Paracecal hernia

　　1. Etiology

　　There are three recesses around the ileocecal junction, which are generally small and are unlikely to form an internal hernia. If they are too large and deep, under the condition of increased intra-abdominal pressure, it is possible for the small intestine to protrude into them, forming an internal hernia and causing complete or incomplete intestinal obstruction.

　　2. Pathogenesis

　　Due to the rotation of the midgut during embryonic development, three recesses are formed at the ileocecal junction, namely the superior ileocecal recess, the inferior ileocecal recess, and the retrocecal recess. The superior and inferior ileocecal recesses are formed by the peritoneal folds during the branching of the ileal artery. The retrocecal recess is caused by abnormal rotation during the intestinal rotation process. Normally, the cecum rotates and descends into the right iliac fossa and is completely attached to the posterior abdominal wall of the right iliac fossa. If this process is abnormal to some extent, it can form a retrocecal recess communicating with the peritoneal cavity.

　　1. Superior ileocecal recess (superior ileocaecal recess):Also known as the ileocecal fossa or Luschka fossa, it is a narrow gap formed by the arch-shaped peritoneal fold called the ileocecal vascular fold (vascular cecalfold) or superior ileocaecal fold, which is enveloped by the peritoneum from the branches of the ileocecal artery that supply the anterior part of the ileocecal junction, namely the prececal artery; its anterior boundary is the ileocecal vascular fold, the posterior part is the ileum mesentery, the right boundary is the ileocecal junction, and the lower part is the distal ileum. The orifice of the recess opens towards the lower left. This recess is common in children and usually becomes smaller with age, and it is significantly reduced and often disappears in the elderly.

　　2, Inferior ileocecal recess (inferiorileocaecal recess):The peritoneal fold from the anterior below the ileum to the anterior aspect of the mesentery of the appendix is called the ileocecal fold or inferior ileocecal fold. Unlike the cecal vascular fold, it generally does not contain blood vessels. There is a space deep between the ileocecal fold (ileocaecalfold) and the mesentery of the appendix, which is the inferior ileocecal recess, also known as the ileocecal pouch. The anterior boundary of the inferior ileocecal recess is the ileocecal fold, the superior aspect is the posterior aspect of the ileum and its mesentery, the right side is the cecum, and the posterior aspect is the upper part of the mesentery of the appendix. The orifice of the recess opens towards the lower left.

　　According to statistics, about 60% to 85% of individuals have an inferior ileocecal recess, and this recess is more prominent in young people, which is often filled with fat as age increases.

　　3, Retrocecal recess (retrocecal recess):The space between the cecum and the posterior abdominal wall. About 10% of individuals have a retrocecal recess, with significant individual differences in size and range. Occasionally, it can extend to a considerable distance behind the ascending colon, with a depth sufficient to allow the insertion of an entire finger. The anterior aspect of the retrocecal recess is the cecum (occasionally the lower part of the ascending colon), the posterior boundary is the parietal layer of the peritoneum at the iliac fossa, and the sides are the cecum to the iliac fossa peritoneum continuation forming the cecal folds (caecalfolds), also known as the parietocolic folds. The appendix is often located in the retrocecal recess.

　　If the crypts around the ileocecal junction are too large and deep, under the condition of increased intra-abdominal pressure, the small intestine can protrude into them, forming an internal hernia; and cause complete or incomplete intestinal obstruction. Clinically, intestinal intubation into the superior ileocecal recess and inferior ileocecal recess is more common than into the retrocecal recess.

　　Intestinal strangulation is the main complication of an extracolic hernia. Clinical manifestations include complete intestinal obstruction, increased abdominal pain turning into persistent pain, accompanied by nausea, vomiting, and abdominal distension; hyperactive bowel sounds. After the bowel becomes necrotic, the mass in the lower right quadrant is significantly tender, and there are signs of peritoneal irritation. Bowel sounds are absent on auscultation. In severe cases, symptoms of infection and toxic shock may appear.

　　1, Septic shock, also known as septicemic shock, is a type of shock commonly seen in surgery and is difficult to treat.

　　2, Sepsis is an acute organ dysfunction secondary to infection, clinically manifested as fever, chills, tachycardia, altered consciousness, and increased white blood cells.

　　If the small intestine protrudes into the crypt of the ileocecal junction to form an extracolic hernia, and causes incomplete intestinal obstruction, the symptoms and signs are recurrent attacks of intermittent colicky pain in the lower right quadrant, and sometimes it can also manifest as referred pain in the lower right quadrant. Some patients may have reflex nausea and vomiting, but abdominal distension may not be obvious. During an attack of abdominal pain, a mass can often be felt in the lower right quadrant. After the protruded small intestine is retracted into the crypt of the ileocecal junction, the abdominal pain subsides, and the mass also disappears.

　　1. Develop good living habits, quit smoking and limit alcohol intake. Smoking, according to the World Health Organization's prediction, if people stop smoking, cancer in the world will decrease by 1/3 after 5 years; secondly, do not drink excessively. Cigarettes and alcohol are highly acidic substances, and people who smoke and drink for a long time are prone to acidic constitution.

　　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 predispositions to diseases, eat some anti-cancer foods and alkaline foods with high alkaline content appropriately, and maintain a good mental state.

　　Carcinoembryonic antigen (CEA) test to exclude the possibility of colonic tumor.

　　Choose the following examinations based on the patient's medical history:

　　1. X-ray examination

　　(1) Abdominal X-ray: indicates varying degrees of intestinal obstruction.

　　(2) Barium enema: can clearly determine the location and type of internal hernia.

　　(3) CT scan.

　　2. Abdominal ultrasound can detect abnormal gas accumulation in a certain part of the abdomen, or see a group of small intestinal loops gathered together, which is not easy to move.

　　1. Foods to Eat in Paracolic Hernia That Are Good for the Body

　　Pay attention to a light diet. In the first few days after surgery, adjust the diet according to individual conditions, mainly consume liquid and semi-liquid foods, and eat more high-protein foods to promote wound healing. 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 in Paracolic Hernia

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

　　Paracolic hernia has the possibility of strangulation at any time. Once the diagnosis is clear, surgical treatment should be performed. If there is a high suspicion of the disease, active efforts should also be made to seek surgical treatment. There are two types of surgical methods:

　　1. Reduce the herniated intestinal tract, close the hernia ring mouth, and prevent recurrence.

　　2. Cut open the hernia sac along the avascular area of the hernia sac to make it open and become part of the peritoneal cavity.