腹内疝的影像诊断（三）
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Figure 14. Pericecal hernia through the paracolic sulci in an 86-year-old man with a 10-day history of lower abdominal pain and vomiting. He underwent an appendectomy at 56 years of age. (a) Contrast-enhanced CT scan of the lower abdomen shows dilated small bowel loops (S) and a cluster of fluid-filled small bowel loops (arrow). The ascending colon (A) is displaced anteriorly, and ascites (arrowhead) is seen in the right paracolic gutter. (b) CT scan of the pelvis shows that the bowel loops of the oral aspect of the intestine are dilated (arrowhead) and the bowel loops of the anal aspect are collapsed (arrow). Laparotomy was performed 6 hours after CT. (c) Diagram (coronal view) of the surgical findings shows that approximately 20 cm of strangulated ileum (I), located 130 cm from the ileocecal valve, was herniated through a 5-cm-diameter defect of the paracolic sulci (arrow); 10 cm of the incarcerated ileum was resected due to gangrenous changes. A = ascending colon.
图14一86岁男性患者的经结肠旁沟的盲肠旁疝，表现为持续10天的下腹疼痛和呕吐。其56岁时曾进行过阑尾切除术。（a）下腹部的增强造影CT扫描显示小肠（S）扩张积液并堆积（长箭头），升结肠（A）向前移位，在右侧结肠旁沟内可见腹水（短箭头）。（b）盆腔CT扫描显示近端肠管扩张（短箭头），远端肠管塌陷（长箭头）。CT扫描6小时后行剖腹术。(c)手术所见的示意图（冠状面）显示距回盲瓣30cm的回肠（I）有约20cm经结肠旁沟上5cm的缺口（长箭头）疝出发生绞窄，有10cm的绞窄回肠因发生坏疽被手术切除。
Sigmoid Mesocolon Hernia
乙状结肠系膜疝
Anatomy
解剖
The sigmoid mesocolon is a peritoneal fold attaching the sigmoid colon to the pelvic wall. The apex is divided near the left common iliac artery and serves as a potential site for an internal hernia. The intersigmoid fossa (Fig 1, G) lies behind this apex of the V-shaped parietal attachment of the sigmoid mesocolon. This pocket is found in 65% of autopsies and varies in size from a dimple to a fossa admitting the fifth finger (1,3,22).
乙状结肠系膜是固定乙状结肠到骨盆壁的腹膜皱襞，其尖端在接近左侧髂总动脉处分叉，成为潜在的腹内疝的部位。乙状结肠间隐窝（图1，G）就位于乙状结肠系膜与壁附着的V形尖端的后面，尸检中65%的可以发现这种隐窝存在，其大小从小的浅窝到可容五指的隐窝不等。
Features
特征
Sigmoid mesocolon hernias account for 6% of all internal hernias (1–3) and are divided into three categories (45): (a) intersigmoid hernia, (b) trans mesosigmoid hernia, and (c) intermesosigmoid hernia. Because preoperative differentiation of the three hernia types involving the sigmoid mesocolon is often difficult, the diagnosis is confirmed only with surgical management in most cases. Intersigmoid hernia, which is the most common type, is herniation into a congenital fossa, the intersigmoid fossa, situated in the attachment of the lateral aspect of the sigmoid mesocolon. Transmesosigmoid hernia is incarceration of small bowel loops through a defect in the sigmoid mesocolon. This defect is oval and ranges in diameter from 2 to 4 cm (1,3,45,46). Transmesosigmoid hernia involves both layers of the sigmoid mesentery and allows herniation of the small bowel loops toward the left lower abdomen, posterior-lateral to the sigmoid colon. This hernia is demonstrated to be without an actual hernial sac (47,48). Intramesosigmoid hernia is incarceration with a hernial sac through a congenital defect, present in only one of the constituent leaves of the sigmoid mesentery (Fig 15) (45).
