急腹症-Acute-Abdomen影像学表现课件

急腹症Acute Abdomen北京协和医院放射科 薛华丹急腹症Acute Abdomen北京协和医院放射科 薛华丹1一一 急腹症急腹症n n检查方法及应用范围：检查方法及应用范围：n n1 1、腹部平片：主要应于胃肠道穿孔性或梗阻性急腹症。、腹部平片：主要应于胃肠道穿孔性或梗阻性急腹症。n n2 2、钡灌肠造影：应用于肠套叠、扭转等梗阻性急腹症、钡灌肠造影：应用于肠套叠、扭转等梗阻性急腹症的诊治。的诊治。n n3 3、CTCT检查：可应用于所有急腹症检查，价值较高。检查：可应用于所有急腹症检查，价值较高。n n4 4、超声检查：主要应用于实质性脏器外伤、腹腔积液、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。局限性脓肿、结石与梗阻、肠套叠及急性炎症的检查。一 急腹症检查方法及应用范围：2Possible causes of intestinal obstuctionn nCongenitaln nInflammatoryn nLesion(extrinsic and intrinsic bowel)n nTraumaPossible causes of intestinal 3急腹症-Acute-Abdomen影像学表现课件4Classificationn nGastric outlet obstruction:n nonly one/two air-fluid levelsonly one/two air-fluid levelsn nHomogeneous mass displacing transverse colonHomogeneous mass displacing transverse colonn nDuodenal obstruction:n ndouble-bubble sign;double-bubble sign;n nFrequently normal due to absence of gas from Frequently normal due to absence of gas from vomitingvomitingClassificationGastric outlet o5急腹症-Acute-Abdomen影像学表现课件6Classificationn nJejunal and ileal obstruction:n nCandy cane:3 loops+3cm gas-fluid Candy cane:3 loops+3cm gas-fluid levels+35 hours onsetlevels+35 hours onsetn nDisparity in size between obstructed and normal Disparity in size between obstructed and normal loopsloopsn nLittle/no gas+stool in colon with complete Little/no gas+stool in colon with complete mechanical obstruction after 12-24 hoursmechanical obstruction after 12-24 hoursn nStepladder appearance;string-of-bead;Stepladder appearance;string-of-bead;Cave:fluid-distended loops may lead one to overlook obstruction!ClassificationJejunal and ilea7 Upright abdominal radiograph shows multiple airfluid levels.Pneumobilia(arrow)is present,as is string-of pearls sign(arrowheads).Upright abdominal radiograp8急腹症-Acute-Abdomen影像学表现课件9Classificationn nColonic obstructionn nDilated colon onlyDilated colon onlyn nDilated small bowel(incompetent ileo-cecal valve)Dilated small bowel(incompetent ileo-cecal valve)n nGas-fluid levels distal to hepatic flexure(fluid is Gas-fluid levels distal to hepatic flexure(fluid is normal in cecum and ascending colon)normal in cecum and ascending colon)n nCecum most dilated portion(10cm will be Cecum most dilated portion(10cm will be critical)critical)ClassificationColonic obstruct10肠扭转肠扭转n n大肠扭转肠扭转大肠扭转11Classificationn nClosed-loop obstructionn nFixation of bowel loop:Fixation of bowel loop:n nCoffee bean sign:gas filled loopCoffee bean sign:gas filled loopn npseudotumor:fluid-filled looppseudotumor:fluid-filled loopn nU-shaped dilated bowel loopU-shaped dilated bowel loopn nIncreasing intraluminal fluidIncreasing intraluminal fluidn nBeak sign:point of obstructionBeak sign:point of obstructionn nWhirl sign:twisting of bowelWhirl sign:twisting of bowelClassificationClosed-loop obst12肠梗阻肠梗阻n n机械性肠梗阻机械性肠梗阻n n单纯性肠梗阻：肠管通畅性障碍单纯性肠梗阻：肠管通畅性障碍n n绞窄性肠梗阻：肠管通畅性障碍伴有血运障碍绞窄性肠梗阻：肠管通畅性障碍伴有血运障碍n n动力性肠梗阻动力性肠梗阻n n麻痹性肠梗阻：麻痹性肠梗阻：n n痉挛性肠梗阻：痉挛性肠梗阻：n n血运性肠梗阻：肠系膜动脉血栓或栓塞所致血运性肠梗阻：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13单纯性肠梗阻单纯性肠梗阻n n阶梯状气液平n n大跨度肠袢n n鱼肋征单纯性肠梗阻阶梯状气液平14急腹症-Acute-Abdomen影像学表现课件15绞窄性肠梗阻绞窄性肠梗阻n n假肿瘤征：n n两端闭锁的绞锁肠段内充满大量液体，仰卧位呈肿块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部见一短小的液面 n n咖啡豆征：闭襻n n小跨度蜷曲肠襻：肠系膜增厚缩短n n长液面征：张力低、血性液体n n空回肠换位征：小肠扭转绞窄性肠梗阻假肿瘤征：16绞窄性肠梗阻绞窄性肠梗阻Strangulated obstructionn nTriadTriad:n nclosed-loop obstruction of the involved segment closed-loop obstruction of the involved segment(majority of cases)(majority of cases)n nMechanical obstruction proximal to the involved Mechanical obstruction proximal to the involved segmentsegmentn nVenous congestion of the involved loopVenous congestion of the involved loopn nAbdominal plain filmAbdominal plain film:n nsigns for volvulussigns for volvulus（肠扭转）（肠扭转）or closed-loop or closed-loop obstruction+bowel thickeningobstruction+bowel thickeningn nCT has 63%100%detection rate!CT has 63%100%detection rate!n nPoor/no enhancement of bowel wallPoor/no enhancement of bowel walln nMesenteric haziness due to edemaMesenteric haziness due to edema绞窄性肠梗阻Strangulated obstructio17肠扭转肠扭转n n小肠扭转：空回肠换位、花瓣样或香蕉样排列 肠扭转小肠扭转：空回肠换位、花瓣样或香蕉样排列 18急腹症-Acute-Abdomen影像学表现课件19麻痹性肠梗阻麻痹性肠梗阻Ileus n nCauses:Causes:n npostoperativepostoperativen nIntra-abdominal inflammationIntra-abdominal inflammationn nischemic bowel diseaseischemic bowel diseasen nLarge+small bowel gastric Large+small bowel gastric distensiondistensionn nDecreased small bowel Decreased small bowel distension in serial filmsdistension in serial filmsn nDelayed but free passage of Delayed but free passage of contrast materialcontrast material麻痹性肠梗阻Ileus Causes:20急腹症-Acute-Abdomen影像学表现课件21Localized ileusn nCauses:often associated with adjacent acute inflammatory process(acute pancreatitis,acute appendicitis,etc.)n nIsolated distended loop of small/large boweln nSentinel loop:loops near the local peritonitisLocalized ileusCauses:often a22胃肠道穿孔胃肠道穿孔游离气腹胃肠道穿孔游离气腹23急腹症-Acute-Abdomen影像学表现课件24肠套叠肠套叠n n小肠型n n回结型n n结肠型n n腹痛/便血/包块n n首选方法：钡灌肠（可治疗）套鞘（外筒）、套入部（中筒和内筒）；治疗肠套叠小肠型套鞘（外筒）、套入部（中筒和内筒）；治疗25急腹症-Acute-Abdomen影像学表现课件26急腹症-Acute-Abdomen影像学表现课件27