Pelvic side abdominal wall hernia after iliac bone removal
Introduction
Brief introduction of the posterior abdominal wall of the humerus After the humeral bone surgery, due to the local defect of the pelvic wall and the connective tissue of the decidua of the abdominal wall is weak, when the abdominal pressure is increased, the abdominal organ is protruded from the abdominal wall of the pelvis, which is called the posterior pelvis bone. The disease is rare in clinical practice. Occurs in the elderly and prolific women. basic knowledge The proportion of illness: 0.001% - 0.003% Susceptible people: mostly in the elderly and prolific women Mode of infection: non-infectious Complications: constipation, intestinal obstruction
Cause
The cause of pelvic floor and abdominal wall
1. Bone-induced local defect, weak humerus after bone removal, lateral abdominal wall sac is not related to incision or peritoneal rupture, improper bone extraction, resulting in defects in the basin, abdominal wall, weak is the main cause of its disease.
(1) Improper bone removal and excessive size, resulting in partial defects in the pelvic wall.
(2) The lower abdomen abdominal wall consists of external oblique muscle, intra-abdominal oblique muscle, transverse abdominis muscle, transverse transverse fascia, peritoneum, etc., wherein: the external oblique muscle starts from the lower 7 ribs, the lower back fascia, The rim and the inguinal ligament; the internal oblique muscles from the lower 5 pairs of ribs, the lower back fascia, the central part of the iliac crest and the inguinal ligament 1/2; the transverse abdominis from the lower 5 pairs of ribs, the lower back fascia, the medial aspect The margin is at the outer third of the inguinal ligament, and the inner and outer plates of the pterygoid and the anterior superior iliac spine are removed, resulting in local bone defects in the pelvic wall and the external oblique muscle, intra-abdominal oblique muscle, and abdomen. The transverse muscles and the inguinal ligaments lost their attachment points, and the injured abdominal wall muscles and the inguinal ligaments were not repaired and fixed when the bone was taken. The result was that in addition to the pelvic wall defects, it still caused a large range. The abdominal wall is slack and bulging, providing an anatomical basis for the occurrence of postoperative delirium.
In addition, after the onset of the disease, as the disease progresses, the enlargement of the sacral mass, the local muscle, and the degeneration of the aponeurosis are aggravated, and the local anatomical structure is increasingly weak and the defect is increased.
2. Abdominal wall decidua connective tissue is weak, can not resist intra-abdominal pressure due to the increase of adipose tissue in the elderly and fat infiltration, ligaments and tendons and other tissue degeneration, especially in elderly women, in the process of repeated pregnancy, abdominal wall muscle pull Damaged and weak, can cause abdominal wall tissue relaxation, weak, in addition, patients with this disease often due to non-union of the fracture, bone graft surgery, long bed after surgery, the body muscle tissue has varying degrees of disuse atrophy, accelerate the muscles Degeneration of the organization.
3. Increased abdominal pressure in elderly patients with chronic bronchitis, emphysema or long-term cough, and a history of long-term habitual constipation, or because of the need to stay in bed for a longer period of time after surgery, may have varying degrees of difficulty in defecation during bedtime and other factors, It can increase the intra-abdominal pressure of the patient and promote the occurrence of sputum.
Prevention
Prevention of pelvic floor and abdominal wall
1. Take the bone correctly. Including: avoiding the removal of the iliac crest and the full thickness of the flap, only the outer plate can be cut to avoid damage to the attachment of the external oblique, intra-abdominal oblique and transverse abdominis muscles; the anterior superior iliac spine should not be removed to prevent damage to the inguinal ligament The stop point causes the lower abdominal wall to relax.
2. Once the injured muscle origin and the inguinal ligament stop point health search should be sutured for repair, if necessary, the artificial patch (Gore-Tex) can be directly used to strengthen the bone and abdominal wall of the bone.
3. Actively deal with cough, constipation and other diseases that may cause abdominal pressure increase and health search.
Complication
Complications of the pelvic floor and abdominal wall Complications constipation intestinal obstruction
First affect the patient's digestive system, resulting in lower abdominal bulge, abdominal distension, abdominal pain, constipation, poor nutrition absorption, fatigue and physical decline. Because the groin is adjacent to the genitourinary system, elderly patients are prone to bladder or prostate diseases such as frequent urination, urgency, and nocturia. Children can affect the normal development of the testes due to the compression of the sputum; while young and middle-aged patients Easy to cause sexual dysfunction. It is also because the intestinal tract or omentum in the hernia sac is easily subjected to inflammatory swelling due to squeezing or collision, which makes the sputum difficult to return, resulting in incarceration of the sputum, and the occurrence of intestinal obstruction and intestinal necrosis.
Symptom
The symptoms of the pelvic floor and the abdominal wall of the humerus are common symptoms.
More common in the elderly and prolific women, early postoperative bed rest, the symptoms are not obvious, after the fracture healing, the bone incision and the lower abdomen abdominal wall were found to be painful and uncomfortable, gradually protruding, standing clearly, the lying position disappeared, Because the ankle ring is large, there is very little incarceration. The body can be seen in the incision scar of the bone extraction, the lower abdominal wall protrudes, and the bone defect and the edge of the ankle ring can be touched, and the contents can be retracted.
Examine
Examination of the lateral abdomen wall of the posterior pelvis
Early symptoms were not obvious because of bed rest after surgery. After getting out of bed after fracture healing, it was found that the bone incision and the abdominal wall of the lower abdomen were gradually dissipated, and the standing position was obvious, and the lying position disappeared. Due to the large ring size, there is very little intrusion.
Physical examination showed that the incision scar and the inferior abdominal wall were convex, and the bone defect and the margin of the ankle ring could be touched.
Diagnosis
Diagnosis and differentiation of the abdominal wall of the pelvis
1. Patients with history have a history of fracture nonunion, tibia bone extraction and bone grafting.
2. Clinical characteristics In elderly and prolific women, the bone incision and the inferior ventral abdominal wall are painful and discomfort when getting out of bed after fracture healing. When standing, the sacral position disappears, and the lower abdominal wall protrudes and the bone defect can be touched. And the edge of the ring, the contents of the can be returned.
