Peritoneal fibrosis

　　About 2/3 of retroperitoneal fibrosis cases have unknown etiology and are clinically referred to as idiopathic retroperitoneal fibrosis. In another 1/3 of cases, the etiology may be related to certain drugs, tumors, trauma, surgery, hemorrhage, urine extravasation, radiation, non-specific gastrointestinal inflammation (such as Crohn's disease), appendicitis, diverticulitis, various infections (such as tuberculosis, histoplasmosis, syphilis, actinomycosis), and other factors, so it is called secondary retroperitoneal fibrosis.

　　Due to retroperitoneal fibrosis, it can cause obstruction of the retroperitoneal or mesenteric lymphatic return, leading to protein-losing enteropathy or malabsorption.

　　Due to renal obstruction, it can cause hypertension and hypertensive headache. Compression symptoms: 75% to 80% of patients exhibit signs of partial or complete ureteral obstruction, such as hydronephrosis, urinary tract irritation, oliguria or anuria, chronic renal failure, and azotemia. Compression of the lymphatic vessels and inferior vena cava can cause lower limb edema, but it is rare. Occasionally, compression of the small intestine or colon can lead to intestinal obstruction.

　　This disease can occur at any age, but it is more common in people aged 40 to 60, accounting for about 2/3 of cases. Males are more prone to the disease, about 2 to 3 times more than females. Clinically, it is divided into three stages: early onset, active phase, and fibrous plate contraction phase.

　　1. Early onset Some patients may be asymptomatic initially, and pain may occur later, most commonly in the lumbar or lower back and radiating to the lower abdomen, inguinal area, external genitalia, or the anterior and medial aspects of the thigh. The pain is dull and distending, starting on one side and may become bilateral as the condition progresses.

　　2. Subacute inflammatory manifestations Symptoms such as abdominal pain, renal area tenderness, low fever, increased white blood cell count, rapid erythrocyte sedimentation rate, fatigue, discomfort, anorexia, nausea, vomiting, and weight loss.

　　3. Abdominal mass About 1/3 of patients can feel a mass in the lower abdomen or pelvis.

　　4. Compression symptoms 75% to 80% of patients exhibit signs of partial or complete ureteral obstruction, such as hydronephrosis, urinary tract irritation, oliguria or anuria, chronic renal failure, and azotemia. Compression of the lymphatic vessels and inferior vena cava can cause lower limb edema, but it is rare. Occasionally, compression of the small intestine or colon can lead to intestinal obstruction.

　　Retroperitoneal fibrosis is a disease with certain self-limiting properties and a slow progression, but the prognosis is relatively good. The lesions caused by ergot derivatives will reverse after stopping the drug. If diagnosed in time, the obstruction can be relieved for a long time. The mortality rate of retroperitoneal fibrosis is about 9%, and the cause of death is usually renal insufficiency, often due to delayed diagnosis.

　　2. Do not eat too much salty and spicy food, do not eat overheated, cold, expired, and deteriorated food; for the elderly, the weak, or those with certain genetic susceptibility to diseases, eat some cancer-preventive foods and alkaline foods with high alkalinity according to circumstances, and maintain a good mental state.

　　1. Develop good living habits, quit smoking and limit alcohol consumption. Smoking, according to the World Health Organization's prediction, if people stop smoking, the world's cancer rate will decrease by one-third in 5 years; secondly, do not drink excessively. Smoking and alcohol are highly acidic substances, and those who smoke and drink for a long time are prone to acidic体质.

　　Enhanced CT and MRI are currently the most valuable auxiliary examination methods for diagnosing and determining the degree of retroperitoneal fibrosis. CT can exclude retroperitoneal tumors, and when symmetrical and continuous plaque-like soft tissue masses are found on both sides of the spine, it is of great significance for diagnosis. Erythrocyte sedimentation rate and alkaline phosphatase are also of significance for the diagnosis of the disease.

