狭窄を来す小腸疾患の診断─X線診断の立場から

Conventional Radiography for the Differential Diagnosis of Small Bowel Disease with Stenosis

要旨●小腸狭窄合併例に対する内視鏡的アプローチには限界があり，その全体像の把握や質的診断には小腸X線造影検査の併用が有用である．狭窄を合併した小腸疾患の診断について，X線造影診断を中心に言及した．小腸狭窄を来した炎症性疾患の鑑別診断には，①狭窄部の形態の分類，②狭窄と腸間膜の位置関係，③狭窄部周囲の随伴所見の解析が有用である．一方，腫瘍性疾患の鑑別診断には，①狭窄部の両端のoverhanging edgeの有無，②粘膜下腫瘍様所見の有無，③壁伸展不良所見の程度，④管外性発育傾向の有無，などの解析が重要である．

　Endoscopic approaches for patients with stenosis of the small intestine are limited, and the concomitant use of X-ray imaging is useful for understanding the general anatomy of such patients and performing qualitative diagnosis. This report mainly covers X-ray diagnosis for cases involving diseases of the small intestine accompanied by stenosis. For the differential diagnosis of inflammatory diseases resulting in stenosis of the small intestine, it is useful to classify the morphology of the stenotic site, analyze the positional relationship between the stenosis and mesentery, and analyze accompanying findings pertaining to areas around the stenotic site. For the differential diagnosis of neoplastic diseases, it is important to analyze the presence/absence of overhanging edges on both sides of the stenotic site, the presence/absence of submucosal tumor-like findings, the extent of reduction in wall extension, and the presence/absence of extraintestinal growth tendencies.