北京协和医院：《放射诊断学》课程教学资源（PPT课件）急腹症

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

急腹症 ■检查方法及应用范围： ■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

一 急腹症 ◼ 检查方法及应用范围： ◼ 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

Possible causes of intestinal obstuction ■Congenital ■Inflammatory Lesion(extrinsic and intrinsic bowel) ■Trauma

Possible causes of intestinal obstuction ◼ Congenital ◼ Inflammatory ◼ Lesion (extrinsic and intrinsic bowel) ◼ Trauma

Classification Gastric outlet obstruction: only one/two air-fluid levels Homogeneous mass displacing transverse colon Duodenal obstruction: ■double-bubble sign; Frequently normal due to absence of gas from vomiting

Classification ◼ Gastric outlet obstruction: ◼ only one/two air-fluid levels ◼ Homogeneous mass displacing transverse colon ◼ Duodenal obstruction: ◼ double-bubble sign; ◼ Frequently normal due to absence of gas from vomiting

Classification ejunal and ileal obstruction:; Candy cane:>3 loops+>3cm gas-fluid levels+>3~5 hours onset Disparity in size between obstructed and normal loops Little/no gas stool in colon with complete mechanical obstruction after 12-24 hours Stepladder appearance;string-of-bead; Cave:fluid-distended loops may lead one to overlook obstruction!!!

Classification ◼ Jejunal and ileal obstruction: ◼ Candy cane: >3 loops+>3cm gas-fluid levels+>3~5 hours onset ◼ Disparity in size between obstructed and normal loops ◼ Little/no gas + stool in colon with complete mechanical obstruction after 12-24 hours ◼ Stepladder appearance; string-of-bead; Cave: fluid-distended loops may lead one to overlook obstruction!!!

Upright abdominal radiograph shows multiple air-fluid levels. Pneumobilia(arrow)is present, as is string-of pearls sign (arrowheads)

Upright abdominal radiograph shows multiple air–fluid levels. Pneumobilia (arrow) is present, as is string-of pearls sign (arrowheads)

Classification ■Colonic obstruction ■Dilated colon only Dilated small bowel (incompetent ileo-cecal valve) Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum and ascending colon) Cecum most dilated portion (>10cm will be critical)

Classification ◼ Colonic obstruction ◼ Dilated colon only ◼ Dilated small bowel (incompetent ileo-cecal valve) ◼ Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum and ascending colon) ◼ Cecum most dilated portion (>10cm will be critical)