idiopathic greater omentum segmental infarction
Introduction
Introduction to idiopathic large omental segmental infarction Idiopathic cerebral infarction (idiopathicsegmentalinfarctionofgreateromentum) is mainly characterized by acute blood circulation disorder of the greater omentum. The cause is unknown and the diagnosis is difficult. It is a rare acute abdomen in clinical practice. Bush (1896) first carried out the disease. A detailed description has been reported in about 200 cases abroad. The domestic case of Wang Timin reported the first case in 1985. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
Idiopathic omental segmental infarction
(1) Causes of the disease
It is unclear that the occurrence of this disease is likely to be related to vascular disease of the greater omentum. Among the factors that can cause acute obstruction of the omental blood circulation, venous lesions are more than arterial lesions. Clinical data studies have shown that, in most cases, veins Lesions are the main cause of this disease.
1. The venous lesions of the omentum are mainly caused by various causes of damage to the omental venous intima, thrombosis, venous occlusion, reflux obstruction, and then affect the retinal arterial blood supply. These factors are:
(1) Sudden rise in intra-abdominal pressure: such as cough, vomiting, forced defecation, etc., so that the veins in the omentum are suddenly pulled or swayed.
(2) Abdominal closed injury: even a slight blunt injury, the greater omentum can also be affected by external forces, and may cause venous damage.
(3) Obesity: There is excessive fat deposition in the omentum of obese patients, which increases their volume, increases their weight, and increases the strength of pulling and moving the omentum during physical activity.
(4) Hypercoagulable state in the vein can promote the formation of thrombus.
(5) Heart failure, etc., affecting the reflow of the omental vein.
2. Omental arterial disease
Although atherosclerosis and nodular arteritis mainly occur in the aorta, it may affect the small omental arteries, causing the arterial lumen to stenosis and occlusion, eventually causing necrosis of the omentum.
(two) pathogenesis
Lesion
The omental idiopathic infarction mainly occurs in the right part of the greater omentum. Clinical data studies have found that the right half of the greater omental vascular variability is more than the left side, and fat deposition, hypertrophy is also more on the right side.
2. Lesion characteristics
The infarcted omentum is usually triangular, ranging from 2 to 20 cm in diameter, but more common in 6 to 8 cm. Localized edema, hemorrhage and necrosis, the appearance is dark red or dark purple, and the infarcted omentum is often associated with surrounding tissue. Extensive adhesion of organs, mainly with the right colon, duodenum and pelvic wall adhesion, a small amount of serous bloody exudation in the peritoneal cavity, longer course, exudate may be purulent, microscopic venous thrombosis Formation, inflammatory cell infiltration, the appearance of the omentum without torsion and external pressure phenomenon, can exclude the possibility of secondary omental necrosis.
Prevention
Idiopathic omental segmental infarction prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Idiopathic omental segmental infarction Complication
Symptom
Idiopathic omental segmental infarction symptoms common symptoms bloody exudate abdominal muscle tension low fever diarrhea acute abdomen lower abdominal pain nausea
The disease can occur at any age, but in the middle, there are more young people, men are 2 to 3 times more than women, and obesity has more chances of getting sick. This disease is similar to acute appendicitis, and it is extremely difficult to diagnose before surgery.
Abdominal pain
Acute abdominal pain is the primary symptom of patients seeking medical treatment. About 75% of patients have sudden right lower quadrant pain, which is persistent with paroxysmal aggravation. The pain is more severe when changing position, often accompanied by anorexia, nausea, but few vomiting, diarrhea or Constipation, sometimes with low fever, the metastatic pain of the abdominal pain during the onset is not obvious, and there is no radioactivity, these symptoms can not be distinguished from acute appendicitis.
2. Abdominal signs
Peritoneal irritation occurs earlier, mainly in the right lower quadrant, and tenderness in the right lower abdomen area. The range of rebound tenderness and abdominal muscle tension is large. In some cases, palpation is carefully performed, and one border is unclear. A tender mass.
Examine
Idiopathic omental segmental infarction
Blood routine examination may have a moderate increase in white blood cell count.
1. B-ultrasound often has uneven mass located between the stomach and the transverse colon.
2. Abdominal diagnostic puncture If the disease is considered, it is feasible to diagnose the abdominal puncture. If the bloody exudate can be extracted, it is an important diagnostic basis.
3. Diagnostic laparoscopy can directly observe the extent and extent of omental infarction.
Diagnosis
Diagnosis and diagnosis of idiopathic greater omental segmental infarction
diagnosis
History
Young and middle-aged men have a progressively worse right abdominal pain, accompanied by anorexia, nausea and fever.
2. Signs
The abdominal wall corresponding to the infarct area has tenderness, rebound tenderness, muscle tension, and sometimes abdominal and abdominal mass.
3. Auxiliary inspection
B ultrasound image can show that the uneven mass is located between the stomach and the transverse colon; the abdominal diagnostic puncture can have serous bloody exudate.
In addition to common acute abdomen, it is necessary to determine whether there is retinal torsion, whether it is associated with cardiovascular disease or intra-abdominal related lesions and causes of secondary retinal torsion and infarction.
