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ID:19834135
大小:12.23 MB
页数:31页
时间:2018-10-06
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1、IntestinalObstuctionHua-danXue2008-11-30Ileus(intestinalobstruction)MechanicalintestinalobstructionSimpleobstruction:occlusion/constrictionofbowellumenStrangulatedobstruction:impairedbloodsupplyofobstructedsegmentIleus(adynamic/non-obstructive)Paralytic&spasmDerangementimpairingproperdistalpropul
2、sionofintestinalcontentsCautionstobariumexamduetothepossibilityofobstructionaggravatingClassification-locationGastricoutletobstruction:Onlyone/twoair-fluidlevelsHomogeneousmassdisplacingtransversecolonDuodenalobstruction:Double-bubblesign;FrequentlynormalduetoabsenceofgasfromvomitingClassificatio
3、n-locationJejunalandilealobstruction:Candycane:>3loops+>3cmgas-fluidlevels+>3~5hoursonsetDisparityinsizebetweenobstructedandnormalloopsLittle/nogas+stoolincolonwithcompletemechanicalobstructionafter12-24hoursStepladderappearance;string-of-bead;Cave:fluid-distendedloopsmayleadonetooverlookobstruct
4、ion!!!MechanicalobstructionClassification-locationColonicobstructionDilatedcolononlyDilatedsmallbowel(incompetentileo-cecalvalve)Gas-fluidlevelsdistaltohepaticflexure(fluidisnormalincecumandascendingcolon)Cecummostdilatedportion(>10cmwillbecritical)Classification–locationLocalizedileusCauses:ofte
5、nassociatedwithadjacentacuteinflammatoryprocess(acutepancreatitis,acuteappendicitis,etc.)Sentinelloop:loopsnearthelocalperitonitisClosed-loopobstructionClosed-loopobstructionClosed-loopobstructionFixationofbowelloop:Coffeebeansign:gasfilledloopPseudo-tumor:fluid-filledloopU-shapeddilatedbowelloop
6、Increasingintra-luminalfluidBeaksign:pointofobstructionWhirlsign:twistingofbowelClosed-loopobstructionLargevolvulusBeaksignClassification-etiology机械性肠梗阻单纯性肠梗阻:肠管通畅性障碍绞窄性肠梗阻:肠管通畅性障碍伴有血运障碍动力性肠梗阻麻痹性肠梗阻:痉挛性肠梗阻: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单纯性肠梗阻阶梯状气液平大跨度肠袢鱼肋征绞窄性肠梗阻StrangulatedobstructionTr
7、iad:closed-loopobstructionoftheinvolvedsegment(majorityofcases)MechanicalobstructionproximaltotheinvolvedsegmentVenouscongestionoftheinvolvedloopAbdominalplainfilm:signsforvolvulus(肠扭转)orclosed-loopobstruction+bowelthi
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