乙状结肠系膜疝占所有腹内疝的6%，可以分为3类：（a）乙状结肠间疝；（b）经乙状结肠系膜疝和（c）乙状结肠系膜间疝。由于术前鉴别这三种累及乙状结肠系膜的疝常常很困难，因此在绝大多数的病例中只有通过手术才能确诊。乙状结肠间疝是最常见的类型，是指疝入位于乙状结肠系膜侧方的先天性隐窝—乙状结肠间隐窝。经乙状结肠系膜疝是指经乙状结肠系膜上的缺损的小肠的嵌顿，这种缺损呈口状，直径2-4cm。经乙状结肠系膜疝穿过两层乙状结肠系膜，小肠肠管向左下腹乙状结肠侧后方疝出，这种疝被认为没有急性的疝囊。乙状结肠系膜间疝是指经乙状结肠系膜仅仅只有一个叶，疝囊经过这个先天性的缺损导致的疝。
Figure 15. Intramesosigmoid hernia in a 79-year-old man with acute lower abdominal pain of 3 hours duration. CT was performed 4 days after conservative treatment with a nasogastric tube. (a, b) Contrast-enhanced CT scans of the pelvis (b obtained 20 mm below a) show multiple dilated small bowel loops (S). A dilated inferior mesenteric vein (arrow) appears as a landmark at the edge of the inferior mesentery. A saclike mass of incarcerated jejunal loops (arrowhead) is located anterior to the left psoas muscle. Laparotomy was performed 4 days after CT. (c) Diagram (coronal view) of the surgical findings shows that 20 cm of jejunum (J), located 230 cm from the ligament of Treitz, was herniated into a defect (arrow) on the left side of the sigmoid mesocolon. The defect was 3 cm in diameter and was located in the anterior layer of the left side of the sigmoid mesocolon.
图15 一79岁男性患者的乙状结肠系膜间疝，表现为急性的下腹部疼痛3小时。经鼻胃管保守治疗4天后的CT扫描。（a，b）盆腔增强造影CT显示小肠肠管多处扩张（S）。作为肠系膜下缘标志的肠系膜下静脉扩张（长箭头）。空肠肠管嵌顿的囊性团块位于左侧腰大肌的前侧。CT扫描4天后行剖腹术。（c）手术表现的示意图（冠状面）显示距Treitz韧带230cm的空肠（J）有约20cm经乙状结肠系膜左侧的缺损（箭头）疝出。缺损直径3cm，位于乙状结肠系膜左侧的前层。
编辑：bluelove
图14一86岁男性患者的经结肠旁沟的盲肠旁疝，表现为持续10天的下腹疼痛和呕吐。其56岁时曾进行过阑尾切除术。（a）下腹部的增强造影CT扫描显示小肠（S）扩张积液并堆积（长箭头），升结肠（A）向前移位，在右侧结肠旁沟内可见腹水（短箭头）。（b）盆腔CT扫描显示近端肠管扩张（短箭头），远端肠管塌陷（长箭头）。CT扫描6小时后行剖腹术。(c)手术所见的示意图（冠状面）显示距回盲瓣30cm的回肠（I）有约20cm经结肠旁沟上5cm的缺口（长箭头）疝出发生绞窄，有10cm的绞窄回肠因发生坏疽被手术切除。
乙状结肠系膜疝
Anatomy
解剖
The sigmoid mesocolon is a peritoneal fold attaching the sigmoid colon to the pelvic wall. The apex is divided near the left common iliac artery and serves as a potential site for an internal hernia. The intersigmoid fossa (Fig 1, G) lies behind this apex of the V-shaped parietal attachment of the sigmoid mesocolon. This pocket is found in 65% of autopsies and varies in size from a dimple to a fossa admitting the fifth finger (1,3,22).
