retroperitoneal fluid oozing disease
Introduction
Brief introduction of liquid infiltration in retroperitoneal cavity Bile, pancreatic juice, duodenal juice, lymph or urine in some pathological conditions after infiltration of the peritoneal cavity called retroperitoneal Extravasation of Fluids (Retroperitoneal Extravasation of Fluids). The disease generally has only mild or insignificant pain, which is different from the significant pain caused by intra-abdominal infection, and the abdominal tenderness and muscle tension are also mild. Often caused by diarrhea or bloating due to peritoneal nerve reflex after stimulation, intestinal obstruction, mental disorder, systemic failure and even shock may also occur. basic knowledge The proportion of illness: 0.0007% Susceptible people: no special people Mode of infection: non-infectious Complications: acute pancreatitis kidney transplantation prostate cancer
Cause
Causes of liquid infiltration in retroperitoneal cavity
1. The cause of the duodenal posterior wall trauma is sudden car breakdown of the driver and the duodenal posterior wall or perforation of the diverticulum.
2. The cause of peritoneal cavity after perfusion of pancreatic juice is surgical injury to pancreas or acute pancreatitis.
3. The cause of peritoneal cavity after bile infiltration is surgical or accidental trauma (open or blunt) to cause biliary tract injury; calculus obstruction causes elevated biliary pressure, causing perforation, and there are also reports of spontaneous rupture of the biliary tract without obvious cause.
4. Lymphatic extravasation is seen in diseases involving the peritoneal lymph nodes and lymphatic vessels or after some operations, such as resection of aortic aneurysm, kidney transplantation, radical resection of uterine cancer, lymphadenectomy for gastric cancer and prostate cancer surgery, retroperitoneal lymphatic infiltration The fluid often selectively interferes with the posterior renal space.
5. When the urinary tract ruptures, the urine (sometimes mixed with blood) infiltrates into the peritoneal space, and the causes of rupture of the renal pelvis and ureter are: penetrating or blunt trauma, surgery, instrument operation and crushing sprain caused by dystocia, etc. Infection or expansion of the renal pelvis greatly increases the sensitivity of rupture caused by external force. The causes of rupture of the kidney or renal pelvis are: kidney tumor, renal tuberculosis, hydronephrosis, stones (compressive necrosis) and lower urinary tract stones or tumors causing urinary tract pressure Raise and so on.
Prevention
Prevention of liquid infiltration in retroperitoneal cavity
The prognosis of this disease should be determined according to the severity of the disease. The cause is complicated and difficult to prevent.
Complication
Complications of retroperitoneal fluid infiltration Complications acute pancreatitis kidney transplantation prostate cancer
Perforation of the posterior wall of the duodenum or diverticulum, surgical injury to the pancreas or acute pancreatitis, biliary tract injury or spontaneous rupture of the biliary tract, aortic aneurysm, kidney transplantation, radical resection of uterine cancer, lymphadenectomy for gastric cancer and prostate cancer.
Symptom
Symptoms of liquid infiltration in the retroperitoneum Common symptoms Abdominal distension, abdominal pain, diarrhea, chills, nausea
The disease generally has only mild or inconspicuous pain. It is different from the obvious pain caused by intra-abdominal infection. The abdominal tenderness and muscle tension are also mild. It often causes diarrhea or bloating due to peritoneal nerve reflex after stimulation, and intestinal obstruction may also occur. Mental disorders, systemic failure, and even shock, the severity of symptoms depends on the location of fluid exudation, the speed, the nature of the exudate, and the extent to which the posterior peritoneal layer is stimulated.
Duodenal fluid leaks into the peritoneal cavity. If the trauma does not cause large penetrating damage, there may be several hours of incubation, and then clinical symptoms appear, resulting in secondary infection.
After the pancreatic juice infiltrates into the peritoneal cavity, the exudate is initially in the fascia and then diffuses into the posterior renal space. Generally, it does not enter the perirenal space. When the exudate is bloody, the Turner sign and the Cullen sign may occur, and the skin on both sides of the abdomen appears. And under the umbilical cord, it turns blue and purple.
When the urinary tract ruptures, urine (sometimes mixed with blood) infiltrates into the peritoneal space. When the lesion is in the renal pelvis and ureter, the exudate is mainly urine. When the renal parenchyma is damaged, it is mainly blood. The pyelography shows that the pressure increases, and the renal pelvis X-ray contrast agent can penetrate into lymphatic vessels, veins, around the kidney or around the ureter. Occasionally, there is no obvious lesion in the urinary tract but there is peritoneal cavity after infiltration of urine. The rupture of the urinary tract can be acute or gradual. Spontaneous rupture occurs several weeks or months after pyeloplasty. The symptoms caused by extravasation of urine are very different, but may be mild; it may also cause abdominal pain, forming tender mass, bloating, nausea and vomiting. Chill, fever, exhaustion and even shock, when the exudate is only urine, no bacterial infection and not much, can be absorbed; if there is a pathogen in the urine, it will cause diffuse inflammation of the surrounding tissue, and lead to suppuration, further forming the kidney Abscess or retroperitoneal abscess, it has been observed that due to the precipitation of magnesium ammonium phosphate, the posterior peritoneal calculus is gradually enlarged, and chronic urinary exudate can lead to aseptic inflammation and perirenal space. The fat dissolves and forms a pseudocyst. At this time, the mass is often touched and accompanied by different degrees of abdominal pain. The extravasation of urine can cause fibrosis in the ureter and the kidney, which makes the urinary tract narrow, but does not happen after the real Peritoneal fibrosis.
Examine
Examination of fluid infiltration in the retroperitoneum
B-mode ultrasound, CT.
Diagnosis
Diagnosis and differentiation of retroperitoneal fluid infiltration
B-mode ultrasound and CT can be used to determine the location and extent of exudate. The density of exudate is generally close to that of water. There are some differences depending on the composition of the exudate. Unless the exudate is surrounded by the fascia, the edge is generally not as easy to determine as the abscess. Usually, the density of exudate is not easy to distinguish its components, and it is sometimes difficult to distinguish it from abnormal soft tissue mass. In the B-mode ultrasound or CT guided fine needle aspiration, the pathology, bacterial and biochemical examinations have certain significance for the diagnosis. .
Pyelonephritis, posterior peritoneal fibrosis, peritoneal inflammation, etc.
