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胃肠扭转（GIT volvulus）

2017/10/3 9:21:07 人评论 次浏览 来源：医学影像学英语 分类：新闻

Giza, Egypt, Egypt

Radiologist

Volvulus

  1. 1. GIT volvulus Dr/ Hytham Nafady

  2. 2. Volvulus ? Twist of the bowel around its own mesentery.

  3. 3. Volvulus (twist of the bowel around its own mesentery) Closed loop obstruction (obstruction of the bowel at 2 points in 1 location) Strangulation (obstruction of the bowel with interruption of its blood supply)

  4. 4. Closed loop obstruction

  5. 5. Volvulus Gastric volvulus Organo-axial Mesentero- axial Midgut volvulus Colonic volvulus Sigmoid Organo- axial Mesentero- axial Cecal Axial Bascule

  6. 6. Colonic volvulus

  7. 7. Causes of closed loop obstruction Closed loop obstruction Small bowel Hernia Adhesions Volvulus Large bowel Volvulus

  8. 8. Etiology

  9. 9. Etiology Gastric volvulus Midgut volvulus Sigmoid volvulus Cecal volvulus 1ry: Congenital weakness of suspensory ligaments. 2ry: Diaphragmatic hernia. Diaphragmatic eventration Malrotation (short mesenteric attachment). Congenital short mesentery. Chronic constipation. Colonic distention. Congenital defect in the peritoneal fixation of the right colon. Congenital long mesentery. Congenital malrotation. Chronic constipation. Colonic distension.

  10. 10. Gastric volvulus 1ry Congenital weakness of the suspensory ligaments Gastro- splenic Gastro- colic Gastro- hepatic Gastro- phrenic 2ry Diaphragmatic hernia Diaphragmatic eventration Gastric volvulus

  11. 11. GS GS GC GH GH Suspensory ligaments

  12. 12. Midgut volvulus Malrotation Colon Volvulus Malrotation

  13. 13. Types

  14. 14. Types of gastric volvulus Organo-axial Mesentro-axial Rotation around a line extending from the gastric cardia to the pylorus Rotation around an axis extending from the greater to the lesser curvatures

  15. 15. Types of sigmoid volvulus 180 degree of rotation 360 degree of rotation 540 degree of rotation Most common Mesenterico axial Organo-axial Twist around mesenteric axis Twist around longitudinal axis Closed loop obstruction No closed loop obstruction (one transition point)

  16. 16. Types of cecal volvulus Type I cecal bascule Type II Axial cecal volvulus Folding of the cecum anterior to the ascending colon Rotation of the distended cecum around the longitudinal axis of the ascending colon.

  17. 17. C.P

  18. 18. Age of presentation Gastric volvulus Midgut volvulus Sigmoid volvulus Cecal volvulus Pediatrics & adults Infants Old age (60-70) Old age (but younger than sigmoid volvulus).

  19. 19. C.P Gastric volvulus Midgut volvulus Sigmoid volvulus Cecal volvulus Acute volvulus: Borchardt triad: 1. Sever epigastric pain. 2. Violent retching without vomiting. 3. Difficulty in advancing in nasogastric tube. Chronic volvulus: Vague non specific symptoms. ?Neonatal intestinal obstruction. ?Bilious vomiting. ?Abdominal distension. ?Acute intestinal obstruction. ?Acute intestinal obstruction.

  20. 20. Plain radiography

  21. 21. Volvulus Gastric volvulus Intrathoracic stomach with air fluid level Midgut volvulus Double bubble sign Colonic volvulus Sigmoid Coffe bean sign Cecal Marked cecal distension

  22. 22. Gastric volvulus ? Intra-thoracic stomach with double air fluid level.

  23. 23. Gastric volvulus ? Intrathoracic stomach with double air fluid level.

  24. 24. Midgut volvulus ? Double bubble sign.

  25. 25. Sigmoid volvulus coffe bean sign

  26. 26. Sigmoid volvulus coffe bean sign

  27. 27. Northern exposure sign

  28. 28. Northern exposure sign

  29. 29. Cecal volvulus

  30. 30. Cecal volvulus SMA SMV Beak sign

  31. 31. Sigmoid volvulus Cecal volvulus sigmoid volvulus can only move upwards and usually goes to the right upper quadrant. Cecal volvulus however can go almost anywhere and can even be located in the pelvis. Sigmoid volvulus Vs cecal volvulus 1 A volvulus always extends away from the area of bowel twist.

