İnce barsakta yabancı cisim

Özet

Yutulan yabancı cisimlerin çoğu sindirim kanalından komplikasyonsuz geçer; ancak keskin balık kılçıkları ince barsakta takılabilir ve duvar penetrasyonu, perforasyon, apse veya obstrüksiyona yol açabilir. BT cismin yerini ve yönelimini, barsak duvarıyla ilişkisini ve çevresindeki komplikasyonları aynı incelemede haritalar; multiplanar rekonstrüksiyon ve kemik penceresi ince lineer kalsifiye cisimlerin bulunmasına yardım eder. Pozitif oral kontrast balık kılçığını örtebilir; cisme yönelik incelemede rutin oral kontrast verilmemeli, gerekirse oral kontrastsız tekrar BT planlanmalıdır.

Faz ve pencere

Portal tanısal

IV kontrastlı görüntüler cismin barsak duvarına girip girmediğini, duvar kontrastlanmasını ve komşu yağ dokusu, koleksiyon, sıvı veya ekstralüminal gazı gösterir; lineer kalsifiye cisim kemik penceresi ve multiplanar kesitlerle aranır.

BT bulguları

• Balık kılçığı BT'de ince, doğrusal hiperdens yabancı cisim olarak görülebilir; ince barsak lümenindeki konumu çok düzlemli görüntülerde değerlendirilir.
• Kemik penceresi doğrusal yoğunluğu yumuşak doku penceresinden daha belirgin kılabilir; aksiyel kesite dik duran cisim koronal/sagittal planda uzanım gösterir.
• Cismin lümende serbest durması, duvara saplanması veya duvar dışına uzanması ayrı ayrı tanımlanır.
• Lokal duvar kalınlaşması/hiperemisi, çevre yağ dokusu dansite artışı ve az miktarda komşu sıvı impaksiyon veya sınırlı perforasyonu destekler.
• Yabancı cisme bağlı ince barsak obstrüksiyonunda proksimal barsak distansiyonu görülebilir.
• Yabancı cisim çevresindeki ekstralüminal gaz, lokal yağlı doku reaksiyonu veya apse, penetrasyon ya da perforasyonla ilişkili olabilir; serbest hava eşlik edebilir.
• Metalik yabancı cisim belirgin hiperdens olabilir; şekil ve konumunu ardışık kesitlerde takip ederek lümende olduğunu doğrula.
• Balık kılçığına bağlı ince barsak penetrasyonunda BT'de fokal duvar kalınlaşması ve çevre yumuşak doku çizgilenmesi ya da lokal sıvı görülebilir; bu bulgular yabancı cisim açısından hedefli aramayı destekler.

Normalde

İnce barsaktaki yabancı cisim, duvar kalınlaşması veya penetrasyon olmaksızın lümen içinde bulunabilir. Kontrastlanan küçük damarlar balık kılçığını taklit edebilir; ince kesitli multiplanar görüntüler yabancı cismin yerini ve barsak duvarıyla ilişkisini değerlendirmeye yardımcı olur.

Ayırıcı tanı

Mezenterik damar

kontrastlı kesitlerde dallanarak mezenter içinde devam eder; yabancı cisim barsak lümeni/duvarıyla ilişkili keskin ve sabit doğrusal yapı gösterir.

Dışkı materyaline bağlı artefaktlar balık kılçığını taklit edebilir; pozitif oral kontrast ise kılçığı örtebilir.

Tuzaklar

• Pozitif oral kontrast balık kılçığını tamamen örtebilir; bu nedenle yabancı cisim şüphesi olan hastalarda rutin oral kontrast verilmemeli, gerekirse oral kontrastsız tekrar BT planlanmalıdır.
• Aksiyel düzleme dik seyreden ince kılçık tek bir küçük hiperdens nokta gibi kalabilir; koronal ve sagittal rekonstrüksiyonlarda devamlılığını ara.
• Kontrastlanan mezenter damarı doğrusal yabancı cisim sanılabilir; damarın dallanmasını izle ve cismin barsak lümeniyle ilişkisini multiplanar kesitlerde doğrula.
• Küçük barsak perforasyonlarında pnömoperitoneum yaygın olmayabilir; odak çevresindeki küçük gaz kabarcığı, duvar kalınlaşması ve lokal yağlı doku reaksiyonu değerlendirilmelidir.

