腹内疝CT表现优质案例课件.ppt

1、腹内疝CT表现优选腹内疝CT表现CT imagesCT imagesCT imagesWhich findings are present?Which findings are present?Venous thrombosis?Mesenteric twisting?Displaced bowel loops?Which findings are present?Which findings are present?Within the left upper abdomen,there is Within the left upper abdomen,there is thin sac fi

2、lled with small bowel with thin sac filled with small bowel with swirling vessels identified within it.swirling vessels identified within it.Which choice is the most likely diagnosis?A,Paraduodenal hernia B,Foramen of Winslow hernia C,Transmesenteric hernia D,Trans omental hernia E,Congenital malrot

3、ationParaduodenal HerniaParaduodenal Hernia the dilated inferior mesenteric vein(arrowhead)is located at the anterior border of the encapsulated loops.Paraduodenal HerniaHow paraduodenal hernia hapenedM:F=3:1 has left and right two subtypes,the former accounts for about 3/4Which findings are present

4、?Displaced bowel loops?CT Diagnosis(Left paraduodenal hernia)Right subtype occur when bowel prolapses through Waldeyer s fossa below to the ascending duodenum,and to the right side of the mesocolon.A,Paraduodenal herniaE,Congenital malrotationCT Diagnosis(Left paraduodenal hernia)M:F=3:1 has left an

5、d right two subtypes,the former accounts for about 3/4coronal construction of contrast-enhanced CT in 28-year-old man shows small-bowel loops between transverse colon(T)and left adrenal gland(arrow)the dilated inferior mesenteric vein(arrowhead)is located at the anterior border of the encapsulated l

6、oops.Which findings are present?Which findings are present?CT scan of the midabdomen shows the inferior mesenteric vein(arrowhead),this vessel is a landmark for the inferior mesocolon.Which findings are present?Whats paraduodenal herniaparaduodenal hernia the most common type of internal hernia(53%)

7、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 How paraduodenal hernia hapened Left paraduodenal hernia occur when bowel prolapses through Landzerts fossa,an aperture present in approximatel

8、y 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.How paraduodenal herniaparaduodena

9、l 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.CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)Axial CT scans demonstrate bowel whin the bowel loops interposed between the

10、stomach and pancreas,some mass effect on the posterior stomach wall,thickened bowel wall,and engorged mesenteric vessels.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 pancreasC

11、T 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)CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)axial contrast-enhanced CT

12、scan in 36-year-old man shows small-bowel loops(arrow)displaying inferior mensteric vein(arrowhead)to left.axial contrast-enhanced CT scan in 36-year-old man shows small-bowel loops(arrow)displaying inferior mensteric vein(arrowhead)to left.which is located at the anteromedial border of the encapsul

13、ated jejunal loops(J).CT Diagnosis(Left paraduodenal hernia)axial contrast-enhanced CT scan in 36-year-old man shows small-bowel loops(arrow)displaying inferior mensteric vein(arrowhead)to left.the dilated inferior mesenteric vein(arrowhead)is located at the anterior border of the encapsulated loops

14、.Mesenteric twisting?asymptomatic,colicky epigastric or periumbilical painWhich findings are present?the most common type of internal hernia(53%)Which findings are present?coronal construction of contrast-enhanced CT in 28-year-old man shows small-bowel loops between transverse colon(T)and left adre

15、nal gland(arrow)Which findings are present?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 findingsM:F=3:1 has left and right two subtypes,the former accounts

16、 for about 3/4Right subtype occur when bowel prolapses through Waldeyer s fossa below to the ascending duodenum,and to the right side of the mesocolon.contrast-enhanced CT scan of the upper abdomen shows a saclike mass of dilated jejunal loops(J)between the pancreatic head and stomach.B,Foramen of W

17、inslow herniaLeft paraduodenal hernia occur when bowel prolapses through Landzerts fossa,an aperture present in approximately 2%of the population.the dilated inferior mesenteric vein(arrowhead)is located at the anterior border of the encapsulated loops.E,Congenital malrotationCT DiagnosisCT Diagnosi

18、s(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)CT DiagnosisCT Diagnosis(Left paraduodenal herniaparaduodenal hernia)CT scan of the midabdomen shows the infer

19、ior 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)CT DiagnosisCT Diagnosis(Left

20、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 Axial CT scans demonstrate bowel whin the bowel loops interpos

21、ed between the stomach and pancreas,some mass effect on the posterior stomach wall,thickened bowel wall,and engorged mesenteric vessels.coronal construction of contrast-enhanced CT in 28-year-old man shows small-bowel loops between transverse colon(T)and left adrenal gland(arrow)contrast-enhanced CT

22、 scan of the upper abdomen shows a saclike mass of dilated jejunal loops(J)between the pancreatic head and stomach.Mesenteric twisting?Displaced bowel loops?How paraduodenal hernia hapenedMesenteric twisting?Which findings are present?Which findings are present?axial contrast-enhanced CT scan in 28-

23、year-old man shows small-bowel loops(white arrow)behind pancreas(P)(black arrow indicates stomach)M:F=3:1 has left and right two subtypes,the former accounts for about 3/4Which findings are present?which is located at the anteromedial border of the encapsulated jejunal loops(J).Mesenteric vessel abn

24、ormalities,including enlargement,stretching,and anterior displacement of the main mesenteric trunks,especially the inferior mesenteric vein,to the left,also are helpful findingsDisplaced bowel loops?Which findings are present?the most common type of internal hernia(53%)Right subtype occur when bowel

25、 prolapses through Waldeyer s fossa below to the ascending duodenum,and to the right side of the mesocolon.M:F=3:1 has left and right two subtypes,the former accounts for about 3/4the most common type of internal hernia(53%)Mesenteric twisting?Which findings are present?the dilated inferior mesenter

26、ic vein(arrowhead)is located at the anterior border of the encapsulated loops.Which findings are present?CT Diagnosis(Left paraduodenal hernia)CT Diagnosis(Left paraduodenal hernia)Which findings are present?How paraduodenal hernia hapenedCT Diagnosis(Left paraduodenal hernia)CT Diagnosis(Left parad

27、uodenal hernia)How paraduodenal hernia hapenedCT Diagnosis(Left paraduodenal 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 findingsWithin the left up

28、per abdomen,there is thin sac filled with small bowel with swirling vessels identified within it.Left paraduodenal hernia occur when bowel prolapses through Landzerts fossa,an aperture present in approximately 2%of the population.CT Diagnosis(Left paraduodenal hernia)Right subtype occur when bowel p

29、rolapses through Waldeyer s fossa below to the ascending duodenum,and to the right side of the mesocolon.How paraduodenal hernia hapenedParaduodenal HerniaCT DiagnosisCT Diagnosis(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 engorged mesenteric vessels(arrow)at the fossa of Landzert(L).