Peritoneal hernia at the pelvic floor after radical resection of rectal cancer via abdominal perineal approach

　　The formation of a cleft at the peritoneal suture at the bottom of the pelvis is the main cause of peritoneal hernia at the pelvic floor after radical resection of rectal cancer via abdominal perineal approach. The following situations may cause the peritoneal suture at the bottom of the pelvis to split:

　　1. After radical resection of rectal cancer via abdominal perineal approach (Miles surgery), there is only one layer of peritoneum at the pelvic floor, without any muscle or fatty tissue to fill and support it. When intra-abdominal pressure increases (such as coughing, sneezing, etc.), the peritoneal suture at the bottom of the pelvis may rupture due to the large tension it withstands, or the sutures may break, resulting in a split.

　　2. Excessive resection of the pelvic floor peritoneum during the cleaning of the tumor tissue, resulting in too much tension after suture, insecure and unstable repair, or local infection, which may cause a tear in the pelvic floor peritoneum.

　　3. Abdominal distension can cause the suture site of the pelvic floor peritoneum to rupture.

　　3. Due to the continuous bleeding from the pre-sacral venous plexus injury, the operation was temporarily terminated by applying warm saline gauze strips to stop the bleeding, and if the gauze strips in the wound adhere to the pelvic floor peritoneum suture site, the pelvic floor peritoneum can be torn when the gauze strips are removed.

　　1. Large intestinal loops hernia:The entry and compression by the hernial ring, or strangulation and necrosis of the intestinal wall can occur, leading to clinical manifestations of diffuse peritonitis and toxic shock, and blood may be aspirated from the abdominal puncture.

　　2. Acute peritonitis:It is a common severe surgical disease caused by bacterial infection, chemical irritation, or injury. Most cases are secondary peritonitis, originating from the infection, necrosis, perforation, or trauma of abdominal organs.

　　3. Toxic shock:It is a syndrome caused by exotoxins of Staphylococcus aureus, characterized by high fever, vomiting, diarrhea, confusion, and rash, which can quickly progress to severe and refractory shock. It mainly occurs in menstruating women who use vaginal cotton塞s, and the main symptoms are caused by toxins produced by Staphylococcus aureus.

　　It often occurs in the early postoperative period, after a severe cough or sneeze, or after the removal of the gauze strips used for hemostasis, with the intestinal loops herniating into the pre-sacral space through the perforation of the pelvic floor peritoneum suture, leading to symptoms of mechanical intestinal obstruction such as intermittent abdominal pain, nausea, vomiting, abdominal distension, and no排气 and defecation at the sigmoid colon stoma.

　　1. Medical history includes a history of abdominoperineal resection for rectal cancer, and pre-sacral negative pressure drainage history:After the operation, there may be conditions that easily increase intraperitoneal pressure, such as coughing, sneezing, urinary retention, and infection or dehiscence of the perineal incision.

　　2. Clinical characteristics:There are symptoms such as intermittent abdominal pain, nausea, vomiting, abdominal distension, and cessation of排气 and defecation, and signs include: in the early stage, local intestinal prolapse can be seen; in the late stage, a palpable, reducible mass can be felt in the perineum, which disappears when lying flat and appears when holding breath.

　　3. Auxiliary examination: X-ray imaging:There may be typical signs of intestinal obstruction; early colonoscopy through the wound shows prolapsed intestinal tract.

　　The resection of the pelvic floor peritoneum should be appropriate, avoiding tension suture:

　　1. During the abdominoperineal resection for rectal cancer, it is necessary to avoid the excessive resection of the pelvic floor peritoneum without affecting the radical resection effect, and to avoid tension suture to prevent the postoperative rupture of the pelvic floor peritoneum.

　　2. The repair of the pelvic floor peritoneum should be tight and firm. Fine needles and 1# or 4# silk threads should be used for interrupted suture of the pelvic floor peritoneum, with the needle distance not too large, 1cm being appropriate. It is strictly forbidden to tear the sutured and ligated peritoneum, leading to an insecure and unstable repair.

　　3. Prevent increased intra-abdominal pressure. Postoperatively, provide nebulized inhalation, assist patients in expectoration, and try to minimize the occurrence of severe coughing and sneezing. In cases where the tension of the peritoneal suture at the bottom of the pelvic cavity is large or the healing is estimated to be poor, the postoperative time for getting out of bed can be appropriately extended to prevent the peritoneal fissure at the bottom of the pelvic cavity from opening.

　　4. The suction force of the postoperative pre-sacral negative pressure drainage should be appropriate, avoiding excessive negative pressure to suck the small intestinal loop into the pre-sacral space.

　　5. Strengthen nutritional support therapy to promote healing.

　　6. Do a good job in perioperative management, pay attention to aseptic operation during surgery to prevent perineal wound infection.

　　At the time of diagnosis, in addition to relying on its clinical manifestations, it is also necessary to rely on auxiliary examinations. This disease's X-ray examination: visible intestinal dilatation and gas-liquid level, etc., typical signs of intestinal obstruction. Colonoscopy: inserted through the perineal wound, the protruding intestinal tract can be seen.

　　1. Foods that are good for the body when eating next to the sigmoid colon stoma hernia

　　Diet should be light. For the first few days after surgery, adjust the diet according to individual conditions, mainly focusing on liquid and semi-liquid foods, and eating more high-protein foods is beneficial for wound recovery. Supplement a variety of vitamins, eat more fresh vegetables and fruits. You can eat various lean meats, milk, eggs, and other foods rich in protein.

　　2. Foods to avoid for anastomotic hernia next to the sigmoid colon stoma

　　Avoid overly greasy foods. Foods such as fermented bean curd, scallions, chili peppers, chives, etc., are not conducive to wound healing because they are prone to cause infection.

　　1. Preoperative Preparation:Correct dehydration and metabolic acidosis, rapidly replenish blood volume, apply broad-spectrum antibiotics to prevent infection, etc., to improve the overall condition and increase the tolerance to surgery.

　　2. Surgical Principles:If the original surgery is a traditional abdominal wall incision surgery, enter the peritoneal cavity through the original incision, reposition and retract the protruding intestinal tract, and if there is intestinal necrosis, excise it and perform intestinal anastomosis, carefully repair the peritoneal fissure at the bottom of the pelvic cavity; if it is a laparoscopic surgery, then laparoscopic surgery should be chosen. For those who develop symptoms later after surgery, those who have the conditions can choose laparoscopic surgery.