　　1. Blood Test There may be red blood cells, decreased hemoglobin; increased eosinophils, and hematocrit less than 33%.

　　2. Urinalysis One-third of patients have proteinuria.

　　3. Erythrocyte Sedimentation Rate 94% of patients have an accelerated erythrocyte sedimentation rate at the initial examination.

　　4. Renal Function Clinically, 75% of patients have varying degrees of renal dysfunction, manifested as oliguria, azotemia, such as increased blood creatinine and blood urea nitrogen.

　　5. Alkaline Phosphatase In recent years, alkaline phosphatase has been considered as a marker for the disease, and an increase in alkaline phosphatase is of great significance for the diagnosis of the disease.

　　6. Ultrasound Examination This examination is non-invasive, non-radioactive, inexpensive, and convenient, and can be one of the screening and diagnostic methods for the disease.

　　7. X-ray Examination.

　　8. Magnetic Resonance Imaging (MRI).

　　9. Radioisotope Scanning.

　　10. Positron Emission Tomography (PET).

　　On the second day after surgery, patients with retroperitoneal fibrosis can consume some liquid and semi-liquid foods, such as congee, soft egg custard, milk, vermicelli, noodles, and other easily digestible foods. It is also recommended to add one or two meals of full nutritional supplements, such as foods for special medical purposes and enteral nutrition agents. This is beneficial for the absorption of nutrients in the body and does not increase the burden on the gastrointestinal tract. However, when starting to eat, the body's digestive capacity is reduced, and one should not be in a hurry. It is advisable to eat small and frequent meals, with 5 to 6 meals per day. If the body's tolerance and appetite increase, it is necessary to quickly resume normal dietary intake and consume more foods rich in high-quality protein and vitamins.

　　What foods should be avoided for retroperitoneal fibrosis?

　　Avoid stimulants such as coffee.

　　Avoid spicy and刺激性 foods such as scallion, garlic, ginger, and cinnamon.

　　Avoid smoking and drinking.

　　Avoid greasy, fried, moldy, and salted foods.

　　Avoid foods such as rooster, goose, and other irritants.

　　For retroperitoneal fibrosis, there is currently no specific treatment method. Because the symptoms at the early stage of the disease are light and atypical, patients often have obvious hydronephrosis when they come to the hospital, and even renal failure has occurred. When it is judged that the possibility of ureteral tumor in the patient is not high, the placement of a ureteral stent or hydronephrosis nephrostomy should be performed as soon as possible to relieve obstruction, and water and electrolyte balance should be monitored. Hemodialysis assistance should be performed if necessary. After the renal function is gradually restored, the examination should be completed.

　　1. Glucocorticoids

　　Early application of glucocorticoids can take effect within a few weeks, and even make the mass significantly shrink or disappear. For patients with mild to moderate urinary tract lesions, the elderly and weak, or those with systemic diseases, prednisone or prednisolone is more suitable. It is sometimes also used for preoperative preparation or postoperative prevention of recurrence. The initial dose is 30-60mg prednisone or prednisolone daily, and the dose is gradually reduced to the minimum effective maintenance dose after the condition is stable, at least 3 months. Some people have achieved good results by combining hormones and azathioprine, and the efficacy of radiotherapy is not yet certain.

　　2. Surgical operation

　　Although fibrosis itself rarely requires surgical resection, once a large amount of fibrosis occurs, hormone therapy is rarely effective. When the organ is compressed and affects its function, surgery is required.

　　By performing a bilateral ureteral release surgery, the omentum can be used to wrap the ureteral catheter, and the ureter can be moved laterally, which can achieve a good sustained relief. Simple release surgery has a high recurrence rate.

　　In the late stage, for severe urinary tract obstruction, percutaneous nephrostomy drainage can be performed, which is superior to retrograde ureteral catheterization or stenting. It can not only relieve symptoms in time but also monitor renal function through urine electrolyte determination, so that most patients can avoid hemodialysis.