急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件

急腹癥

AcuteAbdomen北京協(xié)和醫(yī)院放射科薛華丹急腹癥

AcuteAbdomen北京協(xié)和醫(yī)院放射科薛華丹1一急腹癥檢查方法及應(yīng)用范圍：1、腹部平片：主要應(yīng)于胃腸道穿孔性或梗阻性急腹癥。2、鋇灌腸造影：應(yīng)用于腸套疊、扭轉(zhuǎn)等梗阻性急腹癥的診治。3、CT檢查：可應(yīng)用于所有急腹癥檢查，價值較高。4、超聲檢查：主要應(yīng)用于實(shí)質(zhì)性臟器外傷、腹腔積液、局限性膿腫、結(jié)石與梗阻、腸套疊及急性炎癥的檢查。一急腹癥檢查方法及應(yīng)用范圍：2PossiblecausesofintestinalobstuctionCongenitalInflammatoryLesion(extrinsicandintrinsicbowel)TraumaPossiblecausesofintestinal3急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件4ClassificationGastricoutletobstruction:onlyone/twoair-fluidlevelsHomogeneousmassdisplacingtransversecolonDuodenalobstruction:double-bubblesign;FrequentlynormalduetoabsenceofgasfromvomitingClassificationGastricoutleto5急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件6ClassificationJejunalandilealobstruction:

Candycane:>3loops+>3cmgas-fluidlevels+>3~5hoursonsetDisparityinsizebetweenobstructedandnormalloopsLittle/nogas+stoolincolonwithcompletemechanicalobstructionafter12-24hoursStepladderappearance;string-of-bead;Cave:fluid-distendedloopsmayleadonetooverlookobstruction!!!ClassificationJejunalandilea7

Uprightabdominalradiographshowsmultipleair–fluidlevels.Pneumobilia(arrow)ispresent,asisstring-ofpearlssign(arrowheads).Uprightabdominalradiograp8急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件9ClassificationColonicobstructionDilatedcolononlyDilatedsmallbowel(incompetentileo-cecalvalve)Gas-fluidlevelsdistaltohepaticflexure(fluidisnormalincecumandascendingcolon)Cecummostdilatedportion(>10cmwillbecritical)ClassificationColonicobstruct10腸扭轉(zhuǎn)大腸扭轉(zhuǎn)腸扭轉(zhuǎn)大腸扭轉(zhuǎn)11ClassificationClosed-loopobstructionFixationofbowelloop:Coffeebeansign:gasfilledlooppseudotumor:fluid-filledloopU-shapeddilatedbowelloopIncreasingintraluminalfluidBeaksign:pointofobstructionWhirlsign:twistingofbowelClassificationClosed-loopobst12腸梗阻機(jī)械性腸梗阻單純性腸梗阻：腸管通暢性障礙絞窄性腸梗阻：腸管通暢性障礙伴有血運(yùn)障礙動力性腸梗阻麻痹性腸梗阻：痙攣性腸梗阻：血運(yùn)性腸梗阻：腸系膜動脈血栓或栓塞所致鋇劑造影須慎重使用，鋇劑吸收水分會加重梗阻腸梗阻機(jī)械性腸梗阻鋇劑造影須慎重使用，鋇劑吸收水分會加重梗阻13單純性腸梗阻階梯狀氣液平大跨度腸袢魚肋征單純性腸梗阻階梯狀氣液平14急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件15絞窄性腸梗阻假腫瘤征：兩端閉鎖的絞鎖腸段內(nèi)充滿大量液體，仰臥位呈腫塊影，而站立位或側(cè)臥位水平位片上則在該腫瘤塊影上部見一短小的液面

咖啡豆征：閉襻小跨度蜷曲腸襻：腸系膜增厚縮短長液面征：張力低、血性液體空回腸換位征：小腸扭轉(zhuǎn)絞窄性腸梗阻假腫瘤征：16絞窄性腸梗阻

StrangulatedobstructionTriad:closed-loopobstructionoftheinvolvedsegment(majorityofcases)MechanicalobstructionproximaltotheinvolvedsegmentVenouscongestionoftheinvolvedloopAbdominalplainfilm:signsforvolvulus（腸扭轉(zhuǎn)）orclosed-loopobstruction+bowelthickeningCThas63%~100%detectionrate!!!Poor/noenhancementofbowelwallMesenterichazinessduetoedema絞窄性腸梗阻

Strangulatedobstructio17腸扭轉(zhuǎn)小腸扭轉(zhuǎn)：空回腸換位、花瓣樣或香蕉樣排列腸扭轉(zhuǎn)小腸扭轉(zhuǎn)：空回腸換位、花瓣樣或香蕉樣排列18急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件19麻痹性腸梗阻

IleusCauses:postoperativeIntra-abdominalinflammationischemicboweldiseaseLarge+smallbowel±gastricdistensionDecreasedsmallboweldistensioninserialfilmsDelayedbutfreepassageofcontrastmaterial麻痹性腸梗阻

