Schernthaner R E, Loewe C
Klinische Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Radiologe. 2019 Feb;59(2):133-138. doi: 10.1007/s00117-018-0489-y.
Vascular abnormalities are a rare cause of an acute abdomen. They include arterial bleeding and ischemia, the latter being either in the arterial or venous system. The most common cause of an acute ischemic abdomen is acute mesenteric ischemia caused by a thromboembolic occlusion of the superior mesenteric artery, followed by thrombotic occlusion of the portal vein, the mesenteric vein as well as the hepatic veins and the suprahepatic part of the inferior vena cava. In the case of an acute abdomen due to internal bleeding, all abdominal arteries can be the source but most common are ruptures of aortic aneurysms and inflammatory-driven bleeding from the superior mesenteric artery.
Due to the high mortality, vascular causes should be diagnosed as soon as possible. For this purpose, computed tomography (CT) has evolved into the preferred tool due to its high availability and speed. To differentiate various vascular causes of an acute abdomen, it is important to incorporate a CT protocol without contrast media as well as contrast-enhanced series in arterial and venous phases. Conventional angiography has been replaced by CT for the diagnosis of vascular pathologies causing an acute abdomen; however, it plays an increasing role in the treatment of these pathologies.
血管异常是急腹症的罕见病因。它们包括动脉出血和缺血，后者可发生在动脉或静脉系统。急性缺血性急腹症最常见的病因是肠系膜上动脉血栓栓塞性闭塞引起的急性肠系膜缺血，其次是门静脉、肠系膜静脉以及肝静脉和下腔静脉肝上段的血栓形成性闭塞。对于因内出血导致的急腹症，所有腹部动脉都可能是出血源，但最常见的是主动脉瘤破裂和肠系膜上动脉炎症性出血。
由于死亡率高，应尽快诊断血管病因。为此，计算机断层扫描（CT）因其高可用性和速度已成为首选工具。为了区分急腹症的各种血管病因，纳入无对比剂的CT方案以及动脉期和静脉期的对比增强系列很重要。传统血管造影已被CT取代用于诊断引起急腹症的血管病变；然而，它在这些病变的治疗中发挥着越来越重要的作用。
