腹内疝的临床与CT表现(附8例分析)

Clinical and CT Manifestations of Internal Hernia(Report of 8 Cases)

目的:探讨腹内疝的临床特点和CT表现。方法:回顾性分析经手术证实的8例腹内疝患者的临床特点和CT表现。结果:8例中十二指肠旁疝3例,2例术前诊断正确,1例误诊为肠扭转;5例经肠系膜疝中4例有腹部手术史。8例患者的CT表现中共同征象包括肠梗阻,小肠异常聚集,肠系膜血管异位、伸拉、聚集或扩张。其他肠管移位。左侧十二指肠旁疝表现为胃和胰尾间或胰尾后方囊袋状异常排列的肠管;右侧十二指肠旁疝表现为十二指肠圈部位囊袋状肠管伴肠系膜血管紊乱;经肠系膜疝表现为小肠异常排列,无大网膜脂肪覆盖,结肠中心性移位,常伴小肠梗阻或肠绞窄。5例经肠系膜疝的CT征象均能明确或高度提示内疝。结论:腹内疝的CT表现有一定特征性,CT可对大多数病例作出明确诊断。

Objective：To study the clinical and CT manifestations of internal hernia. Methods：The clinical and CT findings of 8 patients with surgery proved internal hernia were retrospectively reviewed. Results： Of the 8 patients, there were 3 patients with paraduodenal hernia （accurate diagnosis was obtained before surgery in 2 patients and one was misdiagnosed as intestinal volvulus） and 5 patients with transmesenteric hernia （4 patients had history of previous abdominal surgery）. The CT findings in common were small bowel obstruction, abnormal arrangement of small bowel, stretch, displacement,assembling and dilation of mesenteric vessels;displacement of other bowel segments. Sac-like dilation with disarrayed bowel located between stomach and pancreas or behind pancreatic tail could be revealed in left-side paraduodenal hernia, whereas dilated bowel located at the position of duodenal loop accompanied with disordered mesentery vessels could be revealed in right-side paraduodenal hernia. Small bowel disarrangement and lack of overlying omental fat, central displacement of colon could be seen in transmesenteric hernia and frequently complicated by small bowel obstruction or strangulation. Conclusion：Characteristic CT findings could be assessed in internal hernia, which was helpful in making a correct diagnosis in most of the patients.