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1、急腹症AcuteAbdomen影像学表现,急腹症AcuteAbdomen影像学表现急腹症AcuteAbdomen影像学表现一 急腹症检查方法与应用范围：1、腹部平片：主要应于胃肠道穿孔性或梗阻性急腹症。2、钡灌肠造影：应用于肠套叠、扭转等梗阻性急腹症的诊治。3、CT检查：可应用于所有急腹症检查，价值较高。4、超声检查：主要应用于实质性脏器外伤、腹腔积液、局限性脓肿、结石与梗阻、肠套叠及急性炎症的检查。 2,”通过阅读科技书籍，我们能丰富知识，培养逻辑思维能力；,急腹症AcuteAbdomen影像学表现急腹症AcuteAb,一 急腹症,检查方法与应用范围：1、腹部平片：主要应于胃肠道穿孔性或梗阻
2、性急腹症。2、钡灌肠造影：应用于肠套叠、扭转等梗阻性急腹症的诊治。3、CT检查：可应用于所有急腹症检查，价值较高。4、超声检查：主要应用于实质性脏器外伤、腹腔积液、局限性脓肿、结石与梗阻、肠套叠及急性炎症的检查。,2,一 急腹症检查方法与应用范围：2,Possible causes of intestinal obstuction,CongenitalInflammatoryLesion (extrinsic and intrinsic bowel)Trauma,3,Possible causes of intestinal,4,4,Classification,Gastric outlet
3、obstruction: only one/two air-fluid levelsHomogeneous mass displacing transverse colonDuodenal obstruction: double-bubble sign; Frequently normal due to absence of gas from vomiting,5,ClassificationGastric outlet o,6,6,Classification,Jejunal and ileal obstruction: Candy cane: 3 loops+3cm gas-fluid l
4、evels+35 hours onsetDisparity in size between obstructed and normal loopsLittle/no gas + stool in colon with complete mechanical obstruction after 12-24 hoursStepladder appearance; string-of-bead;,Cave: fluid-distended loops may lead one to overlook obstruction!,7,ClassificationJejunal and ilea,Upri
5、ght abdominal radiograph shows multiple airfluid levels. Pneumobilia (arrow) is present, as is string-of pearls sign (arrowheads).,8,Upright abdominal radiograp,9,9,Classification,Colonic obstructionDilated colon onlyDilated small bowel (incompetent ileo-cecal valve)Gas-fluid levels distal to hepati
6、c flexure (fluid is normal in cecum and ascending colon)Cecum most dilated portion (10cm will be critical),10,ClassificationColonic obstruct,肠扭转,大肠扭转,11,肠扭转大肠扭转11,Classification,Closed-loop obstructionFixation of bowel loop:Coffee bean sign: gas filled looppseudotumor: fluid-filled loopU-shaped dila
7、ted bowel loopIncreasing intraluminal fluidBeak sign: point of obstructionWhirl sign: twisting of bowel,12,ClassificationClosed-loop obst,肠梗阻,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,13,肠梗阻机械性肠梗阻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,
8、14,单纯性肠梗阻阶梯状气液平14,15,15,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：肠系膜增厚缩短长液面征：张力低、血性液体空回肠换位征：小肠扭转,16,绞窄性肠梗阻假肿瘤征：16,绞窄性肠梗阻Strangulated obstruction,Triad: closed-loop obstruction of the involved segment (majority of cases)Mechanical obstruction proximal to the i
9、nvolved segmentVenous congestion 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,17,绞窄性肠梗阻Strangulated obstructio,肠扭转,小肠扭转：空回肠换位、花瓣样或香蕉样排列,18
10、,肠扭转小肠扭转：空回肠换位、花瓣样或香蕉样排列 18,19,19,麻痹性肠梗阻Ileus,Causes: postoperativeIntra-abdominal inflammationischemic bowel diseaseLarge + small bowel gastric distensionDecreased small bowel distension in serial filmsDelayed but free passage of contrast material,20,麻痹性肠梗阻Ileus Causes: 20,21,21,Localized ileus,Cau
11、ses: often associated with adjacent acute inflammatory process (acute pancreatitis, acute appendicitis, etc.)Isolated distended loop of small/large bowelSentinel loop: loops near the local peritonitis,22,Localized ileusCauses: often a,胃肠道穿孔,游离气腹,23,胃肠道穿孔游离气腹23,24,24,肠套叠,小肠型回结型结肠型腹痛/便血/包块首选方法：钡灌肠（可治疗）,套鞘（外筒）、套入部（中筒和内筒）；,治疗,25,肠套叠小肠型套鞘（外筒）、套入部（中筒和内筒）； 治疗25,26,26,27,27,Thank You,世界触手可与,携手共进，齐创精品工程,28,Thank You世界触手可与携手共进，齐创精品工程28,谢谢大家！,结 语,谢谢大家！ 结 语,
