Intestinal obstruction肠梗阻.ppt

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1、IntestinalObstuctionHua-danXue2008-11-30Ileus(intestinalobstruction)MechanicalintestinalobstructionSimpleobstruction：occlusion/constrictionofbowellumenStrangulatedobstruction：impairedbloodsupplyofobstructedsegmentIleus(adynamic/non-obstructive)Paralytic&spasmDerangem

2、entimpairingproperdistalpropulsionofintestinalcontentsCautionstobariumexamduetothepossibilityofobstructionaggravatingClassification-locationGastricoutletobstruction:Onlyone/twoair-fluidlevelsHomogeneousmassdisplacingtransversecolonDuodenalobstruction:Double-bubblesig

3、n;FrequentlynormalduetoabsenceofgasfromvomitingClassification-locationJejunalandilealobstruction:Candycane:>3loops+>3cmgas-fluidlevels+>3~5hoursonsetDisparityinsizebetweenobstructedandnormalloopsLittle/nogas+stoolincolonwithcompletemechanicalobstructionafter12-24hour

4、sStepladderappearance;string-of-bead;Cave:fluid-distendedloopsmayleadonetooverlookobstruction!!!MechanicalobstructionClassification-locationColonicobstructionDilatedcolononlyDilatedsmallbowel(incompetentileo-cecalvalve)Gas-fluidlevelsdistaltohepaticflexure(fluidisnor

5、malincecumandascendingcolon)Cecummostdilatedportion(>10cmwillbecritical)Classification–locationLocalizedileusCauses:oftenassociatedwithadjacentacuteinflammatoryprocess(acutepancreatitis,acuteappendicitis,etc.)Sentinelloop:loopsnearthelocalperitonitisClosed-loopobstru

6、ctionClosed-loopobstructionClosed-loopobstructionFixationofbowelloop:Coffeebeansign:gasfilledloopPseudo-tumor:fluid-filledloopU-shapeddilatedbowelloopIncreasingintra-luminalfluidBeaksign:pointofobstructionWhirlsign:twistingofbowelClosed-loopobstructionLargevolvulusBe

7、aksignClassification-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StrangulatedobstructionTriad:closed-loopobstructionoftheinvolvedsegment(majorityofcases)Mechanicalobstructionpro

8、ximaltotheinvolvedsegmentVenouscongestionoftheinvolvedloopAbdominalplainfilm:signsforvolvulus（肠扭转）orclosed-loopobstruction+bowelthi