乙状结肠系膜是固定乙状结肠到骨盆壁的腹膜皱襞，其尖端在接近左侧髂总动脉处分叉，成为潜在的腹内疝的部位。乙状结肠间隐窝（图1，G）就位于乙状结肠系膜与壁附着的V形尖端的后面，尸检中65%的可以发现这种隐窝存在，其大小从小的浅窝到可容五指的隐窝不等。
Features
特征
Sigmoid mesocolon hernias account for 6% of all internal hernias (1–3) and are divided into three categories (45): (a) intersigmoid hernia, (b) trans mesosigmoid hernia, and (c) intermesosigmoid hernia. Because preoperative differentiation of the three hernia types involving the sigmoid mesocolon is often difficult, the diagnosis is confirmed only with surgical management in most cases. Intersigmoid hernia, which is the most common type, is herniation into a congenital fossa, the intersigmoid fossa, situated in the attachment of the lateral aspect of the sigmoid mesocolon. Transmesosigmoid hernia is incarceration of small bowel loops through a defect in the sigmoid mesocolon. This defect is oval and ranges in diameter from 2 to 4 cm (1,3,45,46). Transmesosigmoid hernia involves both layers of the sigmoid mesentery and allows herniation of the small bowel loops toward the left lower abdomen, posterior-lateral to the sigmoid colon. This hernia is demonstrated to be without an actual hernial sac (47,48). Intramesosigmoid hernia is incarceration with a hernial sac through a congenital defect, present in only one of the constituent leaves of the sigmoid mesentery (Fig 15) (45).
乙状结肠系膜疝占所有腹内疝的6%，可以分为3类：（a）乙状结肠间疝；（b）经乙状结肠系膜疝和（c）乙状结肠系膜间疝。由于术前鉴别这三种累及乙状结肠系膜的疝常常很困难，因此在绝大多数的病例中只有通过手术才能确诊。乙状结肠间疝是最常见的类型，是指疝入位于乙状结肠系膜侧方的先天性隐窝—乙状结肠间隐窝。经乙状结肠系膜疝是指经乙状结肠系膜上的缺损的小肠的嵌顿，这种缺损呈口状，直径2-4cm。经乙状结肠系膜疝穿过两层乙状结肠系膜，小肠肠管向左下腹乙状结肠侧后方疝出，这种疝被认为没有急性的疝囊。乙状结肠系膜间疝是指经乙状结肠系膜仅仅只有一个叶，疝囊经过这个先天性的缺损导致的疝。
Figure 15. Intramesosigmoid hernia in a 79-year-old man with acute lower abdominal pain of 3 hours duration. CT was performed 4 days after conservative treatment with a nasogastric tube. (a, b) Contrast-enhanced CT scans of the pelvis (b obtained 20 mm below a) show multiple dilated small bowel loops (S). A dilated inferior mesenteric vein (arrow) appears as a landmark at the edge of the inferior mesentery. A saclike mass of incarcerated jejunal loops (arrowhead) is located anterior to the left psoas muscle. Laparotomy was performed 4 days after CT. (c) Diagram (coronal view) of the surgical findings shows that 20 cm of jejunum (J), located 230 cm from the ligament of Treitz, was herniated into a defect (arrow) on the left side of the sigmoid mesocolon. The defect was 3 cm in diameter and was located in the anterior layer of the left side of the sigmoid mesocolon.
图15 一79岁男性患者的乙状结肠系膜间疝，表现为急性的下腹部疼痛3小时。经鼻胃管保守治疗4天后的CT扫描。（a，b）盆腔增强造影CT显示小肠肠管多处扩张（S）。作为肠系膜下缘标志的肠系膜下静脉扩张（长箭头）。空肠肠管嵌顿的囊性团块位于左侧腰大肌的前侧。CT扫描4天后行剖腹术。（c）手术表现的示意图（冠状面）显示距Treitz韧带230cm的空肠（J）有约20cm经乙状结肠系膜左侧的缺损（箭头）疝出。缺损直径3cm，位于乙状结肠系膜左侧的前层。
编辑：bluelove
作者: 丁香园集体创作
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