Kendini dene

1. Kaynağa göre balık kılçığının BT'de doğrudan tanınmasını sağlayan görünüm hangisidir?

   • Lümende ince, çizgisel ve yüksek dansiteli yapı
   • Yalnız barsak duvarında kalınlaşma
   • Yalnız pozitif oral kontrast görünümü
   • Yalnız tıkanıklık düzeyinin üstünde ans genişlemesi
   Cevabı göster

   Lümende ince, çizgisel ve yüksek dansiteli yapı. Kaynak, balık kılçığının BT'de doğrusal hiperdens yabancı cisim gösterilmesiyle tanındığını belirtir. Pozitif oral kontrast kılçığın silik kalsifikasyonunu örtebilir; bu durumda oral kontrastsız gecikmiş tekrar tarama yapılabilir.

2. Balık kılçığının ince barsaktaki yerini ve barsak duvarıyla ilişkisini değerlendirmek için hangi yaklaşım en uygundur?

   • Portal venöz faz IV kontrastlı BT'yi çok düzlemli rekonstrüksiyonlarla incelemek
   • Yalnız pozitif oral kontrastlı görüntüleri değerlendirmek
   • Yalnız aksiyel kontrastsız görüntülerle yetinmek
   • Yalnız düz karın grafisini değerlendirmek
   Cevabı göster

   Portal venöz faz IV kontrastlı BT'yi çok düzlemli rekonstrüksiyonlarla incelemek. Çok düzlemli rekonstrüksiyonlar cismin yerini değerlendirmeye, IV kontrast ise barsak duvarı katmanlarını ve perforasyonla ilişkisini göstermeye yardımcı olur.

