腹内疝CT表现参考幻灯片.ppt

Case,Oldwomanwithchronic,episodicabdominalpain,1,CTimages,2,CTimages,3,Whichfindingsarepresent?,Venousthrombosis?Mesenterictwisting?Displacedbowelloops?,4,Whichfindingsarepresent?,Withintheleftupperabdomen,thereisthinsacfilledwithsmallbowelwithswirlingvesselsidentifiedwithinit.,5,Whichchoiceisthemostlikelydiagnosis?,A,ParaduodenalherniaB,ForamenofWinslowherniaC,TransmesentericherniaD,TransomentalherniaE,Congenitalmalrotation,6,ParaduodenalHernia,7,Whatsparaduodenalhernia,themostcommontypeofinternalhernia(53%)congenitalhernia,herniasacasymptomatic,colickyepigastricorperiumbilicalpainM:F=3:1hasleftandrighttwosubtypes,theformeraccountsforabout3/4,8,Howparaduodenalherniahapened,LeftparaduodenalherniaoccurwhenbowelprolapsesthroughLandzertsfossa,anaperturepresentinapproximately2%ofthepopulation.,Landzertsfossaislocatedbehindtheascendingorfourthpartoftheduodenumandisformedbytheliftingupofaperitonealfoldbytheinferiormesentericveinandascendingleftcolicarteryastheyrunalongthelateralsideofthefossa.,9,Howparaduodenalherniahapened,RightsubtypeoccurwhenbowelprolapsesthroughWaldeyersfossabelowtotheascendingduodenum,andtotherightsideofthemesocolon.,10,CTDiagnosis(Leftparaduodenalhernia),AxialCTscansdemonstratebowelwhinthebowelloopsinterposedbetweenthestomachandpancreas,somemasseffectontheposteriorstomachwall,thickenedbowelwall,andengorgedmesentericvessels.,11,CTDiagnosis(Leftparaduodenalhernia),axialcontrast-enhancedCTscanin11-year-oldboyshowssmall-bowelloops(arrow)betweenstomachandpancreas,12,CTDiagnosis(Leftparaduodenalhernia),axialcontrast-enhancedCTscanin28-year-oldmanshowssmall-bowelloops(whitearrow)behindpancreas(P)(blackarrowindicatesstomach),13,CTDiagnosis(Leftparaduodenalhernia),axialcontrast-enhancedCTscanin36-year-oldmanshowssmall-bowelloops(arrow)displayinginferiormenstericvein(arrowhead)toleft.,14,CTDiagnosis(Leftparaduodenalhernia),coronalconstructionofcontrast-enhancedCTin28-year-oldmanshowssmall-bowelloopsbetweentransversecolon(T)andleftadrenalgland(arrow),15,CTDiagnosis(Leftparaduodenalhernia),CTscanofthemidabdomenshowstheinferiormesentericvein(arrowhead),thisvesselisalandmarkfortheinferiormesocolon.whichislocatedattheanteromedialborderoftheencapsulatedjejunalloops(J).Diagram(coronalview)ofthesurgicalfindingsshowsthatthefossaLandzertis4cmindiameter(arrowhead),16,CTDiagnosis(Leftparaduodenalhernia),Mesentericvesselabnormalities,includingenlargement,stretching,andanteriordisplacementofthemainmesenterictrunks,especiallytheinferiormesentericvein,totheleft,alsoarehelpfulfindings,17,CTDiagnosis(Leftparaduodenalhernia),contrast-enhancedCTscanoftheupperabdomenshowsasaclikemassofdilatedjejunalloops(J)betweenthepancreaticheadandstomach.thedilatedinferiormesentericvein(arrowhead)islocatedattheanteriorborderoftheencapsulatedloops.Crowedandengorgedmesentericvessels(arrow)atthefossaofLandzert(L).,18,Unlikeherniasatothersites,thediagnosisofaninternalherniaismoredifficultbecausethesiteofdefectinthemesenteryisnotobviousonimaging.Thisisbecauseboththehernialorifice(occupiedbythemesenteryoftheherniatedl