Retroperitoneal Hernia

The formation of the hernial ring can be divided into congenital and acquired factors.

1. Congenital factors

This is due to the peritoneal crypt caused by the rotation of the small intestine during the embryonic period. The peritoneal crypt can be divided into: ① Paradudenal Fossae; ② Intersigmoid Fossae; ③ Pericecal Fossae: which can be further divided into: a. Ileocecal Fossa: below the ileum on the inside of the appendix; b. Ileocolic Fossa: above the ileum on the inside of the ascending colon; c. Postcecal Fossa. Clinically, hernias around the cecum are more common. Anatomically, these crypts all belong to the range of ileal artery branches, and the peritoneum folds due to the rotation of the ileum form an intestinal loop that becomes incarcerated. relatively speaking, the ileocolic and ileocecal fossae have a higher chance of occurrence.

2. Acquired factors

In some crypts and around them, a hernial ring can be formed due to abdominal membrane clefts caused by trauma or surgery. For example, if the stoma is not properly sutured to close the cleft between the stoma and the lateral peritoneum or if the pelvic floor peritoneum is not fully closed during rectosigmoidectomy, rectal stoma, or hysterectomy, a retroperitoneal hernia can occur.

1. The imbalance of acid-base balance in water and electrolytes occurs. Water and electrolytes participate in many important functions and metabolic activities in the body and play a very important role in maintaining normal life activities.

2. Toxic shock: It can manifest as acute intestinal obstruction, with symptoms such as abdominal pain, abdominal distension, vomiting, and fever.

3. Ischemic necrosis of the intestinal tract: history of recurrent abdominal pain, or sudden onset of pain that gradually worsens, accompanied by nausea, vomiting, abdominal distension, and no flatus or defecation.

Intestinal sounds, Nausea, Abdominal pain, Abdominal distension, Acute intestinal volvulus

A few patients have no obvious symptoms, while the majority of patients present with acute intestinal obstruction, with symptoms such as abdominal pain, abdominal distension, vomiting, and fever. It often manifests as acute or chronic intestinal obstruction that can resolve spontaneously, or there may be a history of recurrent abdominal pain. The pain may suddenly occur, gradually worsen, accompanied by nausea, vomiting, abdominal distension, no flatus or defecation. A localized mass may be palpable in the abdomen, and this mass may also have a history of several years. During an attack, there may be tenderness, increased intestinal sounds, or a high-pitched sound similar to water flowing.

1. Avoid trauma and postoperative retroperitoneal hernia caused by surgery. Some hernial rings around some crypts can be formed by abdominal membrane clefts caused by trauma or surgery, such as during operations for rectosigmoidectomy, rectal stoma, or hysterectomy. If the stoma is not properly sutured to close the cleft between the stoma and the lateral peritoneum or if the pelvic floor peritoneum is not fully closed, a retroperitoneal hernia can occur. Therefore, it is necessary to actively prevent it.

2. It is important to actively correct the imbalance of acid-base balance in water and electrolytes, and prevent the necrosis of the intestinal loop. If strangulation occurs, the necrotic intestinal segment should be resected, end-to-end anastomosis should be performed, and the abdominal membrane cleft should be repaired to prevent recurrence.

Abdominal plain film, abdominal MRI examination, abdominal percussion sound, abdominal palpation, abdominal CT

1. X-ray examination It is helpful for diagnosis. According to Willias' opinion, the X-ray signs of posterior peritoneal hernia are mainly: the expanded segments of the small intestine extend beyond the anterior margin of the spine, and from the side, the small intestine accumulates or arranges disorderly in the abnormal location. However, it must be distinguished from the intestinal arrangement disorder caused by short mesentery, congenital intestinal malrotation, or postoperative adhesion causing the intestines to gather together. Some patients with posterior peritoneal hernia can see multiple groups of small intestines gathered in one place and cannot be separated from the palpable mass. In addition, X-ray examination shows that the activity of the involved intestinal loops is almost lost, and there is expansion, congestion, and gas accumulation. Occasionally, a liquid level may appear. The proximal intestinal loops of the hernia may have expansion and retrograde peristalsis. The intestinal tract adjacent to the stomach or hernia sac may sometimes be seen with an incision or displacement. Another characteristic is that the manifestations of X-ray examination can change greatly from one time to another. Some people also perform mesenteric arterial and venous angiography, believing that it is helpful for the diagnosis of posterior peritoneal hernia.

2. B-type ultrasound A liquid shadow mass can be palpated or the obstructed intestinal loop can be identified.

First, postoperative dietary regimen for posterior peritoneal hernia:

1) Jilinshen 4 grams, American ginseng 3 grams, stewed with lean meat.

2) Dongsun 4-5 pieces, stewed with lean meat or chicken breast (drink the soup).

3) Beishu 15 grams, Dangshen 21 grams, Huai Shan 30 grams, Lianzi 15 grams, stewed with lean meat.

4) Tufuling 30 grams, Shengyiren 30 grams, Yuanro 3 pieces, stewed with grass carp or water turtle.

5) Dangshen 17 grams, Shizhi 21 grams, Jiazi 10 grams, Yiren 15 grams, stewed with lean meat or chicken.

6) Tianqi 3 grams, ginseng (or red ginseng) 3 grams, stewed with lean meat or chicken.

2. What kind of food is good for the body with posterior peritoneal hernia:

Surgical treatment: The principle of treatment is early diagnosis and early surgery. The main risk of posterior peritoneal hernia is to cause intestinal obstruction, which accounts for about 0.9% of all intestinal obstructions. Immediate surgery should be performed for acute intestinal obstruction. In addition, it should be actively corrected to restore the acid-base balance of water and electrolytes to prevent necrosis of the intestinal loops. If strangulation occurs, the necrotic intestinal segment should be resected, end-to-end anastomosis should be performed, and the hidden peritoneal fissure should be repaired to prevent recurrence.