omental adhesion syndrome
Introduction
Introduction to omental adhesion syndrome Omentaladhesionsyndrome refers to abdominal infection, traumatic and postoperative healing, fibrous contracture of the omental tissue adhering to the peritoneum, incision or pelvic cavity of the lower abdomen, acute abdominal pain caused by pulling the transverse colon, bloating , constipation and other syndromes, also known as "postoperative pancreatic colon dysfunction". The intrinsic was first reported by Howitz (1888) and later described in detail by McCann (1941). Domestic Cao Shengyu (1954), Wang Hongxu (1965) and Sun Delin (1965) conducted a discussion on the diagnosis and treatment of the intrinsic, but for nearly 30 years. To report less. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific people Mode of infection: non-infectious Complications: nausea and vomiting
Cause
Causes of omental adhesion syndrome
(1) Causes of the disease
The occurrence of this disease is closely related to the infection of the lower abdominal cavity and surgery.
The lower edge of the omentum is apron-like, completely free, and highly active. In addition, the omentum also has many physiological functions such as exudation, absorption and repair, and there are inflammatory lesions in the lower abdomen, surgical and traumatic wounds (especially It is a appendectomy and uterine attachment surgery. The omentum quickly moves and approaches the lesion and the damaged peritoneum and surgical site (including the abdominal wall suture incision and visceral suture in the surgical field), the purpose of which is to limit the spread of inflammation. It promotes the absorption of exudation, strengthens the repair and healing ability of peritoneal and visceral surgical wounds, but this process sometimes has a negative impact on some patients. All kinds of lesions and wounds are wrapped by the omentum and afterwards, due to Excessive formation of fibrous tissue, followed by scar contracture, eventually moved the transverse colon to varying degrees.
(two) pathogenesis
According to the clinical data, the degree of shortening of the omentum due to adhesion can reach 15% to 20% of the original length, so the tension of the omentum is obviously increased, and the result forces the transverse colon to shift downward to different degrees, and the intestine is elongated or The angle of angulation seriously affects the smoothness of the intestine and even obstruction. According to Zheng Fumin and other opinions, the degree of downward displacement of the transverse colon can be divided into 3 degrees.
1. Mild: only a small part of the omentum adheres, contracture, the effect on the transverse colon traction is not obvious, only when the trunk overextension occurs.
2. Moderate: The extent of adhesion of the greater omentum is wider, the contracture is more obvious, the transverse colon is in a state of mild downward movement, and abdominal symptoms often occur.
3. Severe: Because the omentum is obviously contracted, the transverse colon is pulled into the lower abdomen, or the intestine is acutely angulated, or completely occluded, and the clinical symptoms are serious.
Prevention
Omental adhesion syndrome prevention
To prevent the occurrence of this disease, we should pay attention to the following problems during and after surgery:
1. Avoid the use of the omentum to fix the stump at the end of the appendix, so as not to increase the chance of adhesion.
2. If the omentum of blood supply is found to be inoperative, it should be removed to avoid adhesion to the lower abdominal wall due to inflammation in the future.
Complication
Complications of omental adhesion syndrome Complications, nausea and vomiting
The most characteristic manifestation is the symptoms of peritoneal traction. The patient does not dare to straighten his torso. He often bends and walks. It is especially obvious after a full meal. There may be symptoms of gastrointestinal dysfunction such as loss of appetite, nausea, vomiting after meal and abdominal distension. In addition, some patients may have symptoms of partial obstruction of the transverse colon, such as constipation and paroxysmal abdominal pain, and the abdominal pain may be relieved when the position is changed and the side of the curl is lying. In the examination of the body, the equivalent of adhesions can be tender and tender, mostly in the lower right abdomen.
Symptom
Omental adhesion syndrome symptoms common symptoms constipation, abdominal muscle tension, intractable constipation, abdominal pain, bloating, nausea
Most patients have a history of lower abdominal surgery in the near future, especially appendectomy and uterine attachment surgery. The incidence usually starts from 2 weeks after surgery, but individual patients may have symptoms only several years after surgery. Factors exist, such as full meals, frequent physical activity, and so on.
1. Symptoms: Abdominal pain is a common complaint. Abdominal pain occurs more than half an hour after a meal. It is mainly in the middle and upper abdomen and is a paroxysmal pain. It lasts for several minutes to ten minutes, and individual patients can More severe persistent colic, paroxysmal aggravation, severe condition, light, when taking the lateral position, the abdominal symptoms can be significantly relieved, or even disappear, accompanied by symptoms of abdominal pain, nausea, vomiting, abdominal distension and anorexia Etc., most patients have constipation, bowel movements once / 3 to 5 days, individual patients can seek medical treatment for intractable constipation, these are the performance of transverse colonic emptying disorders.
2. Signs: abdominal incision scar area and mid-upper abdomen mild tenderness, sometimes can touch the over-expanded transverse colon, abdominal muscle tension and rebound tenderness is not obvious, some patients may have a typical abdominal wall traction sign positive, the inspection method:
(1) Torso overextension test: The patient is placed on the examination bed on the side of the examination bed, and the torso is stretched backwards as far as possible (ie, the chest and lower limbs are stretched and the waist is pushed forward), or the posture is completed with the help of a doctor. There was a positive in the surgical incision area or mid-abdominal pain.
(2) Incision pull-down test: The patient took the supine position, and the examiner pressed the upper part of the incision with a hand and pulled it downward with force, and the abdominal pain was positive.
The above examination method is to force the adhesion, the contracted omentum, and increase the degree of the lateral colon down, causing symptoms.
Examine
Examination of omental adhesion syndrome
The focus is on understanding the state in which the transverse colon is pulled.
1. Barium enema angiography has 5 image features:
(1) The right colon is widened, angled, and fixed.
(2) The transverse colon shows limitations and segmental paralysis.
(3) Transverse colonic motility is enhanced.
(4) The expectorant is blocked in the transverse colon and the emptying time is prolonged.
(5) The transverse colon is obviously drooping.
2. Fibrous colonoscopy: Enteroscopy through the transverse colon is more difficult, or shows a localized stenosis, but the intestinal mucosa is normal.
3. Laparoscopy: The extent and extent of adhesion collapse of the omentum and the lower abdomen or incision can be observed.
Diagnosis
Diagnosis and diagnosis of omental adhesion syndrome
diagnosis
1. History: The patient has a history of lower abdominal surgery, a history of infection in the lower abdomen, or intractable constipation.
2. Clinical features: paroxysmal pain in the middle and upper abdomen after meals with nausea and vomiting; relief of lateral flexion in the flexion; signs: mild tenderness in the scar area of the abdominal incision, positive traction in the abdominal wall.
3. Auxiliary examination: X sputum enema can be seen in the right colon colon cavity widened, angled, fixed; transverse colon locality, segmental sputum; sputum transverse colon obstruction, extended emptying time; transverse colon sag significantly.
Differential diagnosis
Generally not confused with other diseases.
