腹内疝CT表现培训课件.ppt

1、腹内疝腹内疝CTCT表现表现CT imagesCT images腹内疝CT表现2CT images腹内疝CT表现3Which findings are present?Which findings are present?Venous thrombosis?Mesenteric twisting?Displaced bowel loops?腹内疝CT表现4Which findings are present?Which findings are present?Within the left upper abdomen,there is Within the left upper abdome

2、n,there is thin sac filled with small bowel with thin sac filled with small bowel with swirling vessels identified within it.swirling vessels identified within it.腹内疝CT表现5Paraduodenal HerniaParaduodenal Hernia 7Whats paraduodenal herniaparaduodenal hernia the most common type of internal hernia(53%)

3、congenital hernia,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腹内疝CT表现8 How paraduodenal hernia hapened Left paraduodenal hernia occur when bowel prolapses through Landzerts fossa,an aperture present in appr

4、oximately 2%of 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.腹内疝CT表现9 How paraduodenal

5、herniaparaduodenal hernia hapened Right subtype occur when bowel prolapses through Waldeyer s fossa below to the ascending duodenum,and to the right side of the mesocolon.腹内疝CT表现10CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)Axial CT scans demonstrate bowel whin the bowel loo

6、ps interposed between the stomach and pancreas,some mass effect on the posterior stomach wall,thickened bowel wall,and engorged mesenteric vessels.腹内疝CT表现11CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)axial contrast-enhanced CT scan in 11-year-old boy shows small-bowel loops(

7、arrow)between stomach and pancreas腹内疝CT表现12CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)axial contrast-enhanced CT scan in 28-year-old man shows small-bowel loops(white arrow)behind pancreas(P)(black arrow indicates stomach)腹内疝CT表现13CT DiagnosisCT Diagnosis(Left paraduodenal

8、herniaparaduodenal hernia)axial contrast-enhanced CT scan in 36-year-old man shows small-bowel loops(arrow)displaying inferior mensteric vein(arrowhead)to left.腹内疝CT表现14CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)coronal construction of contrast-enhanced CT in 28-year-old ma

9、n shows small-bowel loops between transverse colon(T)and left adrenal gland(arrow)腹内疝CT表现15CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)CT scan of the midabdomen shows the inferior mesenteric vein(arrowhead),this vessel is a landmark for the inferior mesocolon.which is locate

10、d 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)腹内疝CT表现16CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)Mesenteric vessel abnormalities,including enlargeme

11、nt,stretching,and anterior displacement of the main mesenteric trunks,especially the inferior mesenteric vein,to the left,also are helpful findings 腹内疝CT表现17CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)contrast-enhanced CT scan of the upper abdomen shows a saclike mass of dil

12、ated 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).腹内疝CT表现18 Unlike hernias at other sites,the diagnosis of an

13、 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 the surrounding areas are predominantly fat attenuating.Recognition of mesenteric vascular abnormalities is crucial in the diagnosis of internal hernia.腹内疝CT表现1920