腹内疝C表现.ppt

Case Old woman with chronic, episodic abdominal pain * CT images * CT images * Which findings are present? Venous thrombosis ? Mesenteric twisting? Displaced bowel loops ? * Which findings are present? Within the left upper abdomen, there is thin sac filled with small bowel with swirling vessels identified within it. * Which choice is the most likely diagnosis? A,?Paraduodenal hernia ?B, Foramen of Winslow hernia ?C, Transmesenteric hernia ?D, Trans omental hernia ?E, Congenital malrotation * Paraduodenal Hernia * What’s paraduodenal hernia the most common type of internal hernia (53%) congenital hernia, hernia sac asymptomatic ,colicky epigastric or periumbilical pain M:F=3:1 has left and right two subtypes ,the former accounts for about 3/4 * 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 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. * How paraduodenal hernia hapened Right subtype occur when bowel prolapses through Waldeyer s fossa below to the ascending duodenum, and to the right side of the mesocolon . * * * CT Diagnosis (Left paraduodenal hernia ) Axial CT scans demonstrate bowel whin the bowel loops interposed between the stomach and pancreas, some mass effect on the posterior stomach wall, thickened bowel wall, and engorged mesenteric vessels. * CT Diagnosis (Left paraduodenal hernia ) axial contrast-enhanced CT scan in 11-year-old boy shows small-bowel loops (arrow) between stomach and pancreas * CT 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) * CT Diagnosis (Left paraduod