İlgili konular

• Bezoara bağlı ince barsak obstrüksiyonu

Kaynaklar

Bu sayfadaki 30 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 17 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. CT Evaluation of Swallowed Foreign Bodies Located in the Gastrointestinal Systempmc.ncbi.nlm.nih.gov
2. Abdominal CT manifestations in fish bone foreign body injuries: What the radiologist needs to knowpmc.ncbi.nlm.nih.gov
3. Small Bowel Obstruction Secondary to an Ingested Iron "Stay Fresh" Pack.pubmed.ncbi.nlm.nih.gov
4. Delayed rupture of right external iliac artery pseudoaneurysm after removal of foreign body from small intestine: a case report.pubmed.ncbi.nlm.nih.gov
5. AGA Clinical Practice Update on Endoscopic Management of Perforations in Gastrointestinal Tract: Expert Review.pubmed.ncbi.nlm.nih.gov
6. Friday: Fish Day.pubmed.ncbi.nlm.nih.gov
7. Management of trichobezoar: About 6 cases.pubmed.ncbi.nlm.nih.gov
8. Enterocutaneous Fistula: A Simplified Clinical Approach.pubmed.ncbi.nlm.nih.gov
9. Small Bowel Perforations: What the Radiologist Needs to Know.pubmed.ncbi.nlm.nih.gov
10. Medical treatment for a fish bone-induced ileal micro-perforation: a case report.pubmed.ncbi.nlm.nih.gov
11. A Toothpick a day, keeps the doctor away?pubmed.ncbi.nlm.nih.gov
12. [Rare cause of recurrent subileus].pubmed.ncbi.nlm.nih.gov
13. Asymptomatic gossypiboma with complete intramural migration and ileoileal fistula.pubmed.ncbi.nlm.nih.gov
14. Rapunzel syndrome: A South African variety.pubmed.ncbi.nlm.nih.gov
15. Rapunzel syndrome.pubmed.ncbi.nlm.nih.gov
16. Diagnostic challenge of underlying colon cancer revealed by atypical presentation: two case reports and literature review.pubmed.ncbi.nlm.nih.gov
17. Small bowel perforation by ingested fish bone in a post-gastric bypass patient: a case report.pubmed.ncbi.nlm.nih.gov
18. Intestinal perforation secondary to ingested chicken bone: case report and literature review.pubmed.ncbi.nlm.nih.gov
19. A Focus on Inflammatory and Bacterial Biomarkers in Secondary Peritonitis.pubmed.ncbi.nlm.nih.gov
20. Imaging Modalities for Evaluation of Intestinal Obstruction.pubmed.ncbi.nlm.nih.gov
21. EACR 2025 Congress: Innovative Cancer Science, 16-19 June 2025.pubmed.ncbi.nlm.nih.gov
22. Ingestion of a Duck Bone That Lodges in a Jejunal Diverticulum Causing Localized Perforation Requiring Laparotomy and Small Bowel Resection.pubmed.ncbi.nlm.nih.gov
23. Case Report: A rare cause of pancreatitis - fish bone.pubmed.ncbi.nlm.nih.gov
24. Fishbone perforation of the stomach into the lesser sac and pancreas with abscess, a fishy business.pubmed.ncbi.nlm.nih.gov
25. Fishbone Perforated Appendicitis.pubmed.ncbi.nlm.nih.gov
26. Bladder multilithiasis across different clinical scenarios: Multimodality imaging findings, differential diagnosis, and complication assessment in 4 patients.pubmed.ncbi.nlm.nih.gov
27. Vascular Calcification Patterns in the Elderly: Correlation Between Aortic and Iliac Calcification Burden.pubmed.ncbi.nlm.nih.gov
28. Advancing human-centric AI for robust X-ray analysis through holistic self-supervised learning.pubmed.ncbi.nlm.nih.gov
29. Inflammatory bowel disease imaging: Current practice and future directions.pubmed.ncbi.nlm.nih.gov
30. Fluid transport in the brain.pubmed.ncbi.nlm.nih.gov
31. Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study.pubmed.ncbi.nlm.nih.gov
32. Unforeseen consequences: A case report of misdiagnosis in pediatric ingestion of a fish bone.pubmed.ncbi.nlm.nih.gov
33. Development of an online authentic radiology viewing and reporting platform to test the skills of radiology trainees in Low- and Middle-Income Countries.pubmed.ncbi.nlm.nih.gov
34. Nutrition phenotypes in inflammatory bowel disease: emerging concepts and future directions to guide clinical practice.pubmed.ncbi.nlm.nih.gov
35. Vat Photopolymerization of Smart Polymers for Biomedical Applications.pubmed.ncbi.nlm.nih.gov
36. Human biomarker navigator.pubmed.ncbi.nlm.nih.gov
37. Inflammatory mass or malignancy? The radiology of fish bone phlegmon: a review of 3 cases.pubmed.ncbi.nlm.nih.gov
38. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology.pubmed.ncbi.nlm.nih.gov
39. Gastric Perforation due to Fish Bone.pubmed.ncbi.nlm.nih.gov
40. Nail in the appendix: Asymptomatic foreign body lodging detected by imaging.pubmed.ncbi.nlm.nih.gov
41. Overview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications.pubmed.ncbi.nlm.nih.gov
42. Online Magnetic Resonance-Guided Radiotherapy (oMRgRT) for Gynecological Cancers.pubmed.ncbi.nlm.nih.gov
