十二指肠损伤 ppt课件.ppt

消化内镜胃窦及胰头活检术后 Axial CT images in patient with perforation of the second portion of the duodenum 1 day after gastroduodenoscopy with endoscopic pancreatic fine-needle aspiration biopsy and gastric biopsy. (a) Unenhanced CT image shows air in anterior pararenal space (white arrow) and right perirenal space (black arrow). (b) A more caudal image shows a focus of discontinuity (short black arrow) in the wall of the second portion of the duodenum, with extraluminal extravasation of oral contrast material (long black arrow). Air is also demonstrated in the right posterior pararenal space (long white arrow), right properitoneal compartment (short white arrow), and peritoneal cavity (arrowhead). (c) Contrast-enhanced CT image obtained 2 years later shows the right anterior renal fascia (white arrow) to extend to the second portion of the duodenum (arrowhead). The cystic lesion in the pancreatic head is an intraductal papillary mucinous neoplasm (black arrow). 消化内镜胰头活检术后 Contrast-enhanced axial CT images in patient with perforation of the second portion of the duodenum after endoscopic pancreatic fine-needle aspiration biopsy 1 week earlier. The amount of air in the right perirenal space exceeds that in the right anterior pararenal space. 内镜检查后 Duodenal perforation after endoscopy in a 51-year-old man. CT scan shows a thick-walled, contracted duodenum with air in the adjacent retroperitoneum (arrow). 鉴别诊断 腹膜间位器官破裂，如升﹑降结肠破裂。 腹膜内位器官破裂，特别是注意Morrison窝积气与腹膜后间隙积气的鉴别，右肝上间隙与肝裸区积气的鉴别。 膀胱破裂。 腹后壁穿通伤。 空肠破裂 ?Jejunal perforation in a 66-year-old woman after a motor vehicle accident. Axial CT image shows hypervascular thickened jejunum with a suspicious defect (curved arrow) and with focal fluid, fat stranding, and extraluminal air (straight arrow) adjacent to jejunal loops. The patient later underwent resection of a 20-cm segment of the small bowel. No mesenteric injury was found at surgery. 十二指肠溃疡穿孔 Abdominal pain and a perforated duodenal ulcer in a 79-year-old man. CT scan obtaine