, Dilawari J B. Duplex Doppler sonography in patients with Budd-Chiari syndrome.  J Gastroenterol Hepatol. 1999;  14 904-907
    CrossrefPubMedGoogle Scholar
  • 57 Valla D C, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management.  J Hepatol. 2000;  32 865-871
    CrossrefPubMedGoogle Scholar
  • 58 Amitrano L, Brancaccio V, Guardascione M, Margaglione M, Iannaccone L, D'Andrea G. et al . Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis.  Hepatology. 2000;  31 345-348
    CrossrefPubMedGoogle Scholar
  • 59 Denninger M H, Chait Y, Casadevall N, Hillaire S, Guillin M C, Bezeaud A. et al . Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors.  Hepatology. 2000;  3 l 587-591
    PubMedGoogle Scholar
  • 60 Okuda K, Ohnishi K, Kimura K, Matsutani S, Sumida M, Goto N. et al . Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients.  Gastroenterology. 1985;  89 279-286
    PubMedGoogle Scholar
  • 61 Belli L, Romani F, Sansalone C V, Asem P, Rondinara G. Portal thrombosis in cirrhotics. A retrospective analysis.  Ann Surg. 1986;  203 286-291
    CrossrefPubMedGoogle Scholar
  • 62 Pirisi M, Avellini C, Fabris C, Scott C, Bardus P, Soardo G. et al . Portal vein thrombosis in hepatocellular carcinoma: age and sex distribution in an autopsy study.  J Cancer Res Clin Oncol. 1998;  124 397-400
    CrossrefPubMedGoogle Scholar
  • 63 Meuwly J, Gudinchet F, Schnyder P. Applications of ultrasound contrast agents in abdominal pathology.  J Ultrasound Med. 2000;  19 S125
    PubMedGoogle Scholar
  • 64 Lim J, Lee D, Ko Y. Sonographic detection of duodenal ulcer.  J Ultrasound Med. 1992;  11 91
    PubMedGoogle Scholar
  • 65 Stolte M, Seitter V, Muller H. Improvement in the quality of the endoscopic/bioptic diagnosis of gastric ulcers between 1990 and 1997 - an analysis of 1658 patients.  Z Gastroenterol. 2001;  39 349-355
    Article in Thieme ConnectPubMedGoogle Scholar
  • 66 Seitz K, Reising K D. Sonografischer Nachweis freier Luft in der Bauchhöhle.  Ultraschall in Med. 1982;  3 4-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 67 Seitz K, Merz M. Ultrasound ileus diagnosis.  Ultraschall Med. 1998;  19 242-249
    Article in Thieme ConnectPubMedGoogle Scholar
  • 68 Ko Y, Lim J, Lee D. et al . Small bowel obstruction: sonographic evaluation.  Radiology. 1993;  188 649-653
    CrossrefPubMedGoogle Scholar
  • 69 Grunshaw N D, Renwick I G, Scarisbrick G, Nasmyth D G. Prospective evaluation of ultrasound in distal ileal and colonic obstruction.  Clin Radiol. 2000;  55 356-362
    CrossrefPubMedGoogle Scholar
  • 70 Bozkurt T, Richter F, Lux G. Ultrasonography as a primary diagnostic tool in patients with inflammatory disease and tumors of the small intestine and large bowel.  J Clin Ultrasound. 1994;  22 85-91
    PubMedGoogle Scholar
  • 71 Tarjan Z, Toth G, Gyorke T, Mester A, Karlinger K, Mako E. Ultrasound in Crohn's disease of the small bowel.  Eur J Radiol. 2000;  35 176-182
    CrossrefPubMedGoogle Scholar
  • 72 Haber H, Busch A, Ziebach R, Stern M. Bowel wall thickness measured by ultrasound as a marker of Crohn's disease activity in children.  Lancet. 2000;  355 1239-1240
    CrossrefPubMedGoogle Scholar
  • 73 Esteban J M, Maldonado L, Sanchiz V, Minguez M, Benages A. Activity of Crohn's disease assessed by colour Doppler ultrasound analysis of the affected loops.  Eur Radiol. 2001;  11 1423-1428
    CrossrefPubMedGoogle Scholar
  • 74 van Oostayen J A, Wasser M N. Use of Doppler ultrasound in Crohn's disease.  Gut. 2000;  47 156
    CrossrefPubMedGoogle Scholar
  • 75 Klein H M, Lensing R, Klosterhalfen B, Tons C, Gunther R W. Diagnostic imaging of mesenteric infarction.  Radiology. 1995;  197 79-82
    CrossrefPubMedGoogle Scholar
  • 76 Zwolak R M. Can duplex ultrasound replace arteriography in screening for mesenteric ischemia?.  Semin Vasc Surg. 1999 ;  12 252-260
    PubMedGoogle Scholar
  • 77 Fournier R, Gouzien P, Russier Y, Garola P, Veillard J. Intestinal intussusception in adults: contribution of ultrasonography.  J Chir. 1994;  131 430-433
    PubMedGoogle Scholar
  • 78 Rohrschneider W. Invagination.  Radiologe. 1997;  37 446-453
    CrossrefPubMedGoogle Scholar

Dr. Jean-Yves Meuwly, ME

Service de radiodiagnostic et radiologie interventionnelle · Centre Hospitalier Universitaire Vaudois (CHUV) ·

Rue du Bugnon 46 · 1011 Lausanne · Schweiz

Phone: + 41-21-3144444

Fax: + 41-21-3144443

Email: Jean-Yves.Meuwly@chuv.hospvd.ch

      >