腹内疝CT表现（经验分析）

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

2、 abdomen, there is Within 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听风C学堂Which choice is the most likely diagnosis? A, Paraduodenal hernia B, Foramen of Wi

3、nslow hernia C, Transmesenteric hernia D, Trans omental hernia E, Congenital malrotation6听风C学堂Paraduodenal HerniaParaduodenal Hernia 7听风C学堂Whats paraduodenal herniaparaduodenal hernia the most common type of internal hernia (53%) congenital hernia, hernia sac asymptomatic ,colicky epigastric or peri

4、umbilical pain M:F=3:1 has left and right two subtypes ,the former accounts for about 3/48听风C学堂 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 th

5、e 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. 9听风C学堂 How paraduodenal herniaparaduodenal hernia hapened Right subtype occur when bowel pr

6、olapses through Waldeyer s fossa below to the ascending duodenum, and to the right side of the mesocolon .10听风C学堂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

7、 on the posterior stomach wall, thickened bowel wall, and engorged mesenteric vessels.11听风C学堂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听风C学堂CT DiagnosisCT Di

8、agnosis (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)13听风C学堂CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) axial contrast-enhanced CT

9、 scan in 36-year-old man shows small-bowel loops (arrow) displaying inferior mensteric vein (arrowhead) to left.14听风C学堂CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) coronal construction of contrast-enhanced CT in 28-year-old man shows small-bowel loops between transverse co

10、lon (T) and left adrenal gland (arrow)15听风C学堂CT 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 located at the anteromedial border of the enca

11、psulated jejunal loops (J). Diagram (coronal view) of the surgical findings shows that the fossa Landzert is 4cm in diameter (arrowhead)16听风C学堂CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) Mesenteric vessel abnormalities, including enlargement, stretching, and anterior disp

12、lacement of the main mesenteric trunks, especially the inferior mesenteric vein, to the left, also are helpful findings 17听风C学堂CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) contrast-enhanced CT scan of the upper abdomen shows a saclike mass of dilated jejunal loops (J) betw

13、een 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) .18听风C学堂 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 b