腹内疝CT表现.ppt

1、Case,Oldwomanwithchronic,episodicabdominalpain,CTimages,CTimages,Whichfindingsarepresent?,Venousthrombosis?Mesenterictwisting?Displacedbowelloops?,Whichfindingsarepresent?,Withintheleftupperabdomen,thereisthinsacfilledwithsmallbowelwithswirlingvesselsidentifiedwithinit.,Whichchoiceisthemostlikelydia

2、gnosis?,A,ParaduodenalherniaB,ForamenofWinslowherniaC,TransmesentericherniaD,TransomentalherniaE,Congenitalmalrotation,ParaduodenalHernia,Whatsparaduodenalhernia,themostcommontypeofinternalhernia(53%)congenitalhernia,herniasacasymptomatic,colickyepigastricorperiumbilicalpainM:F=3:1hasleftandrighttwo

3、subtypes,theformeraccountsforabout3/4,Howparaduodenalherniahapened,LeftparaduodenalherniaoccurwhenbowelprolapsesthroughLandzertsfossa,anaperturepresentinapproximately2%ofthepopulation.,Landzertsfossaislocatedbehindtheascendingorfourthpartoftheduodenumandisformedbytheliftingupofaperitonealfoldbythein

4、feriormesentericveinandascendingleftcolicarteryastheyrunalongthelateralsideofthefossa.,Howparaduodenalherniahapened,RightsubtypeoccurwhenbowelprolapsesthroughWaldeyersfossabelowtotheascendingduodenum,andtotherightsideofthemesocolon.,CTDiagnosis(Leftparaduodenalhernia),AxialCTscansdemonstratebowelwhi

5、nthebowelloopsinterposedbetweenthestomachandpancreas,somemasseffectontheposteriorstomachwall,thickenedbowelwall,andengorgedmesentericvessels.,CTDiagnosis(Leftparaduodenalhernia),axialcontrast-enhancedCTscanin11-year-oldboyshowssmall-bowelloops(arrow)betweenstomachandpancreas,CTDiagnosis(Leftparaduod

6、enalhernia),axialcontrast-enhancedCTscanin28-year-oldmanshowssmall-bowelloops(whitearrow)behindpancreas(P)(blackarrowindicatesstomach),CTDiagnosis(Leftparaduodenalhernia),axialcontrast-enhancedCTscanin36-year-oldmanshowssmall-bowelloops(arrow)displayinginferiormenstericvein(arrowhead)toleft.,CTDiagn

7、osis(Leftparaduodenalhernia),coronalconstructionofcontrast-enhancedCTin28-year-oldmanshowssmall-bowelloopsbetweentransversecolon(T)andleftadrenalgland(arrow),CTDiagnosis(Leftparaduodenalhernia),CTscanofthemidabdomenshowstheinferiormesentericvein(arrowhead),thisvesselisalandmarkfortheinferiormesocolo

8、n.whichislocatedattheanteromedialborderoftheencapsulatedjejunalloops(J).Diagram(coronalview)ofthesurgicalfindingsshowsthatthefossaLandzertis4cmindiameter(arrowhead),CTDiagnosis(Leftparaduodenalhernia),Mesentericvesselabnormalities,includingenlargement,stretching,andanteriordisplacementofthemainmesen

9、terictrunks,especiallytheinferiormesentericvein,totheleft,alsoarehelpfulfindings,CTDiagnosis(Leftparaduodenalhernia),contrast-enhancedCTscanoftheupperabdomenshowsasaclikemassofdilatedjejunalloops(J)betweenthepancreaticheadandstomach.thedilatedinferiormesentericvein(arrowhead)islocatedattheanteriorborderoftheencapsulatedloops.Crowedandengorgedmesentericvessels(arrow)atthefossaofLandzert(L).,Unlikeherniasatothersites,thediagnosisofaninternalherniaismoredifficultbecausethesiteofdefectinthemesenteryisnotobviousonimaging.Thisisbecauseboththehernialorifice(occupiedbythemesenteryofthehernia