43. Imaging of Strictures in Crohn's Disease.pubmed.ncbi.nlm.nih.gov
44. Evaluation of imaging findings in gastrointestinal anisakiasis in emergency CT and ultrasound.pubmed.ncbi.nlm.nih.gov
45. Tuberculosis revisted: classic imaging findings in childhood.pubmed.ncbi.nlm.nih.gov
46. Imaging of inferior vena cava normal variants, anomalies and pathologies, Part 2: Acquired.pubmed.ncbi.nlm.nih.gov
47. Imaging in Infective Endocarditis-Current Opinions and Trends in Cardiac Computed Tomography.pubmed.ncbi.nlm.nih.gov
48. MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management-A Reappraisal.pubmed.ncbi.nlm.nih.gov
49. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Nonproliferative and Proliferative Lesions of the Rabbit.pubmed.ncbi.nlm.nih.gov
50. Engineered live bacteria for liver diseases and gut-liver axis disorders: from genetic modification to advanced delivery systems.pubmed.ncbi.nlm.nih.gov
51. Engineered probiotics constitutively expressing SOD alleviate inflammatory bowel disease by targeting ROS.pubmed.ncbi.nlm.nih.gov
52. Oral probiotic delivery-based therapeutic strategies for inflammatory bowel disease.pubmed.ncbi.nlm.nih.gov
53. The clinician's guide to prevention and treatment of osteoporosis.pubmed.ncbi.nlm.nih.gov
54. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.pubmed.ncbi.nlm.nih.gov
55. 2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension.pubmed.ncbi.nlm.nih.gov
56. Laparoscopic ultrasound versus intraoperative gastroscopy for tumor localization in laparoscopic gastrectomy: a comparative cohort study.pubmed.ncbi.nlm.nih.gov
57. Enhancing remanent magnetization of injectable hydrogels improves realtime transluminal localization of tumor in hollow soft viscera.pubmed.ncbi.nlm.nih.gov
58. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II.pubmed.ncbi.nlm.nih.gov
59. Small particles, large questions: unravelling the toxicity and potential health risks of PET micro-/nanoplastics.pubmed.ncbi.nlm.nih.gov
60. Special Issue: EACR 2026 Congress: Innovative Cancer Science, 8-11 June 2026.pubmed.ncbi.nlm.nih.gov
61. Guidelines for standard operation of imaging modalities in orbital diseases (2024).pubmed.ncbi.nlm.nih.gov
62. Imaging Regional Airway Involvement of Asthma: Heterogeneity in Ventilation, Mucus Plugs and Remodeling.pubmed.ncbi.nlm.nih.gov
63. Pre- and Postoperative Imaging of the Aortic Root.pubmed.ncbi.nlm.nih.gov
64. Dual-energy computed tomography in children: Technique and clinical applications.pubmed.ncbi.nlm.nih.gov
65. Imaging presentations of foreign bodies that make for a challenging diagnosis: pictorial essay.pubmed.ncbi.nlm.nih.gov
66. The Immune Checkpoint Inhibitors Journey: From Early Promise to Lasting Impact.pubmed.ncbi.nlm.nih.gov
67. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.pubmed.ncbi.nlm.nih.gov
68. Utility of CT in detecting and monitoring subphrenic jujube pits: a retrospective cross-sectional study of clinical cases and ex vivo experiments.pubmed.ncbi.nlm.nih.gov
69. Harm From Foreign Body Ingestion in Adults and Children: A Systematic Review of Case Reports.pubmed.ncbi.nlm.nih.gov
70. The Overlap Between Crohn's Disease and Intestinal Tuberculosis: A Never-Ending Story.pubmed.ncbi.nlm.nih.gov
71. Fishbone ingestion is a non-negligible cause of intestinal perforation.pubmed.ncbi.nlm.nih.gov
72. The stent that time forgot: perforated small bowel diverticulitis seventy years in the making, a case report.pubmed.ncbi.nlm.nih.gov
73. A fish out of the Meckel diverticulum, foreign body bowel perforation: a case report.pubmed.ncbi.nlm.nih.gov
74. A Degrading Potassium Tablet Mimicking Active Gastric Bleeding in a Computer Tomographic Investigation.pubmed.ncbi.nlm.nih.gov
75. Severe hypocalcaemia episodes in a patient of primary hypoparathyroidism precipitated by underlying stress due to haemophagocytic lymphohistiocytosis (HLH) secondary to pulmonary tuberculosis.pubmed.ncbi.nlm.nih.gov
76. Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study.pubmed.ncbi.nlm.nih.gov
77. Post-Bariatric Surgery Complications and the Role of Endoscopic Intervention.pubmed.ncbi.nlm.nih.gov
78. Endoscopic Management of Post-Bariatric Surgery Complications: Diagnostic Work-Up and Innovative Approaches for Leak, Fistula, and Stricture Management.pubmed.ncbi.nlm.nih.gov
79. Colonic diverticular hemorrhage: Etiology, diagnostic challenges, and evolving therapeutic strategies.pubmed.ncbi.nlm.nih.gov
