腹膜后感染与脓肿

　　腹膜后感染与脓肿一般局限在某原发部位，但可能向对侧或由一个间隙向另一间隙播散。腹膜后感染和脓肿的病因为：.

　　一、肾前间隙

　　1、十二指肠、胰肠、后腹膜阑尾、及邻近结肠疾病以及感染和炎症、穿透性消化性溃疡、肿瘤穿孔。

　　2、远处来的转移性感染。

　　3、意外事故或手术引起损伤。

　　二、肾周间隙

　　1、肾脏疾病如肾盂肾炎、结核、癌等。

　　2、损伤、手术。

　　3、血源性转移性感染。

　　三、肾后间隙

　　1、从腰大肌、后筋膜间隙或骨盆后腹膜区，感染直接蔓延。

　　2、血源性细菌播散。

　　3、从附近或远处感染源经淋巴蔓延。

　　4、外伤性血肿继发感染。

　　四、后筋膜间隙

　　1、椎体或十二肋感染，腰大肌化脓后感染蔓延。

　　2、经血、或淋巴远处感染的蔓延。

　　3、术后感染。

　　4、腰穿的并发症。

　　腹膜后感染与脓肿常引起弥漫性后腹膜感染，急性蜂窝组织炎，肾脓肿，腹腔内脏器、腹膜后器官、脊柱或第十二肋的感染，盆腔腹膜后腔脓肿以及菌血症等，还有以下几种疾病。

　　1、泌尿系统化脓性感染：脓肿侵及肾脏、输尿管或膀胱时可出现尿急、尿频脓尿等泌尿系感染症状。

　　2、腹腔脏器和组织的弥漫性感染：脓肿可破溃于胸腔、腹腔、纵隔、前腹壁、腰大肌、臀部或股部等，引起脓胸、腹膜炎等化脓性病变。

　　3. Gastrointestinal bleeding or intestinal fistula:Acute necrotizing pancreatitis complicated with retroperitoneal abscess can cause extensive invasion in the posterior part of the pancreas, transverse colon, mesentery root of the small intestine, perinephric space, and other areas, resulting in a diffuse retroperitoneal lesion containing a large amount of necrotic tissue, inflammatory exudates, and bacterial toxins. In addition to aggravating the condition of acute pancreatitis, it often leads to gastrointestinal bleeding and intestinal fistula and other complications.

　　4. Acute renal failure:During retroperitoneal diffuse lesions, the large absorption of necrotic tissue, inflammatory exudates, and bacterial toxins can trigger systemic coagulation, hemorrhage, renal failure, and even serious complications such as multiple organ dysfunction.

　　The main symptoms of retroperitoneal infection and abscess include fever, chills, night sweats, pain on both sides of the abdomen or in the lumbar region, which are the prominent manifestations of the disease. Other symptoms include nausea, vomiting, anorexia, weight loss, and general fatigue. Some patients have few other symptoms besides general fatigue, and common signs include fever (38-39℃), tachycardia, and localized mild tenderness in most cases (28%). Part (38%) can be felt as tender masses (sometimes they need to be felt through rectal or pelvic examination), and there is generally no rigidity of the abdominal muscles. Sometimes there is tenderness in the costovertebral area, swelling in the side, scrotal swelling, and lateral curvature of the spine. When the perirenal abscess occurs, the costovertebral angle is bulging, with tenderness and spasms of the psoas muscle; if the iliopsoas muscle is involved, there is lateral curvature of the spine and flexion and internal rotation of the affected hip joint with extension pain, increased white blood cells, and in severe cases, toxic granules and anemia. Uncommon manifestations include sinus tracts, subcutaneous emphysema, rupture of abscess into the abdominal cavity, small intestine, colon, vagina, pleura, mediastinum, bronchus, pericardium, or blood vessels, with corresponding symptoms.

