急腹症英文版课件

1、Intestinal ObstuctionHua-dan Xue 2008-11-30Ileus (intestinal obstruction)Mechanical intestinal obstructionSimple obstruction：occlusion/constriction of bowel lumenStrangulated obstruction：impaired blood supply of obstructed segmentIleus (adynamic/non-obstructive) Paralytic & spasmDerangement impairin

2、g proper distal propulsion of intestinal contentsCautions to barium exam due to the possibility of obstruction aggravating Classification - locationGastric outlet obstruction: Only one/two air-fluid levelsHomogeneous mass displacing transverse colonDuodenal obstruction: Double-bubble sign; Frequentl

3、y normal due to absence of gas from vomitingClassification - locationJejunal and ileal obstruction: Candy cane: 3 loops+3cm gas-fluid levels+35 hours onsetDisparity in size between obstructed and normal loopsLittle/no gas + stool in colon with complete mechanical obstruction after 12-24 hoursSteplad

4、der appearance; string-of-bead;Cave: fluid-distended loops may lead one to overlook obstruction!Mechanical obstructionClassification - locationColonic obstructionDilated colon onlyDilated small bowel (incompetent ileo-cecal valve)Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum a

5、nd ascending colon)Cecum most dilated portion (10cm will be critical)Classification locationLocalized ileusCauses: often associated with adjacent acute inflammatory process (acute pancreatitis, acute appendicitis, etc.)Sentinel loop: loops near the local peritonitisClosed-loop obstructionClosed-loop

6、 obstructionClosed-loop obstructionFixation of bowel loop:Coffee bean sign: gas filled loopPseudo-tumor: fluid-filled loopU-shaped dilated bowel loopIncreasing intra-luminal fluidBeak sign: point of obstructionWhirl sign: twisting of bowelClosed-loop obstructionLarge volvulusBeak signClassification

7、- etiology机械性肠梗阻单纯性肠梗阻：肠管通畅性障碍绞窄性肠梗阻：肠管通畅性障碍伴有血运障碍动力性肠梗阻麻痹性肠梗阻：痉挛性肠梗阻：血运性肠梗阻：肠系膜动脉血栓或栓塞所致 钡剂造影须慎重使用，钡剂吸收水分会加重梗阻单纯性肠梗阻阶梯状气液平大跨度肠袢鱼肋征绞窄性肠梗阻Strangulated obstructionTriad: closed-loop obstruction of the involved segment (majority of cases)Mechanical obstruction proximal to the involved segmentVenous con

8、gestion of the involved loopAbdominal plain film :signs for volvulus（肠扭转） or closed-loop obstruction + bowel thickeningCT has 63%100% detection rate!Poor/no enhancement of bowel wallMesenteric haziness due to edema绞窄性肠梗阻假肿瘤征：两端闭锁的绞锁肠段内充满大量液体，仰卧位呈肿块影，而站立位或侧卧位水平位片上则在该肿瘤块影上部见一短小的液面 咖啡豆征：闭襻小跨度蜷曲肠襻：肠系膜增厚

9、缩短长液面征：张力低、血性液体空回肠换位征：小肠扭转肠扭转小肠扭转：空回肠换位、花瓣样或香蕉样排列 麻痹性肠梗阻Ileus Causes: postoperativeintraabdominal inflammationischemic bowel diseaseLarge + small bowel gastric distensionDecreased small bowel distension in serial filmsDelayed but free passage of contrast materialStrangulated obstructionTriad: Closed

10、-loop obstruction of the involved segment (majority of cases)Mechanical obstruction proximal to the involved segmentVenous congestion of the involved loopAbdominal plain film :Signs for volvulus or closed-loop obstruction + bowel thickeningCT has 63%100% detection rate!Poor/no enhancement of bowel w

11、allMesenteric haziness due to edemaComparison - Simple obstructionStepladder gas-fluid levelLarge span loopFish-rib appearanceComparison - Strangulated obstructionPseudo-tumorCoffee bean sign：closed loopSmall span loop：shortening of mesentery Long gas-fluid level：low tensionDisplacement of jejunum a

12、nd ileumVolvulusSmall intestine volvulus：displacement of ileum and jejunum, banana-like flower-leaves-like form (representing the twisting bowel) Ileus (paralytic )Causes: PostoperativeIntra-abdominal inflammationIschemic bowel diseaseLarge + small bowel gastric distensionDecreased small bowel diste

13、nsion in serial filmsDelayed but free passage of contrast materialFinding the reasonsPost-operationInfectionIntussusception Thrombosis Tumor (extrinsic and intrinsic bowel)CongenitalIntestinal obstructionModalities, Methods and indications 1、Plain abdominal film：acute perforation and obstruction of bowel2、Barium enema：diagnose and therapy of obstructive disorders, e.g. intussusception, volvulus 3、CT scan：all kinds o