80. The wandering mimic: Meckel's diverticulum with enterolith simulating an intraperitoneal hydatid cyst.pubmed.ncbi.nlm.nih.gov
81. When Meckel's diverticulum mimics malignancy: a case report of massive enterolithiasis in an adult patient.pubmed.ncbi.nlm.nih.gov
82. A rare concurrence of acute appendicitis with Meckel's diverticulitis: a case report.pubmed.ncbi.nlm.nih.gov
83. International Guideline on the Diagnosis and Management of Pediatric Patients With Hereditary Angioedema.pubmed.ncbi.nlm.nih.gov
84. Strategies for transportation of peptides across the skin for treatment of multiple diseases.pubmed.ncbi.nlm.nih.gov
85. Bladder Stone Formation on Migrated Hem-o-Lok Clips at the Vesicourethral Anastomosis After Robot-Assisted Radical Prostatectomy: A Case Report.pubmed.ncbi.nlm.nih.gov
86. Polymer clip granuloma mimicking lymph node recurrence: a case report.pubmed.ncbi.nlm.nih.gov
87. Meckel's Diverticulum as an Unexpected Cause of Acute Intestinal Obstruction in an Adult.pubmed.ncbi.nlm.nih.gov
88. Ileal Perforation Caused by the Accidental Ingestion of a Press-Through Package in an Elderly Patient With Dementia: A Case Report.pubmed.ncbi.nlm.nih.gov
89. Coexistence of rectal adenocarcinoma and rectal and lymph node tuberculosis: a case report with a limited narrative review.pubmed.ncbi.nlm.nih.gov
90. Timely Diagnosis of Acyclovir-Induced Neurotoxicity During Acute Care Surgery Resuscitation: A Rare Complication of Common Herpes Zoster Treatment.pubmed.ncbi.nlm.nih.gov
91. Case Report: A rare case of post-traumatic intra-abdominal testicular migration mimicking torsion in a 9-year-old boy.pubmed.ncbi.nlm.nih.gov
92. Ballistic fragment embolism to superior mesenteric artery after the shrapnel injury to the chest: a case report of casualty from Russia-Ukraine war.pubmed.ncbi.nlm.nih.gov
93. Ectopic thyroid tissue in the breast mimicking a breast lesion: A rare case report.pubmed.ncbi.nlm.nih.gov
94. Complicated lower rectal perforation secondary to ingested meat bone foreign body injury: a case report.pubmed.ncbi.nlm.nih.gov
95. Accidental fish bone ingestion complicated by gastric abscess: A case report.pubmed.ncbi.nlm.nih.gov
96. Intestinal volvulus and obstruction due to combined button battery and magnet ingestion: a medico-legal case report.pubmed.ncbi.nlm.nih.gov
97. Imaging approach to deposition and neurogenic arthropathies.pubmed.ncbi.nlm.nih.gov
98. Beyond biliary causes, fish bone perforation as a rare etiology of recurrent fever in a post-Whipple patient: A case report.pubmed.ncbi.nlm.nih.gov
99. Proximal Roux-en-Y Limb Intussusception After Pediatric Living Donor Liver Transplantation for Biliary Atresia: A Rare Surgical Emergency.pubmed.ncbi.nlm.nih.gov
100. Sigmoid volvulus and incidental enterobiasis in a young adult: a case report.pubmed.ncbi.nlm.nih.gov
101. From obstruction to ischaemia: a systematic review and meta-analysis on the diagnostic accuracy of CT scans in identifying small and large bowel obstruction, underlying causes and predicting critical complications in adults.pubmed.ncbi.nlm.nih.gov
102. Transmural Migration of a Retained Surgical Sponge Causing Contained Ileal Perforation.pubmed.ncbi.nlm.nih.gov
103. Late intestinal obstruction due to intraluminal textiloma: a case report.pubmed.ncbi.nlm.nih.gov
104. Twist in the cecum: A case series of mobile cecum, cecal volvulus and cecal bascule.pubmed.ncbi.nlm.nih.gov
105. Intussusception of a Meckel's Diverticulum in a 58-Year-Old Female: A Case Report.pubmed.ncbi.nlm.nih.gov
106. Recurrent Intestinal Obstruction Secondary to Crohn's Disease in Dextrocardia With Situs Inversus Totalis: A Case Report.pubmed.ncbi.nlm.nih.gov
107. Acute Colonic Diverticulitis: CT Findings, Classifications, and a Proposal of a Structured Reporting Template.pubmed.ncbi.nlm.nih.gov
108. CT findings of accidental fish bone ingestion and its complications.pubmed.ncbi.nlm.nih.gov
109. Coexistence of Autoantibodies against the Golgi Complex and Ro52 Antigen in a Patient with Nonspecific Interstitial Pneumonia.pubmed.ncbi.nlm.nih.gov
110. Jejunal Perforation Associated With a Horseshoe-Shaped Abdominal Contusion After a Horse Kick: A Case Report.pubmed.ncbi.nlm.nih.gov
111. Strangulated Small Bowel Within a Posterior Rectus Sheath Hernia in a Patient Without Prior Abdominal Surgery.pubmed.ncbi.nlm.nih.gov
112. Clinical and CT features of patients with pneumatosis intestinalis: A retrospective single-center study.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.