绞窄性肠梗阻的CT诊断(53页）.ppt

男，34岁，全腹疼痛1天伴呕吐，体检：全腹腹肌紧张、压痛、反跳痛 Colonic carcinoma with proximal ischemic colitis in a 72-year-old man. (a) Contrast-enhanced CT scan shows concentric bowel wall thickening in the ischemic sigmoid colon (open arrows) with an intervening normal-appearing segment separating the ischemic segment from the tumoral segment in the rectum (solid arrows). (b) Photograph of the resected specimen shows normal colonic mucosa between the tumoral segment (arrows) and ischemic segment (arrowheads). （a） （b） 男，81岁，腹痛、腹胀伴停止排气排便1天 乙状结肠扩张系膜扭转 手术结果:整个小肠系膜根部扭转1080度,切除肠段57厘米. 漩涡征 漩涡征、缆绳征、腹水 男性，70岁缘于入院前10小时无明显诱因出现腹部疼痛，呈持续性绞痛 漩涡征、缆绳征、腹水 第二天 探查病变部位情况：腹腔内大量血性腹水，共约1500ml，小肠系膜可见增生膜状组织，局部粘连，回盲部近端长约150cm回肠中下段扭转并形成内疝，肠管扩张明显，色暗红，无蠕动，刺激后无反应，呈坏疽样改变，系膜血管无明显搏动，血管内可见血栓形成，空肠及近端近端回肠色泽红润，蠕动良好，无明显扩张，结肠无明显梗阻征象。 男性，76岁 肠扭转 单纯性肠梗阻 女，56岁，剧烈腹胀腹痛7h，呕吐频繁，腹膜刺激征（+） 血管增粗 大部分小肠壁水肿增厚，系膜肿胀，血管增粗密度增高 男性，13岁，腹痛伴便血3天 探查病变部位情况：腹腔内见有少量腹水，淡黄色；空肠及部分回肠肠壁见有广泛渗血点，肠系膜血管扩张，小肠及系膜反时针扭转约180度；屈氏韧带及空肠起始部位于脊柱右侧 肠壁积气征：肠腔内气体经受损的粘膜进入肠壁 肠壁积气 肠壁积气 肠壁积气 手术结果：腹壁疝小肠嵌顿坏死 女性，26岁，剖宫产术后腹痛、腹胀12天 肠壁积气 血管增粗 系膜模糊 两天后手术 探查病变部位情况：多处小肠肠内粘膜呈暗黑色，考虑坏死可能；距回盲部约30cm小肠嵌顿于盆腔内，部分肠管坏死 门静脉、肠系膜静脉管腔积气 肠壁积气 Bowel infarct due to mesenteric venous thrombosis in a 52-year-old man. Contrast-enhanced CT scan shows diffuse bowel wall thickening in the jejunum (arrows) and a hypoattenuating thrombus in the SMV (arrowhead). (b) Follow-up CT scan obtained 5 weeks later shows that the thickened bowel （a） （b） Hypoperfusion results in increased bowel permeability to macromolecules and albumin, which leads to diffuse bowel wall thickening Shock bowel in a 26-year-old woman after cesarean section. Contrast-enhanced CT scan shows diffuse bowel wall thickening in the ileum (arrows) with a large intraperitoneal fluid collection due to hemoperitoneum. increased enhancement on CT scans due to slowed perfusion and interstitial leakage of molecules of contrast material, and accumulation of intraluminal fluid secondary to the failed resorption capacity Systemic lupus eryt