  32. 32. Sigmoid volvulus Cecal volvulus Associated with large bowel dilatation. Associated with small bowel dilatation. Sigmoid volvulus Vs cecal volvulus 2

  33. 33. Barium

  34. 34. Volvulus Gastric volvulus Organo-axial Greater curvature above lesser curvature Mesentero-axial Gastric antrum above gastric fundus Midgut volvulus Cork scerw duodenum Colonic volvulus Sigmoid Beak sign Cecal Beak sign

  35. 35. Organo-axial gastric volvulus

  36. 36. Mesentero-axial gastric volvulus

  37. 37. Mesentero-axial gastric volvulus

  38. 38. Mesentero-axial gastric volvulus

  39. 39. Mesentero-axial gastric volvulus

  40. 40. Midgut volvulus ? Cork screw duodenum & proximal jejunum.

  41. 41. Midgut volvulus ? Cork screw duodenum & proximal jejunum. D S R

  42. 42. Sigmoid volvulus bird beak sign R S

  43. 43. Cecal volvulus bird beak sign R A D

  44. 44. CT

  45. 45. Volvulus Gastric volvulus Organo-axial Greater curvature above lesser curvature Mesentero-axial Gastric antrum above gastric fundus Midgut volvulus Malrotation (SMV to the left of SMA) Whirl sign Colonic volvulus Sigmoid Whirl sign Cecal Whirl sign

  46. 46. Organo-axial gastric volvulus

  47. 47. Organo-axial gastric volvulus

  48. 48. Organo-axial gastric volvulus

  49. 49. Organo-axial gastric volvulus

  50. 50. Organo-axial gastric volvulus

  51. 51. Organo-axial gastric volvulus

  52. 52. Organo-axial gastric volvulus

  53. 53. Organo-axial gastric volvulus

  54. 54. Organo-axial gastric volvulus

  55. 55. Organo-axial gastric volvulus

  56. 56. Organo-axial gastric volvulus

  57. 57. Organo-axial gastric volvulus

  58. 58. Organo-axial gastric volvulus Diaphragmatic hernia

  59. 59. Mesentero-axial gastric volvulus

  60. 60. Mesentero-axial gastric volvulus

  61. 61. Mesentero-axial gastric volvulus

  62. 62. Mesentero-axial gastric volvulus

  63. 63. Mesentero-axial gastric volvulus

  64. 64. Mesentero-axial gastric volvulus

  65. 65. Mesentero-axial gastric volvulus

  66. 66. Mesentero-axial gastric volvulus

  67. 67. Mesentero-axial gastric volvulus

  68. 68. Mesentero-axial gastric volvulus

  69. 69. PD Mesentero-axial gastric volvulus

  70. 70. Mesentero-axial gastric volvulus

  71. 71. Mesentero-axial gastric volvulus

  72. 72. Mesentero-axial gastric volvulus

  73. 73. EG Mesentero-axial gastric volvulus

  74. 74. Mesentero-axial gastric volvulus

  75. 75. Mesentero-axial gastric volvulus

  76. 76. Mesentero-axial gastric volvulus

  77. 77. Mesentero-axial gastric volvulus

  78. 78. Mesentero-axial gastric volvulus

  79. 79. Mesentero-axial gastric volvulus

  80. 80. Mesentero-axial gastric volvulus

  81. 81. Mesentero-axial gastric volvulus

  82. 82. Mid-gut volvulus (malrotation)

  83. 83. Mid-gut volvulus (malrotation)

  84. 84. Mid-gut volvulus (swirl sign)

  85. 85. Sigmoid volvulus

  86. 86. Sigmoid volvulus

  87. 87. Sigmoid volvulus

  88. 88. Sigmoid volvulus

  89. 89. Sigmoid volvulus

  90. 90. Sigmoid volvulus

  91. 91. Sigmoid volvulus

  92. 92. Sigmoid volvulus

  93. 93. Cecal volvulus

  94. 94. Cecal volvulus

  95. 95. Cecal volvulus

  96. 96. Cecal volvulus

  97. 97. Cecal volvulus

  98. 98. Cecal volvulus

  99. 99. Cecal volvulus

  100. 100. Cecal volvulus

FROM：https://www.slideshare.net/hytham_nafady/volvulus-34007550

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