Paracecal hernia

Introduction to the cecum Paraescillosis is a type of posterior peritoneal hernia that protrudes from the small intestine into the guinea formed in the crypt. About 5% of the retroperitoneal hernia. Intermittent right lower quadrant pain and reversible mass were the main clinical manifestations. Once the strangulation occurs, surgery should be performed promptly. Patients may have recurrent episodes of intermittent right lower quadrant, or metastatic right lower abdominal pain, and a small number of patients with reflex nausea and vomiting. basic knowledge The proportion of illness: the incidence rate is about 0.003% - 0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction abdominal pain nausea and vomiting bloating shock

Causes of cecal paralysis

(1) Causes of the disease

There are 3 crypts around the ileocecal area, which are generally small and are unlikely to form internal hemorrhoids. If they are too large and too deep, in the case of increased intra-abdominal pressure, the small intestine may protrude into it and form internal hemorrhoids. And cause complete or incomplete intestinal obstruction.

(two) pathogenesis

Due to the rotation of the midgut during the embryonic period, three crypts were formed in the ileocecal area, namely the ileocecal crypt, the ileocecal crypt and the cecal crypt, the ileocecal crypt and the ileocecal crypt were the ileum. When the artery branches, the peritoneum is formed by wrinkles. The posterior crypt of the cecum is caused by abnormality during the rotation of the intestine. Under normal circumstances, the cecum rotates down to the right axilla and completely adheres to the right axilla. On the abdominal wall, if a certain degree of abnormality occurs in this process, a cecal posterior crypt that communicates with the abdominal cavity can be formed.

1. The superior ileocaecal recess, also known as the ileal fossa or Luschka fossa, is a branch of the ileocecal artery in front of the ileocecal junction, the anterior cecum, and the peritoneal arch of the peritoneum. A narrow gap formed by a vascular cecal fold, or a superior ileocaecal fold; the anterior boundary is the cecal vasospasm, the posterior mesenteric membrane, and the right margin is the ileocecal junction. Below is the end of the ileum, the crypt opening to the lower left, the crypt is common in children, usually smaller with age, the elderly are significantly reduced and often disappear.

2. Inferior ileocaecal recess The peritoneal folds in front of the ileum to the front of the appendix are called ileocecal or ileocecal sacs. Unlike cecal vasospasm, they are generally free of blood vessels. There is a gap between the ileocaecal fold) and the appendix mesentery, which is the ileocecal lower crypt, also known as the cecal fossa (Fig. 1). The anterior crypt is the ileocecal ridge, and the upper part is the ileum. The mesentery, the right side is the cecum, the posterior part of the appendix is the posterior part, and the crypt opening opens to the lower left.

According to statistics, about 60% to 85% of individuals have ectopic crypts, and young people are more obvious in this crypt, and are often filled with fat as they grow older.

3. Retrocecal recess A gap between the posterior cecum and the posterior wall of the abdomen (Fig. 1). About 10% of the individuals have cecal recesses. The size and extent of the individual are very different. Occasionally, they can extend upward. A considerable distance to the rear of the ascending colon, the depth is sufficient to allow the entire finger to reach, the cecum in front of the crypt is the cecum (occasionally the lower part of the ascending colon), the posterior border is the peritoneal wall of the armpit, and the cecum to the axillary lining continues on both sides. Caecal folds, also known as parietocolic folds, are often found in the crypts.

If the crypt around the ileocecal area is too large or too deep, in the case of increased intra-abdominal pressure, the small intestine may be inserted into it to form internal hemorrhoids; and complete or incomplete intestinal obstruction may occur. Clinically, the intestinal tract is invaded. In the ileocecal crypt and ileocecal crypts, the guinea formed by the crypt is more common.

Paracement prevention

1. Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.

2. Don't eat too much salty and spicy food, don't eat food that is overheated, too cold, expired and deteriorated; those who are frail or have certain genetic diseases should eat some anti-cancer foods and high alkali content as appropriate. Alkaline foods maintain a good mental state.

Paralytic complications Complications, intestinal obstruction, abdominal pain, nausea and vomiting, bloating, shock

Intestinal strangulation is the main complication of paraescillosis, clinical manifestations of complete intestinal obstruction, abdominal pain increased and converted to persistent pain, accompanied by nausea, vomiting and abdominal distension; bowel sounds hyperthyroidism, intestinal necrosis, right lower abdomen mass The tenderness is obvious, and there is a sign of peritoneal irritation. The auscultation of the bowel sounds disappears. In severe cases, the infection and toxic shock symptoms occur.

Symptoms of cecal paralysis Common symptoms Nausea and vomiting Abdominal pain Right lower quadrant pain Abdominal distension Lower abdomen mass

If the small intestine protrudes into the ileocecal crypt and forms a cecal paralysis, and causes incomplete intestinal obstruction, its symptoms and signs are recurrent episodes of intermittent right lower quadrant, sometimes manifested as metastatic right lower abdominal pain, part The patient is accompanied by reflex nausea and vomiting, but the bloating may not be obvious. When the abdominal pain occurs, it often touches a mass in the right lower abdomen. When the small intestine in the crypt of the ileocecary is returned, the abdominal pain is relieved, and the mass is also relieved. It disappears.

Examination of the cecum

Serum-derived embryo antigen (CEA) was examined to rule out the possibility of cecal tumors.

Select the following tests based on the patient's medical history:

X-ray inspection

(1) Abdominal plain film: suggesting different degrees of intestinal obstruction.

(2) tincture enema: can identify the location and type of internal hemorrhoids.

(3) CT scan.

2. Abdominal B-ultrasound can detect abnormal gas accumulation in a certain part of the abdomen, or see a small group of small intestines gathered together, not easy to be moved.

Diagnosis and identification of cecal paralysis

Comprehensive literature reports that the diagnosis of cecal paralysis is quite difficult before surgery. Most of them are diagnosed at the time of surgical exploration. When the patient has intermittent pain in the right lower quadrant, and the right lower quadrant can touch the mass during abdominal pain, the abdominal pain is relieved. The block disappeared, and even the appearance of acute intestinal obstruction on the basis of chronic medical history, and there is tenderness mass, should consider the possibility of paralysis of the cecum.

According to the patient's medical history, the condition of choice of abdominal B-ultrasound and / or CT examination, barium enema X examination, serum carcinoembryonic antigen (CEA) and other tests, should be associated with acute appendicitis, appendicitis abscess, right ovarian cyst pedicle torsion, cecal tumor Identification, surgical exploration and treatment if necessary.

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