腹内疝CT表现PPT课件

1、2021/3/91 Case Old woman with chronic, episodic abdominal pain 2021/3/92CT imagesCT images2021/3/93CT images2021/3/94Which findings are present?Which findings are present? Venous thrombosis ? Mesenteric twisting? Displaced bowel loops ?2021/3/95Which findings are present?Which findings are present?

2、Within the left upper 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. 2021/3/96Which choice is the most likely diagnosis? A,Paraduodenal

3、hernia B, Foramen of Winslow hernia C, Transmesenteric hernia D, Trans omental hernia E, Congenital malrotation2021/3/97Paraduodenal Hernia 2021/3/98Whats paraduodenal herniaparaduodenal hernia the most common type of internal hernia (53%) congenital hernia, hernia sac asymptomatic ,colicky epigastr

4、ic or periumbilical pain M:F=3:1 has left and right two subtypes ,the former accounts for about 3/42021/3/99 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 loca

5、ted 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. 2021/3/910 How paraduodenal herniaparaduodenal hernia hapened Right subtype oc

6、cur when bowel prolapses through Waldeyer s fossa below to the ascending duodenum, and to the right side of the mesocolon .2021/3/911CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) Axial CT scans demonstrate bowel whin the bowel loops interposed between the stomach and pancre

7、as, some mass effect on the posterior stomach wall, thickened bowel wall, and engorged mesenteric vessels.2021/3/912CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) axial contrast-enhanced CT scan in 11-year-old boy shows small-bowel loops (arrow) between stomach and pancreas2

8、021/3/913CT 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)2021/3/914CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia

9、 ) axial contrast-enhanced CT scan in 36-year-old man shows small-bowel loops (arrow) displaying inferior mensteric vein (arrowhead) to left.2021/3/915CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) coronal construction of contrast-enhanced CT in 28-year-old man shows small-b

10、owel loops between transverse colon (T) and left adrenal gland (arrow)2021/3/916CT 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

11、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)2021/3/917CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) Mesenteric vessel abnormalities, including enla

12、rgement, stretching, and anterior displacement of the main mesenteric trunks, especially the inferior mesenteric vein, to the left, also are helpful findings 2021/3/918CT DiagnosisCT Diagnosis (Left paraduodenal herniaparaduodenal hernia ) contrast-enhanced CT scan of the upper abdomen shows a sacli

13、ke 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) .2021/3/919 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 l