dxy

网友[xihuansushi]：

本文原文来源于J Ultrasound Med 2006; 25:105–110

Sonographic Features of Internal Hernia
腹内疝的超声诊断
Internal hernias are rare, with reported incidence of 0.2% to 0.9% of autopsies. A substantial proportion of these remain asymptomatic. Internal hernia is an uncommon cause of small-bowel obstruction. About 4% of bowel obstructions are due to internal hernia.
Because of the risk of strangulation of the hernia contents, even small internal hernias are dangerous and may be lethal. This necessitates an early and confident diagnosis. The diagnostic features of this condition on barium studies, angiography, and computed tomography (CT) have been described. To my knowledge, there is only 1 report of sonographic features of internal hernia, but diagnostic criteria that would allow more confident sonographic diagnosis have not been evaluated. Four cases of internal hernia are reported here.
腹内疝比较少见，据报道尸检的发病率为0.2%到0.9%，其大部分是没有症状的。腹内疝不常导致小肠梗阻，大约4%的肠梗阻是由于腹内疝导致的。
由于疝囊存在绞窄的危险性，即使是较小的腹内疝也很危险，有可能是致命的，这迫使要早期准确诊断。腹内疝的钡餐、血管造影和CT的诊断特征已有过描述，但就我们所知，仅有1例有关腹内疝的超声报道。腹内疝的诊断标准的确定能使得超声诊断更为明确，但目前还没有出台。这里我们报道了4例腹内疝。

Case Descriptions
病例报道
Case 1
病例1
A 25-year-old man had epigastric pain and vomiting. Because the symptoms did not resolve with conservative treatment, he was referred for sonography. There were multiple dilated small-bowel loops showing active peristalsis suggestive of small-bowel obstruction. A point of transition between the dilated and nondilated bowel was seen close to the midline above the umbilicus, with the dilated bowel on the right side (Figure 1). The bowel did not show any intrinsic abnormality at the site of transition.
一位25岁的男性患者出现心口疼和呕吐，由于经过对症的治疗后症状没能缓解，所以来做超声检查，发现多处的小肠扩张，蠕动亢进，提示小肠梗阻。扩张和非扩张的临界点位于脐上正中，扩张肠管位于右侧（图1）。临界区的肠管没有发现内在的异常。

Figure 1. Oblique scan above the umbilicus showing the zone of transition (arrow) between the dilated and nondilated bowel.
图1 脐上斜向扫描显示在扩张和非扩张肠管间存在过渡区（箭头）。

There was a cluster of collapsed small-bowel loops to the left of this zone of transition (Figure 2). These loops did not show peristalsis and had an appearance of compressed and crowded loops, as if they were tightly packed within a sac.
临界区左侧的部分小肠肠管塌陷（图2），看不到蠕动，表现为肠管的受压和堆积，好像被紧紧地填入一个囊内。
Because of the clinical condition of the patient, no further investigation was done. The patient was subjected to laparoscopy, which revealed a left paraduodenal internal hernia that was repaired appropriately. The patient had an uneventful recovery.
鉴于病人的临床病情，没有再做进一步的检查，而是直接进行了腹腔镜检查，发现一个十二指肠左侧的腹内疝，并予以了适当的修复。病人恢复良好。

Figure 2. Transverse (A) and longitudinal (B) scans to the left of the zone of transition showing the cluster of crowded and compressed loops of bowel as if they are tightly packed within a sac.
图2 过渡区左侧横向（A）和纵向（B）扫描显示肠管堆积成团并受压，好像在疝囊内紧紧的压在一起。