这里我们报道了4例腹内疝的超声表现，其中3例的表现一致，这3例中包括1例十二指肠旁疝和2例盲肠旁疝，所见特征有：（1）小肠梗阻，表现为肠管扩张，蠕动增强；（2）扩张和非扩张肠管间有过渡区；（3）小肠堆积成团并受压，好像是被袋子包裹着一样。这种表现出现在过渡区的远端一侧，位于十二指肠旁疝的左侧和盲肠旁疝的右侧。当进入疝囊的输入端肠管因为疝囊内的肠管堆积受压而导致梗阻时就会出现这种表现。这些特征和CT所描述的相似。第四个病人表现为包含扩张的小肠肠管的疝囊，在疝囊的颈部存在过渡区。这种表现是由于疝囊颈部的输出端肠管梗阻导致疝囊内部的肠管扩张造成的。
The differential diagnosis for the sonographic appearance of internal hernia is an abdominal cocoon. The sonographic features of this condition have been described here previously, and 4 additional patients with an abdominal cocoon were seen after that first report. In all those patients, there was no evidence of small-bowel obstruction or zone of transition. The loops do not appear to be compressed and show normal peristalsis. These features help differentiate between these conditions.
腹内疝的超声表现需要与腹茧症相鉴别，后者的超声特征曾有过描述。在第一例腹茧症的病例被报道后又有4例被发现。在这些所有的病例中均没有发现小肠梗阻或过渡区，肠管也不表现受压，蠕动正常，这有助于区分两者。
In conclusion, there are recognizable features of internal hernia on sonography. When such features are seen, a sonographic diagnosis of internal hernia can be made.
总之，超声可以辨认腹内疝的特征。如果发现这些征象，超声可以做出腹内疝的诊断。
腹内疝的CT诊断
摘要
Computed tomography (CT) plays an important role in diagnosis of acute intestinal obstruction and planning of surgical treatment. Although internal hernias are uncommon, they may be included in the differential diagnosis in cases of intestinal obstruction, especially in the absence of a history of abdominal surgery or trauma. CT findings of internal hernias include evidence of small bowel obstruction (SBO); the most common manifestation of internal hernias is strangulating SBO, which occurs after closed-loop obstruction. Therefore, in patients suspected to have internal hernias, early surgical intervention may be indicated to reduce the high morbidity and mortality rates. In a study of 13 cases of internal hernias, nine different types of internal hernias were found and the surgical and radiologic findings were correlated. The following factors may be helpful in preoperative diagnosis of internal hernias with CT: (a) knowledge of the normal anatomy of the peritoneal cavity and the characteristic anatomic location of each type of internal hernia; (b) observation of a saclike mass or cluster of dilated small bowel loops at an abnormal anatomic location in the presence of SBO; and (c) observation of an engorged, stretched, and displaced mesenteric vascular pedicle and of converging vessels at the hernial orifice.
CT在急性肠梗阻的诊断和手术治疗的准备中具有重要的价值。尽管腹内疝并不常见，但在肠梗阻病例的鉴别诊断中也需要排除这种可能，尤其是对那些没有腹部手术史和创伤史的病例。腹内疝的CT表现包括小肠梗阻（SBO），腹内疝最常见的类型是绞窄性SBO，它发生在肠管的闭合梗阻之后，因此对怀疑腹内疝的病人要进行早期的手术探查，以降低其高发病率和高死亡率。一项对13例腹内疝的研究中发现有9种不同类型的腹内疝，手术中的表现和放射学的表现具有相关性。下列因素有助于CT预测诊断腹内疝：（a）了解腹腔正常的解剖和各型腹内疝的特征解剖部位；（b）在SBO病人的异常解剖部位发现有囊状团块或小肠肠管扩张堆积；（c）观察肠系膜血管蒂的充盈、伸展和移位情况，以及疝孔处的血管会聚情况。
序论
Internal hernias involve protrusion of the viscera through the peritoneum or mesentery and into a compartment in the abdominal cavity. The most common presentation is an acute intestinal obstruction of small bowel loops that develops through normal or abnormal apertures (1,2). The responsible hernial orifices are usually preexisting anatomic structures, such as foramina, recesses, and fossae. Pathologic defects of the mesentery and visceral peritoneum, which are caused by congenital mechanisms, surgery, trauma, inflammation, and circulation, are also potential herniation orifices (3,4).
腹内疝是腹腔内容物经腹膜或肠系膜凸入腹腔裂隙中，最常表现为小肠肠管进入正常或异常孔隙而导致肠梗阻，而疝孔通常是已经存在的解剖结构，比如裂孔、隐窝和陷凹，另外由先天性异常、手术、创伤、感染和循环异常导致肠系膜和脏层腹膜的病理性缺损也是潜在的疝孔。
Preoperative diagnosis is difficult because clinical symptoms may range from intermittent and mild digestive complaints to acute-onset intestinal obstruction. Internal hernias are silent if they are easily reducible, but the majority often cause epigastric discomfort, periumbilical pain, and recurrent episodes of intestinal obstruction (3,5). Internal hernias are clinically apparent only when incarcerated internal hernias result from small bowel obstruction (SBO); therefore, a delay in diagnosis may lead to strangulation and an increased risk of serious complications.
由于腹内疝的临床症状的表现差别很大，可以是间歇性和轻度消化不适，也可以表现为急性发作的肠梗阻，所以术前诊断很困难。腹内疝如果易于复原则可以不表现症状，但绝大多数导致上腹不适、脐周疼痛和反复发作的肠梗阻。腹内疝仅在小肠梗阻（SBO）发展到腹内疝嵌钝才表现出明显的临床症状，因此，延误诊断可导致肠绞窄并增加其他严重并发症的危险性。
We categorized various internal hernias and potential orifices with relative frequency (Table) on the basis of their topographic distribution in the peritoneal cavity (Figs 1, 2) according to the classification of Welch (8).
我们按照Welch分类法对各种腹内疝和潜在疝孔及其发生频率（表）根据其在腹腔内的分布区域（图1，2）进行了分类。
*Pelvic hernias include hernias through the broad ligament, perirectal fossa, and fossa of Douglas.
盆腔疝包括阔韧带疝、直肠旁疝和Douglas窝疝。
The relative frequency of hernia through the broad ligament is 4%–5%.
阔韧带疝的附属频率是4-5%。
Figure 1. Drawing (coronal view) shows the locations and directions of internal hernias of the upper and lower abdominal peritoneal cavity. A = foramen of Winslow hernia, B = left paraduodenal hernia, C = right paraduodenal hernia, D = transmesenteric hernia, E = pericecal hernia, F = transomental hernia, G = intersigmoid hernia. (Adapted and reprinted, with permission, from reference 6.)
图1 示意图（冠状面）显示上腹腔和下腹腔腹内疝的部位和方向。A，Winslow孔疝；B，左侧十二指肠旁疝；C，右侧十二指肠旁疝；D，肠系膜疝；E，盲肠旁疝；F，网膜疝；G，乙状结肠疝。
