Stellenwert der Computertomographie bei der Diagnostik der akuten Darmischämie

Zusammenfassung

Die frühzeitige Erfassung einer akuten Darmischämie ist der wesentlichste prognostische Faktor für die betroffenen Patienten. Die Computertomographie, welche als wohl einziges bildgebendes Verfahren in der Lage ist, die breite Differenzialdiagnose eines akuten Abdomens abzuklären, hat im Laufe der letzten Jahre bewiesen, dass sie auch bei der Erfassung der akuten Darmischämie einen zentralen Stellenwert besitzt. Der vorliegende Beitrag vermittelt eine Zusammenfassung der anatomischen und physiologischen Grundlagen der mesenterialen Perfusion, gibt eine Übersicht über mögliche Ursachen und Pathogenesen einer intestinalen Durchblutungsstörung und beschreibt die typischen CT-Befunde bei verschiedenen Formen der akuten Darmischämie. Dabei werden auch Hinweise auf mögliche „pitfalls” gegeben, welche für falsch negative oder falsch positive CT-Diagnosen verantwortlich sein können.

Abstract

Early detection of acute intestinal ischemia has the most important prognostic impact on the outcome of affected patients. Computed tomography is not only an imaging modality to resolve the broad differential diagnosis of the acute abdomen but has, in the last few years, also proven to play a central role in the detection of acute intestinal ischemia. This contribution presents a summary of the anatomic and physiologic fundamentals of mesenterial perfusion, provides an overview of possible causes and pathogenesis of intestinal perfusion disturbances, and describes the typical CT findings of the different types of acute intestinal ischemia. Also discussed are possible pitfalls, which can be responsible for both false negative and false positive diagnoses.

Key words

Computed tomography, - Intestinal Ischemia, - Differential Diagnosis, - Prognosis, - Lung, - Diagnosis

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