腹内疝CT表现ppt课件

CaseOldwomanwithchronic,episodicabdominalpain1CTimages2CTimages3Whichfindingsarepresent?Venousthrombosis?Mesenterictwisting?Displacedbowelloops?4Whichfindingsarepresent?Withintheleftupperabdomen,thereisthinsacfilledwithsmallbowelwithswirlingvesselsidentifiedwithinit.5Whichchoiceisthemostlikelydiagnosis?A,ParaduodenalherniaB,ForamenofWinslowherniaC,TransmesentericherniaD,TransomentalherniaE,Congenitalmalrotation6ParaduodenalHernia7What’sparaduodenalherniathemostcommontypeofinternalhernia(53%)congenitalhernia,herniasacasymptomatic,colickyepigastricorperiumbilicalpainM:F=3:1hasleftandrighttwosubtypes,theformeraccountsforabout3/48HowparaduodenalherniahapenedLeftparaduodenalherniaoccurwhenbowelprolapsesthroughLandzert'sfossa,anaperturepresentinapproximately2%ofthepopulation.9Landzert'sfossaislocatedbehindtheascendingorfourthpartoftheduodenumandisformedbytheliftingupofaperitonealfoldbytheinferiormesentericveinandascendingleftcolicarteryastheyrunalongthelateralsideofthefossa.HowparaduodenalherniahapenedRightsubtypeoccurwhenbowelprolapsesthroughWaldeyer'sfossabelowtotheascendingduodenum,andtotherightsideofthemesocolon.10CTDiagnosis(Leftparaduodenalhernia)AxialCTscansdemonstratebowelwhinthebowelloopsinterposedbetweenthestomachandpancreas,somemasseffectontheposteriorstomachwall,thickenedbowelwall,andengorgedmesentericvessels.11CTDiagnosis(Leftparaduodenalhernia)axialcontrast-enhancedCTscanin11-year-oldboyshowssmall-bowelloops(arrow)betweenstomachandpancreas12CTDiagnosis(Leftparaduodenalhernia)axialcontrast-enhancedCTscanin28-year-oldmanshowssmall-bowelloops(whitearrow)behindpancreas(P)(blackarrowindicatesstomach)13CTDiagnosis(Leftparaduodenalhernia)axialcontrast-enhancedCTscanin36-year-oldmanshowssmall-bowelloops(arrow)displayinginferiormenstericvein(arrowhead)toleft.14CTDiagnosis(Leftparaduodenalhernia)coronalconstructionofcontrast-enhancedCTin28-year-oldmanshowssmall-bowelloopsbetweentransversecolon(T)andleftadrenalgland(arrow)15CTDiagnosis(Leftparaduodenalhernia)CTscanofthemidabdomenshowstheinferiormesentericvein(arrowhead),thisvesselisalandmarkfortheinferiormesocolon.whichislocatedattheanteromedialborderoftheencapsulatedjejunalloops(J).Diagram(coronalview)ofthesurgicalfindingsshowsthatthefossaLandzertis4cmindiameter(arrowhead)16CTDiagnosis(Leftparaduodenalhernia)Mesentericvesselabnormalities,includingenlargement,stretching,andanteriordisplacementofthemainmesenterictrunks,especiallytheinferiormesentericvein,totheleft,alsoarehelpfulfindings17CTDiagnosis(Leftparaduodenalhernia)contrast-enhancedCTscanoftheupperabdomenshowsasaclikemassofdilatedjejunalloops(J)betweenthepancreaticheadandstomach.thedilatedinferiormesentericvein(arrowhead)islocatedattheanteriorborderoftheencapsulatedloops.Crowedandengorgedmesentericvessels(arrow)atthefossaofLandzert(L).18Unlikeherniasatothersites,thediagnosisofaninternalherniaismoredifficultbecausethesiteofdefectinthemesenteryisnotobviousonimaging.Thisisbecauseboththehernialorifice(occupiedbythemesenteryoftheherniatedloops)andthesurroundingareasarepredominantlyfatattenuating.Recognitionofmesentericvascularabnormalitiesiscrucialinthediagnosisofinternalhernia.1920