Pelvic floor peritoneal hernia after transabdominal perineal radical resection for rectal cancer

Introduction of pelvic floor peritoneal hernia after radical resection of rectal cancer After radical resection of abdominal rectal cancer, abdominal organs and tissues protrude into the anterior tibiofibular space through the peritoneal suture of the pelvic floor. It is called peritoneal hernia of pelvic floor periorbital surgery (also known as transperitoneal perineal rectum). Herniaofpelvicfloorcausedbymilesoperation after radical resection of cancer. It is rare in clinical practice, and occurs mostly in the early stage after radical resection of abdominal aorectal cancer. When the abdominal pressure is increased or the hemostatic gauze is taken out, the intestinal tube is prolapsed. Later in the postoperative period, it showed a reversible mass in the perineum. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction, abdominal pain

The cause of pelvic floor peritoneal hernia after radical resection of rectal cancer

(1) Causes of the disease

1. The pelvic floor is formed by a perforation at the peritoneal suture. This is the main reason for pelvic floor peritoneal hernia after radical resection of rectal cancer. The following conditions can cause the pelvic floor to be ruptured at the peritoneal suture:

(1) After transabdominal perineal rectal cancer radical surgery (Miles surgery), there is only one layer of peritoneum at the pelvic floor, there is no muscle under it, fat tissue is filled and supported, when the intra-abdominal pressure is increased (such as cough, sneezing, etc.), due to pelvic cavity The peritoneal suture at the bottom is subjected to a large tension and is broken, or the suture is broken.

(2) Excision of the pelvic floor peritoneum when the tumor tissue is removed, the tension is too large after suturing, the suture repair is not tight, the firmness is not strong, or the local infection occurs, which causes the peritoneum of the pelvic cavity to crack.

(3) bloating causes the peritoneal suture at the base of the pelvic cavity to rupture.

(4) Some patients have bleeding due to anterior venous plexus injury. The operation is temporarily stopped by warming saline gauze strips during surgery. If the gauze strips in the wound are adhered to the peritoneal suture at the bottom of the pelvic cavity, the gauze can be removed. The pelvic floor peritoneum is torn.

2. The perineal suture is sutured in one stage. The peritoneal suture at the bottom of the pelvic cavity is not tight and not firm. When the suction pressure of the negative pressure is too large before the operation, it is possible to inhale the small intestine fistula into the anterior sacral space, and the peritoneal hernia of the pelvic floor occurs.

3. The tumor position is low or the pelvic floor muscles in the anal canal cancer operation, the adipose tissue is extensively removed, resulting in enlarged pelvic cavity and weak relaxation.

(two) pathogenesis

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Prevention of pelvic floor peritoneal hernia after radical resection of rectal cancer

Peritoneal resection of the pelvic floor should be appropriate to avoid tension suture.

1. Without affecting the curative effect of rectal cancer, attention should be paid to the removal of excessive pelvic floor peritoneum during radical resection of abdominal rectal cancer, and to avoid tension suture to prevent peritoneal rupture of the pelvic floor.

2. Repair the pelvic floor peritoneum should be strict and firm, apply fine needle, suture the pelvic bottom peritoneum with No. 1 or No. 4 silk thread, the needle spacing should not be too large, 1cm is appropriate, avoid suturing, tear it when ligation and cause repair Not tight and not strong.

3. To prevent the increase of intra-abdominal pressure, postoperative aerosol inhalation, assist patients with sputum drainage, minimize the occurrence of severe cough, sneezing, in the case of large peritoneal suture tension or estimated poor healing in the pelvic floor, appropriate Prolong the time of getting out of bed after surgery to prevent the peritoneal rupture of the pelvic floor.

4. The suction pressure of the negative pressure before the operation is appropriate, to avoid the negative pressure is too large, the small intestine is inhaled into the anterior space.

5. Strengthen nutrition support treatment and promote healing.

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

Complications of pelvic floor peritoneal hernia after radical resection of rectal cancer Complications, intestinal obstruction, abdominal pain

Abdominal pain, intestinal obstruction.

Symptoms of pelvic floor peritoneal hernia after radical resection of abdominal rectal cancer. Common symptoms Paroxysmal abdominal pain, stool becomes thin like pencil

Most occur in the early postoperative period, after severe coughing or sneezing, or after removing the gauze strips used to compress hemostasis, the patient develops bursts with the intestinal fistula being inserted into the anterior sacral space by the perforation of the peritoneal suture at the base of the pelvic cavity. Sexual abdominal pain, nausea, vomiting, abdominal distension, sigmoid colostomy without venting, no clinical manifestations of mechanical intestinal obstruction.

Occurred in the late postoperative period, mainly manifested as a reversible mass of the perineum, standing or exerting force, coughing, defecation or holding out, disappearing after lying down or pushing the mass by hand.

1. History: history of radical operation of transabdominal perineal rectal cancer, history of negative pressure drainage before sputum; postoperative cough, sneezing, urinary retention and other causes of increased intra-abdominal pressure; surgical incision infection or perineal incision splitting, etc. .

2. Clinical features: paroxysmal abdominal pain, nausea, vomiting, abdominal distension and cessation of exhaustion and defecation. Signs: early, localized intestinal tube prolapse; late, perineal sable and reversible mass, supine Disappeared, appeared when holding your breath.

3. Auxiliary examination: X-ray images may have typical signs of intestinal obstruction; early colonic microscopy, visible intestines.

Examination of pelvic floor peritoneal hernia after radical resection of rectal cancer

1. X-ray examination: visible signs of intestinal obstruction such as intestinal flexion and gas-liquid plane.

2. Colonoscopy: After the perineal wound is inserted, the intestine can be seen.

Diagnosis and diagnosis of pelvic floor peritoneal fistula after radical resection of rectal cancer

Early postoperative patients should be differentiated from paralytic ileus and sigmoid colostomy.

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