retroperitoneal hernia
Introduction
Introduction to retroperitoneal hernia Retroperitoneal Hernia is a type of intra-abdominal hernia, also known as peritoneal crypt. Posterior peritoneal fistula is rare. Intra-abdominal hernia includes: the abdominal contents pass through the mesentery, especially the mesenteric membrane and the broad ligament intrusion into the abnormal opening; through the omental hernia, congenital volvulus abnormalities and peritoneal adhesion of foreign bodies in the peritoneal folds Posterior peritoneal hernia. The location is often around the duodenum, around the cecum around the sigmoid colon. It has been reported that the peritoneal organs or tissues break into the extraperitoneal area, but are rare. basic knowledge The proportion of illness: 0.0062% Susceptible people: no special people Mode of infection: non-infectious Complications: toxic shock syndrome
Cause
Retroperitoneal hernia
Congenital factors (25%):
Due to the peritoneal crypt caused by the rotation of the small intestine during the embryonic period, the peritoneal crypt can be further divided into: 1 duodenal crypt (Paradudcnal Fossae); 2 sigmoid crypt (Intersigmoid Fossae); 3 hidden around the cecum Pericecal Fossae: can be further divided into: a. ileocecal crypt: below the posterior ileum of the appendix; b. ileocecal crypt: above the ileum of the ascending colon; c. cecal crypt, clinically The crypts around the cecum are more common. These crypts are anatomically divided into the branches of the ileum, and the ileum rotates and the peritoneum wrinkles to form intestinal incarceration. Relatively, there are more chances of returning to the colon crypt and ileocecal crypt. some.
Acquired factors (20%):
In some crypts and around the peritoneal pores caused by trauma or surgery to form an ankle ring, such as rectal surgery or rectal fistula and hysterectomy, etc., do not pay attention to suture closure of the intestine and lateral peritoneal pores or pelvic floor Retroperitoneal stenosis, etc., can form a retroperitoneal hernia.
Prevention
Retroperitoneal hernia prevention
Should actively correct the imbalance of water and electrolyte acid-base balance, to prevent intestinal necrosis, such as strangulation should be removed necrotic intestine segment, end-to-end anastomosis, repair the cryptic peritoneal fissure pores to avoid recurrence.
Complication
Retroperitoneal complications Complications toxic shock syndrome
There are complications such as imbalance of water and electrolyte acid-base balance, toxic shock and intestinal necrosis.
Symptom
Retroperitoneal symptoms common symptoms acute volvulus abdominal pain nausea abdominal distension bowel
A small number of patients with no obvious symptoms, most patients with acute intestinal obstruction, abdominal pain, bloating, vomiting and fever, often manifested as acute or chronic intestinal remission, or a history of recurrent abdominal pain, or sudden onset of pain, Gradually exacerbated, accompanied by nausea, vomiting, bloating, no deflation, and abdomen can reach the limited mass. This mass may also have several years of history, tenderness during the attack, bowel sounds can be hyperthyroidism or high-profile gas over-water .
Examine
Examination of retroperitoneal hernia
1. X-ray examination is helpful for diagnosis. According to Williams' opinion, the X sign of retroperitoneal hernia is mainly: the expansion segment of the small intestine extends backward beyond the front edge of the spine. From the side, the small intestine accumulates or arranges disorder in abnormal parts. However, it must be differentiated from the mesentery, the congenital intestines fail to rotate or the postoperative adhesions cause the intestines to gather together to distinguish the intestinal disorders. Some patients with posterior peritoneal hernias can see multiple groups of small intestines gathered in one place that cannot be touched. Separate the blocks. In addition, X-ray examination shows that the activity of the affected intestinal sputum is almost lost, and there is expansion, stagnation and accumulation of gas. Occasionally, the liquid level may appear. The proximal iliac crest may have dilatation and reverse peristalsis, beside the stomach or the sac. The intestine sometimes sees a notch or a shift. Another feature is that the performance of one and another X-ray examination can vary greatly, and some people have a mesenteric artery angiography, which is believed to contribute to the diagnosis of retroperitoneal hernia.
2. B-type ultrasound can detect the liquid dark area mass or the intestinal fistula that can recognize the obstruction.
Diagnosis
Diagnostic diagnosis of retroperitoneal hernia
The diagnosis of this disease is difficult before surgery. The exact diagnosis can only be confirmed by surgery. However, there are also misdiagnosis during operation. The mass of the posterior peritoneum is coagulated into a malignant tumor or cyst. Because the disease is rare, the site is easily misdiagnosed. Or missed diagnosis, once it occurs, the consequences are serious. If you find irreversible intestinal obstruction, you should think about the possibility of abdominal hernia and actively take surgical treatment.
Must be short with the mesentery, the congenital intestines fail to rotate or postoperative adhesions make the intestines gather together to distinguish the intestinal disorders, some patients with posterior peritoneal hernia, can see multiple groups of small intestines gathered in one place can not be separated from the touched mass In addition, X-ray examination shows that the activity of the affected intestinal fistula is almost lost, and there is expansion, stagnation and accumulation of gas, and even the liquid level may appear. The proximal intestinal fistula may have dilatation and reverse peristalsis, and the intestines beside the stomach or hernia sac sometimes Seeing the notch or shifting, another feature is that the performance of one and another X-ray examination can vary greatly, and some people have a mesenteric artery angiography, which is believed to contribute to the diagnosis of retroperitoneal hernia.
