수입계제 증후군: 전산화단층촬영에 의한 양악성의 감별진단

Abstract

We evaluated retrospectively the CT findings of 17 patients in whom ALS was diagnosed surgically, clinically and radiologically. A subtotal gastrectomy with Billroth Ⅱ anastomosis was done in 10 patients, a total gastrectomy with Roux-en Y esophagojejunostomy in five, a bypass gastrojejunostomy in one and a cholecystectomy with Roux-en Y choledochojejunostomy in one. The 17 cases of ALS were as follow; five benign causes included internal hernia (n=2), marginal ulcer (n=1), kinking of the anastomosis site (n=1) and a unknown cause, and 12 malignant causes included recurrent stomach cancer (n=11) and the progression of stomach cancer after a bypass gastrojejunostomy. The interval between the initial operation and the diagnosis of ALS was from 10 to 21 days in the three benign cases, and from 3 to 16 months in the 10 malignant cases. The A-loop was 42 mm in mean diameter in all the benign and malignant cases. The A-loop was evenly dilated without focal wall thickening in all five benign cases and three of the malignant cases, but unevenly dilated with irregular focal thickening of the distal duodenum and duodenojejunal junction in 9 malignant cases. CT could depict the causes of ALS in 15 cases (88%). Other associated CT findings were : in the benign cases, moderate dilation of the bile ducts (n=1), the internal hernia (n=2), and subhepatic abscess (n=1); and in the malignant cases, carcinomatosis peritonei (n=11), distended gallbladder with wall thickening (n=6), dilation of the bile ducts (n=7), hydronephrosis (n=2), adrenal metastasis (n=1), and retroperitoneal lymphadenopathy (n=1). In conclusion, the benign ALS cases had even dilation of the A-loop without focal wall thickening, and a short interval between the initial operation and the diagnosis of ALS. But the malignant ALS cases had uneven dilation of the A-loop with focal irregular wall thickening of the distal duodenum and the duodenojejunal junction, carcinomatosis peritonei, and obstructive jaundice.