　　The key to preventing retroperitoneal infection and abscess lies in early diagnosis. During the period of suspected diagnosis, on the one hand, nutritional support therapy should be strengthened, and on the other hand, anti-infection and anti-shock treatment should be enhanced, while all checks should be completed.Actively treat the primary disease and prevent infection. In the event of infection, symptomatic treatment should be given in a timely manner. Placing drainage materials in the retroperitoneal space during surgery is an effective measure to prevent the spread of secondary infection in the retroperitoneal space.. Strengthen nutritional support therapy to improve the patient's nutritional status and immunity, promote tissue healing, and control and localize infection..

　　For retroperitoneal infection and abscess, B-ultrasound examination, X-ray, CT, and MRI should be performed, as follows:

　　1. B-ultrasound examination

　　B-ultrasound examination can detect a liquid dark area echo in a retroperitoneal region and can determine its size and location. The operation is simple, can be repeated, has high diagnostic value, and is the preferred examination method.

　　2. X-ray

　　Comparison of the lateral abdominal films and oblique films can observe the bilateral peritoneal fat lines, bilateral psoas muscle shadows, and vertebral conditions, etc., and can detect soft tissue masses, clear renal contours, and changes in the shape of the psoas muscle.

　　3. CT and MRI (MRI)

　　CT and magnetic resonance imaging (MRI) have a high diagnostic rate, and CT can provide an accurate location of the abscess and display the relationship with surrounding organs.

　　4. Percutaneous aspiration of pus

　　Percutaneous aspiration of pus can be performed under CT or B-ultrasound guidance with fine needle aspiration, and the aspirated material can be subjected to pathological, bacteriological, and biochemical examinations. Contrast medium can also be injected to measure the size of the abscess, and catheter drainage can be performed simultaneously, which can improve the diagnostic and therapeutic effects more effectively.

　　In addition to general treatment, patients with retroperitoneal infection and abscesses should also pay attention to dietary regulation.

　　1. Supply easily digestible protein foods such as milk, eggs, fish, and soy products.

　　2. Eat more foods rich in vitamin A, B-group, and vitamin C, such as oranges, apples, tomatoes, etc. Fruits and vegetables.

　　3. Adequate nutrients should be provided for the patient, such as lean meat, chicken, pigeon soup, etc.

　　4. It is recommended to eat more turtle, sea turtle, sandworm, crucian carp, grass carp, shark, water snake, shrimp, white flower snake, crucian carp, mulberry, fig, lychee, walnut, loquat, almond, luffa, etc. to enhance the body's immunity.

　　5.Foods that are不利于 wound healing, such as deer meat, preserved bean curd, scallions, chili, chives, etc., because they are prone to cause infection and are not conducive to wound healing, should be avoided..

　　6. Avoid smoking, alcohol, greasy, fried, moldy, and preserved foods.

　　7. After surgical incision and drainage, avoid foods that can cause inflammation, such as rooster and goose, to prevent inflammation.

　　8. It is recommended to avoid or eat less spicy foods, such as alcohol, chili, ginger, garlic, cinnamon, etc., as they can stimulate local inflammation and worsen the abscess.

　　The treatment of retroperitoneal infection and abscesses is divided into surgical treatment and non-surgical treatment, as follows:

　　First, non-surgical treatment

　　1. The rational use of antibiotics has significantly improved the prognosis of post-peritoneal abscesses after infection. Therefore, attention should be paid to the rational use of a large amount of effective antibiotics.

　　2. Symptomatic treatment.

　　3. Supportive therapy: According to whether the patient has anemia and the overall condition, sufficient amounts of nutrients should be supplemented, as well as blood transfusion and albumin supplementation.

　　4. Correcting water and electrolyte imbalance and acid-base balance disorder.

　　5. Puncture and aspiration of pus or tube drainage guided by B-ultrasound.

　　Second, surgical treatment

　　For patients with severe illness and large abscesses, and for those who do not respond well to non-surgical treatment, timely surgical incision and drainage should be performed. The main approaches for retroperitoneal drainage are:

　　1. Retroperitoneal drainage via the lumbar region.

　　2. Pre-sacral drainage.

　　3. Thoracotomy combined with pleural incision and drainage.

　　4. Peri-abdominal drainage surgery.

　　The first three drainage methods are commonly used, while the latter ones are slightly less effective and more prone to complications.