腹内疝C表现.ppt

1、Case,Old woman with chronic, episodic abdominal pain,1,CT images,2,CT images,3,Which findings are present?,Venous thrombosis ? Mesenteric twisting? Displaced bowel loops ?,4,Which findings are present?,Within the left upper abdomen, there is thin sac filled with small bowel with swirling vessels ide

2、ntified within it.,5,Which choice is the most likely diagnosis?,A,Paraduodenal hernia B, Foramen of Winslow hernia C, Transmesenteric hernia D, Trans omental hernia E, Congenital malrotation,6,Paraduodenal Hernia,7,Whats paraduodenal hernia,the most common type of internal hernia (53%) congenital he

3、rnia, hernia sac asymptomatic ,colicky epigastric or periumbilical pain M:F=3:1 has left and right two subtypes ,the former accounts for about 3/4,8,How paraduodenal hernia hapened,Left paraduodenal hernia occur when bowel prolapses through Landzerts fossa, an aperture present in approximately 2% of

4、 the population.,Landzerts fossa is located behind the ascending or fourth part of the duodenum and is formed by the lifting up of a peritoneal fold by the inferior mesenteric vein and ascending left colic artery as they run along the lateral side of the fossa.,9,How paraduodenal hernia hapened,Righ

5、t subtype occur when bowel prolapses through Waldeyer s fossa below to the ascending duodenum, and to the right side of the mesocolon .,10,2020/10/16,11,CT Diagnosis (Left paraduodenal hernia ),Axial CT scans demonstrate bowel whin the bowel loops interposed between the stomach and pancreas, some ma

6、ss effect on the posterior stomach wall, thickened bowel wall, and engorged mesenteric vessels.,12,CT Diagnosis (Left paraduodenal hernia ),axial contrast-enhanced CT scan in 11-year-old boy shows small-bowel loops (arrow) between stomach and pancreas,13,CT Diagnosis (Left paraduodenal hernia ),axia

7、l contrast-enhanced CT scan in 28-year-old man shows small-bowel loops (white arrow) behind pancreas (P) (black arrow indicates stomach),14,CT Diagnosis (Left paraduodenal hernia ),axial contrast-enhanced CT scan in 36-year-old man shows small-bowel loops (arrow) displaying inferior mensteric vein (

8、arrowhead) to left.,15,CT Diagnosis (Left paraduodenal hernia ),coronal construction of contrast-enhanced CT in 28-year-old man shows small-bowel loops between transverse colon (T) and left adrenal gland (arrow),16,CT Diagnosis (Left paraduodenal hernia ),CT scan of the midabdomen shows the inferior

9、 mesenteric vein (arrowhead), this vessel is a landmark for the inferior mesocolon. which is located at the anteromedial border of the encapsulated jejunal loops (J). Diagram (coronal view) of the surgical findings shows that the fossa Landzert is 4cm in diameter (arrowhead),17,CT Diagnosis (Left pa

10、raduodenal hernia ),Mesenteric vessel abnormalities, including enlargement, stretching, and anterior displacement of the main mesenteric trunks, especially the inferior mesenteric vein, to the left, also are helpful findings,18,CT Diagnosis (Left paraduodenal hernia ),contrast-enhanced CT scan of th

11、e upper abdomen shows a saclike mass of dilated jejunal loops (J) between the pancreatic head and stomach. the dilated inferior mesenteric vein (arrowhead) is located at the anterior border of the encapsulated loops. Crowed and engorged mesenteric vessels (arrow) at the fossa of Landzert (L) .,19,Unlike hernias at other sites, the diagnosis of an internal hernia is more difficult because the site of defect in the mesentery is not obvious on imaging. This is because both the hernial orifice (occupied by the mesentery of the herniated loops ) and