腹内疝CT表现参考课件.ppt

1、 Case Old woman with chronic,episodic abdominal pain 1 CT imagesCT images2 CT images3 Which findings are present?Which findings are present?Venous thrombosis?Mesenteric twisting?Displaced bowel loops?4 Which findings are present?Which findings are present?Within the left upper abdomen,there is Withi

2、n the left upper abdomen,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.5 Which choice is the most likely diagnosis?A,Paraduodenal hernia B,Foramen of Winslow hernia C,Transmesenteric he

3、rnia D,Trans omental hernia E,Congenital malrotation6 Paraduodenal HerniaParaduodenal Hernia 7 Whats paraduodenal herniaparaduodenal hernia the most common type of internal hernia(53%)congenital hernia,hernia sac asymptomatic,colicky epigastric or periumbilical pain M:F=3:1 has left and right two su

4、btypes,the former accounts for about 3/48 How paraduodenal hernia hapened Left paraduodenal hernia occur when bowel prolapses through Landzerts fossa,an aperture present in approximately 2%of the population.Landzerts fossa is located behind the ascending or fourth part of the duodenum and is formed

5、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 herniaparaduodenal hernia hapened Right subtype occur when bowel prolapses through Waldeyer s fossa below to the ascending duodenu

6、m,and to the right side of the mesocolon.10 CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)Axial CT scans demonstrate bowel whin the bowel loops interposed between the stomach and pancreas,some mass effect on the posterior stomach wall,thickened bowel wall,and engorged mesenter

7、ic vessels.11 CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)axial contrast-enhanced CT scan in 11-year-old boy shows small-bowel loops(arrow)between stomach and pancreas12 CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)axial contrast-enhanced CT scan in 2

8、8-year-old man shows small-bowel loops(white arrow)behind pancreas(P)(black arrow indicates stomach)13 CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)axial contrast-enhanced CT scan in 36-year-old man shows small-bowel loops(arrow)displaying inferior mensteric vein(arrowhead)to

9、 left.14 CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal 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)15 CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)CT sca

10、n of the midabdomen shows the inferior 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(arrow

11、head)16 CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal 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 17 CT DiagnosisCT Diagno

12、sis(Left paraduodenal herniaparaduodenal hernia)contrast-enhanced CT scan of the 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

13、 engorged mesenteric vessels(arrow)at the fossa of Landzert(L).18 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 the surrounding areas are predominantly fat attenuating.Recognition of mesenteric vascular abnormalities is crucial in the diagnosis of inter nal her nia.19 20