Sonographic features of Lemmel’s syndrome: Differential diagnosis from stones in the lower portion of the common bile duct

IF 1.1 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Arab Journal of Gastroenterology Pub Date : 2024-05-01 DOI:10.1016/j.ajg.2024.01.003
Jinxiu Ju , Yating Su , Qingjing Zeng , Jiayi Liang , Xiaodan Zhang , Jie Ren , Lili Wu , Rongqin Zheng
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Abstract

Background and study aims

Periampullary diverticula (PAD), a location-specific type of duodenal diverticula, can cause serious complications. PAD is difficult to differentially diagnose, mainly due to its nonspecific symptoms. This study aimed to identify sonographic features of PAD and to evaluate their value in the differential diagnosis of PAD from stones in the lower common bile duct (CBD).

Patients and Methods

A total of 30 patients with PAD and 60 patients with lower CBD stones were retrospectively enrolled, and sonographic features were analyzed. Measurements of sonographic features included echo shaped, posterior echo changes, location and relation to surrounding organs, and status of intrahepatic and extrahepatic bile duct dilation, and their diagnostic performance was assessed.

Results

Characteristic sonographic features of PAD were identified, including strong echoes (28/30, 93.3 %), strip shape (28/30, 93.3 %), multiple reflections in the posterior echo (27/30, 90.0 %), and location outside the CBD or near the biliary wall in connection with the duodenum (27/30, 90.0 %). Inter-observer agreement was good (Kappa values = 0.69–0.82). Comparative analysis of sonographic features revealed significant differences in echo shape, posterior echo changes (multiple reflections and acoustic shadowing), location and relation to surrounding organs, and intrahepatic and extrahepatic bile duct dilatation status between the dilatation status of the two groups. In particular, these characteristics achieved a sensitivity of 100 % and a specificity of 98 % for the differential diagnosis of PAD and lower CBD stones.

Conclusions

This study identified characteristic sonographic features of PAD, which could be used as potential diagnostic indicators to distinguish PAD from lower CBD stones.

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勒梅尔综合征的声像图特征:与胆总管下段结石的鉴别诊断。
背景和研究目的:胰周憩室(PAD)是十二指肠憩室的一种特殊类型,可引起严重的并发症。PAD 很难进行鉴别诊断,这主要是由于其症状没有特异性。本研究旨在确定PAD的声像图特征,并评估其在鉴别诊断PAD与下总胆管(CBD)结石中的价值:本研究回顾性地纳入了30名PAD患者和60名CBD下段结石患者,并对其声像图特征进行了分析。声像图特征的测量包括回声形状、后方回声变化、位置及与周围器官的关系、肝内和肝外胆管扩张状况,并对其诊断性能进行评估:PAD的声像图特征包括强回声(28/30,93.3%)、条状(28/30,93.3%)、后方回声多次反射(27/30,90.0%)、位于CBD外或靠近十二指肠胆道壁(27/30,90.0%)。观察者之间的一致性良好(Kappa 值 = 0.69-0.82)。对声像图特征的比较分析表明,两组胆管扩张状况在回声形状、后方回声变化(多重反射和声影)、位置和与周围器官的关系以及肝内和肝外胆管扩张状况方面存在显著差异。特别是,这些特征在鉴别诊断PAD和CBD下段结石方面的敏感性为100%,特异性为98%:本研究发现了PAD的声像图特征,可作为鉴别PAD和CBD下段结石的潜在诊断指标。
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来源期刊
Arab Journal of Gastroenterology
Arab Journal of Gastroenterology Medicine-Gastroenterology
CiteScore
2.70
自引率
0.00%
发文量
52
期刊介绍: Arab Journal of Gastroenterology (AJG) publishes different studies related to the digestive system. It aims to be the foremost scientific peer reviewed journal encompassing diverse studies related to the digestive system and its disorders, and serving the Pan-Arab and wider community working on gastrointestinal disorders.
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