腹內(nèi)疝CT表現(xiàn)培訓(xùn)課件

1、腹內(nèi)疝CT表現(xiàn)腹內(nèi)疝CT表現(xiàn)CT images腹內(nèi)疝CT表現(xiàn)2CT images腹內(nèi)疝CT表現(xiàn)2CT images腹內(nèi)疝CT表現(xiàn)3CT images腹內(nèi)疝CT表現(xiàn)3Which findings are present? Venous thrombosis ?Mesenteric twisting?Displaced bowel loops ?腹內(nèi)疝CT表現(xiàn)4Which findings are present? VeWhich findings are present? Within the left upper abdomen, there is thin sac filled with s

2、mall bowel with swirling vessels identified within it. 腹內(nèi)疝CT表現(xiàn)5Which findings are present? 腹內(nèi)疝CT表現(xiàn)培訓(xùn)課件Paraduodenal Hernia 腹內(nèi)疝CT表現(xiàn)7Paraduodenal Hernia 腹內(nèi)疝CT表現(xiàn)7Whats paraduodenal hernia the most common type of internal hernia (53%)congenital hernia, hernia sacasymptomatic ,colicky epigastric or perium

3、bilical pain M:F=3:1 has left and right two subtypes ,the former accounts for about 3/4腹內(nèi)疝CT表現(xiàn)8Whats paraduodenal hernia the How paraduodenal hernia hapened Left paraduodenal hernia occur when bowel prolapses through Landzerts fossa, an aperture present in approximately 2% of the population. Landzer

4、ts 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. 腹內(nèi)疝CT表現(xiàn)9 How paraduodenal hernia hapen How paraduodenal hernia

5、 hapened Right subtype occur when bowel prolapses through Waldeyer s fossa below to the ascending duodenum, and to the right side of the mesocolon .腹內(nèi)疝CT表現(xiàn)10 How paraduodenal hernia hapenCT Diagnosis (Left paraduodenal hernia ) Axial CT scans demonstrate bowel whin the bowel loops interposed between

6、 the stomach and pancreas, some mass effect on the posterior stomach wall, thickened bowel wall, and engorged mesenteric vessels.腹內(nèi)疝CT表現(xiàn)11CT Diagnosis (Left paraduodenaCT Diagnosis (Left paraduodenal hernia ) axial contrast-enhanced CT scan in 11-year-old boy shows small-bowel loops (arrow) between

7、stomach and pancreas腹內(nèi)疝CT表現(xiàn)12CT Diagnosis (Left paraduodenaCT Diagnosis (Left paraduodenal hernia ) axial contrast-enhanced CT scan in 28-year-old man shows small-bowel loops (white arrow) behind pancreas (P) (black arrow indicates stomach)腹內(nèi)疝CT表現(xiàn)13CT Diagnosis (Left paraduodenaCT Diagnosis (Left pa

8、raduodenal hernia ) axial contrast-enhanced CT scan in 36-year-old man shows small-bowel loops (arrow) displaying inferior mensteric vein (arrowhead) to left.腹內(nèi)疝CT表現(xiàn)14CT Diagnosis (Left paraduodenaCT Diagnosis (Left paraduodenal 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)腹內(nèi)疝CT表現(xiàn)15CT Diagnosis (Left paraduodenaCT Diagnosis (Left paraduodenal hernia ) CT scan of the midabdomen shows the inferior mesenteric vein (arrowhead), this vessel is a landmark for the inferior mesocolon. which i

10、s 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)腹內(nèi)疝CT表現(xiàn)16CT Diagnosis (Left paraduodenaCT Diagnosis (Left paraduodenal hernia ) Mesenteric vessel abnormalities, inc

11、luding enlargement, stretching, and anterior displacement of the main mesenteric trunks, especially the inferior mesenteric vein, to the left, also are helpful findings 腹內(nèi)疝CT表現(xiàn)17CT Diagnosis (Left paraduodenaCT Diagnosis (Left paraduodenal hernia ) contrast-enhanced CT scan of the upper abdomen show

12、s 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) .腹內(nèi)疝CT表現(xiàn)18CT Diagnosis (Left paraduodena 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