上海交通大学《影像学》6 17-11-2016 急腹症.pptVIP

a 49-year-old man who was involved in a motor vehicle collision. Large traumatic duodenal hematoma 急腹症主要病因及鉴别 消化系统疾病 泌尿生殖系疾病 生殖系统疾病 大血管疾病 其他系统或全身疾病 * * 结肠梗阻 大肠癌、乙状结肠扭转引起 乙状结肠扭转 鸟嘴征 巨大肠袢征 盲肠扭转（cecal volvulus） 麻痹性肠梗阻 肠麻痹：全部肠管处于麻痹状态，无狭窄 常见原因：急性腹膜炎、腹部术后、脓毒血症、低钾血症、严重外伤、休克 特征 大小肠呈均等性扩张、积气，可有液面 全结肠扩张、充气是其特征 多次检查肠管形态改变不明显 综合影像评价肠梗阻 Criteria for SBO How Severe Is the Obstruction Where Is the Transition Point What Is the Cause of the Obstruction Is the SBO Simple or Complicated Plain film criteria for SBO Presence of small bowel distention,with maximal dilated loops averaging 30mm in diameter CT criteria for SBO Presence of dilated small bowel loops Other signs How Severe Is the Obstruction梗阻程度 梗阻点远端、近端管径超过50% there is a 50% difference in caliber between the proximal dilated bowel and the distal collapsed bowel 扩张的小肠内内容物集聚 the small bowel feces in the dilated small bowel 造影剂通过受限 passage of the contrast material through the transition point into the collapsed distal bowel 完全梗阻 Where Is the Transition Point梗阻点 肠曲扩张、液平位置 扩张肠粘膜的特点 近端扩张与远端萎缩肠管的过渡点 小肠出现内容物积聚处 What Is the Cause of the Obstruction梗阻原因 Intrinsic bowel lesions Extrinsic cause A rule of thumb never to forget is that the answer is almost always in the transition point Cause of the Obstruction Hernias Adhesions Crohn disease Malignancy SBO secondary to an inguinal hernia SBO secondary to the acute presentation of Crohn disease SBO secondary to adhesions ?Target sign ?meniscus sign 肠套叠 肠套叠钡剂灌肠复位 单纯性还是绞窄性肠梗阻 绞窄性肠梗阻多为闭袢性肠梗阻，常见于扭转、内疝、套叠 绞窄性肠梗阻特征 闭袢内大量积液:假肿瘤征 闭袢内大量积气扩张：咖啡豆征 肠壁气肿症 随访：病变发展快，1-2天出现腹水 平扫 肠壁轻度增厚、及分层 肠系膜血管集聚、纠集 肠壁密度增加、积气以及肠系膜出血 增强 强化减弱或不对称强化 Strangulated SBO绞窄性肠梗阻 CT特异性表现  Closed-loop obstruction in a patient with intestinal torsion  Bowel infarction Thickening and increased attenuation of the affected bowel wall A halo or “target sign” Pneumatosis intestinalis Gas in the portal vein Strangulated SBO 绞窄性肠梗阻 严重肠缺血 Strangulated SBO 胃肠穿孔的原因 胃肠溃疡 炎症 肿瘤 创伤、破裂 肠穿