Rectus abdominis intrathecal hematoma

Introduction to intraductal hematoma of rectus abdominis The rectus abdominis is located on both sides of the abdominal white line (the midline of the abdomen) and is covered by the rectus sheath. The rectus abdominis has 3 to 4 strokes, which are closely adhered to the anterior layer of the rectus sheath, but not to the posterior layer of the abductor, and there are blood vessels at the iliac crest. The superior abdominal wall artery is the final branch of the internal thoracic artery and descends behind the rectus abdominis in the sheath of the rectus abdominis. The inferior epigastric artery is emanating from the external iliac artery, and finally enters the rectus abdominis sheath and is anastomosed to the superior abdominal artery behind the rectus abdominis. When the blood vessels behind the rectus abdominis rupture under certain factors (external force, abdominal pressure, etc.), the hemorrhage is easily formed in the tendon sheath. This injury is called the intraductal hematoma of the rectus abdominis. basic knowledge Sickness ratio: 5% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction

The cause of intraductal hematoma in the rectus abdominis

Anatomical factors (15%):

The internal rectus sheath of the rectus abdominis is tortuous, and the lower part of the rectus abdominis is surrounded by a strong muscle membrane. The branch of the artery has a long distance before entering the muscle. The Hai's triangle below the posterior sheath of the rectus abdominis is weak. The protection and support of the abdominal wall blood vessels are poor. When the muscles contract strongly, the blood vessels are easily torn and become a local anatomical factor of the disease.

Body type, pregnancy, drugs (20%):

Obese people have low rectus abdominis. The effects of estrogen in pregnant women, combined with excessive contraction of the abdominal muscles during childbirth. Long-term use of anti-metabolites, antihypertensives and anticoagulants.

Other (10%):

Direct or indirect local trauma. Muscle degeneration or myositis. Suffering from arteriosclerosis leads to local vascular degeneration.

Pathogenesis

When the blood vessels in the rectus abdominis rupture due to certain factors, the hemiplegia is formed locally due to the adhesion of the rectus abdominis tendon to the anterior sheath to prevent blood from developing to the longitudinal axis.

Rectus sheath intrathecal hematoma prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Intrathecal hematoma complications of the rectus abdominis Complications, intestinal obstruction

It can be caused by abdominal infection, perforation, obstruction, visceral injury and other causes. The peritoneum is rich in nerves and blood vessels. The patient usually presents with severe pain that is unbearable in the abdomen, sweating, high fever, weakness, and non-verbal symptoms. A variety of diseases can cause peritoneal irritation.

Intrathecal hematoma symptoms of the rectus abdominis common symptoms peritoneal irritation

When coughing, vomiting or abdominal muscle contraction, abdominal pain occurs, accompanied by nausea, vomiting, and then abdominal mass, the mass is usually limited to one side of the straight muscle, not across the midline, blood infiltration into the muscles to make the muscles hard, It is a gut-like mass that can reach a non-movable tender mass. The abdominal muscles can still be contracted when the abdominal muscles contract. If the hematoma extends downward beyond the Douglas semicircular line, the blood can spread along the extraperitoneal tissue and cause the lower abdominal peritoneal irritation. .

Examination of intraductal hematoma of rectus abdominis

Blood examination, the total number of white blood cells is normal or slightly higher, and neutrophils generally have no change.

1. Imaging examination

(1) Abdominal X-ray: The lateral radiograph shows an image of rectus abdominis widening.

(2) B-ultrasound or CT scan: The tumor can be found in the rectus abdominis muscle of the abdominal wall, the density is low, the boundary is clear, and it is not in phase with the abdominal cavity.

2. Abdominal wall puncture: When abdominal organ injury can not be ruled out, abdominal wall puncture can be performed, and local blood-sucking liquid is the most important diagnostic tool for this disease.

Diagnosis and diagnosis of intraductal hematoma of rectus abdominis

Diagnostic criteria

1. History: Detailed inquiries about whether there is history of trauma; whether there is antihypertensive, anticoagulant, anti-metabolite application history; whether there is vascular atherosclerotic disease; whether there is stimulation of lower abdominal muscle contraction factors and pathogenesis.

2. Clinical features: the elderly are more common, the average age of onset is 66 years old, more women than men; nausea, vomiting accompanied by a side of the abdomen mass, the mass of the mass is tender, fixed, shaped like a sausage, the abdominal muscles can still shrink when contracted And.

3. Auxiliary examination: suggesting the possibility of local hematoma.

Need to distinguish from other acute abdomen, such as perforation of the appendix, perforation of ulcer disease, mesenteric vascular embolization and intra-abdominal injury.

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