冨田 周介¹, 工藤 正俊¹, 藤見 勝彦¹, 新垣 光彌¹, 小森 英司¹, 藤堂 彰男¹, 北浦 保智¹, 浜田 充生², 大谷 雅美², 字井 一世², 藤本 敏明²

Syusuke TOMITA¹, Masatoshi KUDO¹, Katsuhiko FUJIMI¹, Mitsuya SHINGAKI¹, Eiji KOMORI¹, Akio TODO¹, Yasutomo KITAURA¹, Michio HAMADA², Masami OHTANI², Kazuyo UI², Toshiaki FUJIMOTO²

¹神戸市立中央市民病院内科, ²神戸市立中央市民病院中央検査室

¹Department of Internal Medicine, Kobe Central Municipal Hospital, ²Department of Central Laboratory, Kobe Central Municipal Hospital

キーワード : ultrasonic examination, abdominal emergency

To define the role of ultrasound in evaluating acute abdominal pathology, emergent ultrasonic examination prior to surgery or autopsy was performed in 160 patients. Diagnosis of acute cholecystitis was done with following five findings; expansion of the gallbladder, containing stones and debris in it, thiekening and sonolucent layer of the wall. Ultrasound can predict acute cholecystitis in 83 out of 86 patients. In 22 out of 34 patients with choledocholithiasis, stones in the extrahepatic bile duct were visualized with longitudinal sonogram. In three out of four patients with choledochal cyst, local or generalized dilation of the extrahepatic bile duct was visualized. There were five patients with pancreatitis indicating surgical intervention. In three out of these five patients, pancreatic pseudocysts were visualized. In the others, peripancreatic effusion and pancreatic lithiasis was visualized in each patient. All six cases with bowel obstruction including two of strangulating type were correctly diagnosed by ultrasonic findings of fluid-filled distended loop with Kerckring's fold. In six out of eight patients with hepatoma admitted for intraperitoneal bleeding, hepatic masses were determined. In three out of four patients with ruptured abdominal aortic aneurysm, pulsatile echo free space communicating with the aorta was visualized. In four out of five patients with acute dissecting aneurysm, fluttering intimal flap within the abdominal aorta was delineated.
We conclude that ultrasonic examination should be performed as the first choice in patient with acute abdomen.