不典型腹内疝的多层螺旋CT诊断

Mutiple-slice spiral CT diagnosis of atypical intraabdominal hernia

目的探讨多层螺旋CT检查对不典型腹内疝的诊断价值。方法对手术证实的16例不典型腹内疝的临床及CT资料进行回顾性分析。结果16例患者的疝内容物均为小肠及其系膜结构：继发于腹部手术或腹腔感染后粘连致内疝者9例，肠系膜裂孔疝6例，盆底腹膜裂孑L疝1例。主要CT表现为：（1）梗阻的小肠肠袢异常聚集，成簇状排列（9例）：小肠肠壁增厚、水肿，呈“靶环征”伴周旁间隙渗出（5例）；病变区域以外腹腔出现肠管空虚征象（4例）。（2）肠系膜血管走行异常，包括肠系膜聚集、牵拉、僵直改变，肠系膜血管主干左、右移位（12例）；肠系膜血管增粗（4例）；肠系膜扭转，表现为“旋涡征”（3例）。（3）经CT多平面重组后可显示疝环所在（5例），疝环区可见聚集、拉长僵直、再度扇形放射状走形的肠系膜血管，与成簇状排列的积液扩张多个肠袢相互构成“降落伞征”或“成束气球征”。结论不典型腹内疝的CT表现具有一定的特征性．对临床诊断有重要价值。

Objective To discuss the value of mutiple-slice spiral CT diagnosis of atypical intraabdominal hernia. Methods The clinical and CT findings of 16 cases of atypical intraabdominal hernia confirmed surgically were retrospectively analysed. Results In all the 16 cases, the contents of hernia were small bowels and the mesentery. Nine cases were caused by the adhesion after abdominal operations or infection, 6 by the mesenteric foramen, and 1 by the gap of pelvic peritoneum. The main CT findings were as follows： （1）the obstructed small bowels gathered abnormally and showed cluster shape（9 cases）; the walls of the bowels thickened with edema and showed ＂target＂ sign with exudate in the neighboring spaces （5 cases）; other part of the abdominal cavity became empty for lack of small bowels （4 cases）. （2） Abnormal arrangement of the branches of mesenteric vessel, which appeared gathered or pulled or rigid and displacement of the main branches to left or right （12 cases）. Thickened mesenteric vessel （4 cases）： torsion of mesentery with ＂whirlpool＂ sign （3 cases）. （3） With the help of multiplanar reformation, 5 cases showed the evidence of hernia rings. In the ring area, there were gathered or pulled or rigid and radiating mesenteric vessel and the dilated or effusion bowels in cluster arrangement forming ＂parachute＂ and ＂bundle of balloons＂ sign. Conclusion CT manifestations of atypical intraabdominal hernia has some specific characteristics, which is of important value for clinical diagnosis and treatment.