IleusCauses:20急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件21LocalizedileusCauses:oftenassociatedwithadjacentacuteinflammatoryprocess(acutepancreatitis,acuteappendicitis,etc.)Isolateddistendedloopofsmall/largebowelSentinelloop:loopsnearthelocalperitonitisLocalizedileusCauses:oftena22胃腸道穿孔游離氣腹胃腸道穿孔游離氣腹23急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件24腸套疊小腸型回結(jié)型結(jié)腸型腹痛/便血/包塊首選方法：鋇灌腸（可治療）套鞘（外筒）、套入部（中筒和內(nèi)筒）；治療腸套疊小腸型套鞘（外筒）、套入部（中筒和內(nèi)筒）；治療25急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件26急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件27急腹癥

AcuteAbdomen北京協(xié)和醫(yī)院放射科薛華丹急腹癥

AcuteAbdomen北京協(xié)和醫(yī)院放射科薛華丹28一急腹癥檢查方法及應(yīng)用范圍：1、腹部平片：主要應(yīng)于胃腸道穿孔性或梗阻性急腹癥。2、鋇灌腸造影：應(yīng)用于腸套疊、扭轉(zhuǎn)等梗阻性急腹癥的診治。3、CT檢查：可應(yīng)用于所有急腹癥檢查，價值較高。4、超聲檢查：主要應(yīng)用于實(shí)質(zhì)性臟器外傷、腹腔積液、局限性膿腫、結(jié)石與梗阻、腸套疊及急性炎癥的檢查。一急腹癥檢查方法及應(yīng)用范圍：29PossiblecausesofintestinalobstuctionCongenitalInflammatoryLesion(extrinsicandintrinsicbowel)TraumaPossiblecausesofintestinal30急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件31ClassificationGastricoutletobstruction:onlyone/twoair-fluidlevelsHomogeneousmassdisplacingtransversecolonDuodenalobstruction:double-bubblesign;FrequentlynormalduetoabsenceofgasfromvomitingClassificationGastricoutleto32急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件33ClassificationJejunalandilealobstruction:

Candycane:>3loops+>3cmgas-fluidlevels+>3~5hoursonsetDisparityinsizebetweenobstructedandnormalloopsLittle/nogas+stoolincolonwithcompletemechanicalobstructionafter12-24hoursStepladderappearance;string-of-bead;Cave:fluid-distendedloopsmayleadonetooverlookobstruction!!!ClassificationJejunalandilea34

Uprightabdominalradiographshowsmultipleair–fluidlevels.Pneumobilia(arrow)ispresent,asisstring-ofpearlssign(arrowheads).Uprightabdominalradiograp35急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件36ClassificationColonicobstructionDilatedcolononlyDilatedsmallbowel(incompetentileo-cecalvalve)Gas-fluidlevelsdistaltohepaticflexure(fluidisnormalincecumandascendingcolon)Cecummostdilatedportion(>10cmwillbecritical)ClassificationColonicobstruct37腸扭轉(zhuǎn)大腸扭轉(zhuǎn)腸扭轉(zhuǎn)大腸扭轉(zhuǎn)38ClassificationClosed-loopobstructionFixationofbowelloop:Coffeebeansign:gasfilledlooppseudotumor:fluid-filledloopU-shapeddilatedbowelloopIncreasingintraluminalfluidBeaksign:pointofobstructionWhirlsign:twistingofbowelClassificationClosed-loopobst39腸梗阻機(jī)械性腸梗阻單純性腸梗阻：腸管通暢性障礙絞窄性腸梗阻：腸管通暢性障礙伴有血運(yùn)障礙動力性腸梗阻麻痹性腸梗阻：痙攣性腸梗阻：血運(yùn)性腸梗阻：腸系膜動脈血栓或栓塞所致鋇劑造影須慎重使用，鋇劑吸收水分會加重梗阻腸梗阻機(jī)械性腸梗阻鋇劑造影須慎重使用，鋇劑吸收水分會加重梗阻40單純性腸梗阻階梯狀氣液平大跨度腸袢魚肋征單純性腸梗阻階梯狀氣液平41急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件42絞窄性腸梗阻假腫瘤征：兩端閉鎖的絞鎖腸段內(nèi)充滿大量液體，仰臥位呈腫塊影，而站立位或側(cè)臥位水平位片上則在該腫瘤塊影上部見一短小的液面

咖啡豆征：閉襻小跨度蜷曲腸襻：腸系膜增厚縮短長液面征：張力低、血性液體空回腸換位征：小腸扭轉(zhuǎn)絞窄性腸梗阻假腫瘤征：43絞窄性腸梗阻

StrangulatedobstructionTriad:closed-loopobstructionoftheinvolvedsegment(majorityofcases)MechanicalobstructionproximaltotheinvolvedsegmentVenouscongestionoftheinvolvedloopAbdominalplainfilm:signsforvolvulus（腸扭轉(zhuǎn)）orclosed-loopobstruction+bowelthickeningCThas63%~100%detectionrate!!!Poor/noenhancementofbowelwallMesenterichazinessduetoedema絞窄性腸梗阻

Strangulatedobstructio44腸扭轉(zhuǎn)小腸扭轉(zhuǎn)：空回腸換位、花瓣樣或香蕉樣排列腸扭轉(zhuǎn)小腸扭轉(zhuǎn)：空回腸換位、花瓣樣或香蕉樣排列45急腹癥-Acute-Abdomen影像學(xué)表現(xiàn)課件46麻痹性腸梗阻

IleusCauses:postoperativeIntra-