Lateral abdominal mass with fixed tenderness

Introduction Abdominal wall mass, fixed tenderness is the main clinical signs of the semilunar hernia. The anterior and posterior layers of the rectus abdominis sheath heal at the lateral edge of the rectus abdominis, forming a semi-moon-shaped, convex-laterally curved, sacral structure, ie the meniscus. The peritoneal or intra-abdominal organs protrude through the meniscus of the lateral abdominis, called the spigelian hernia, also known as the lateral abdomen. Spige (1617) first described the anatomy of the meniscus, so it is also known as spiglian. The incidence of incarceration and strangulation in the semilunar sputum is higher, so once the disease is diagnosed, it should be treated surgically.

Cause

(1) Causes of the disease

1. Abdominal wall tissue inflammation, abscess, or local tissue degeneration into a weak area after surgery.

2. Direct trauma.

3. Nerve damage causes the local tissue to lose nerve support and the ability to resist abdominal pressure is reduced.

The anatomical structure can be divided into 3 layers. The first layer is the inward extension of the external oblique muscle, and the anterior sheath of the rectus abdominis is fused in the middle of the rectus abdominis. The second layer is the aponeurosis of the internal oblique muscle, the thickest, forming the semilunar line. The main body participates in the anterior and posterior sheath of the rectus abdominis above the semi-annular line; the third layer is the aponeurosis of the transverse abdominis muscle that occludes inward and rectus. In this case, the aponeurosis is moved to the anterior and posterior sheath of the rectus abdominis. When a defect or a gap is formed for some reasons, the peritoneum and the viscera can be released to form sputum.

(two) pathogenesis

The semilunar line, also known as the spigelian fascia, consists of the external oblique, intra-abdominal oblique, and transverse transverse aponeurosis. The "range" of the fascia refers to the external oblique muscle, the internal oblique muscle, and the transverse abdominis and the abdomen. The area between the lateral edges of the muscle is another weak area of the abdominal wall. The spigelian fascia is slightly curved, with the leading edge of the ninth rib, the lower pubic tuberosity, about 0.5-1.0 cm wide, and the lateral edge of the rectus sheath is its surface marker. When the diaphragm of the transverse abdominis ruptures, or the aponeurosis of the abdominal oblique aponeurosis and the diaphragm of the transverse abdominis, or all of the rupture of the diaphragm, the rupture of the meniscus leads to a defect in the meniscus. In the case of increased intra-abdominal pressure, the extraperitoneal fat or viscera passes through the half-moon line. The defect is prominent and forms a hernia. The aponeurosis of the abdominal oblique aponeurosis or the external oblique muscle can sometimes remain intact, forming a sacral cover with the subcutaneous tissue and the skin. The meniscus is a kind of abdominal wall hernia. The hernia sac is mostly in the lower part of the external oblique aponeurosis and in front of the transverse fascia. The front of the sac is often covered with a mass of fat, which can contain no contents, or it can contain the omentum and intestinal fistula.

The semilunar ridge occurs more than above the inferior vena cava and above and below the umbilical level, especially at the intersection of the semilunar and the semicircular line (the midpoint of the umbilical cord and pubic symphysis). The half moon line is generally small, so there are more chances of incarceration or strangling.

an examination

Related inspection

Abdominal vascular ultrasonography abdominal abdomen CT CT endoscopic CT examination

Symptom

The symptoms of this disease are mild, only the pain or swell of the sputum area, and often worsened by the increase of intra-abdominal pressure. As the disease progresses, the pain gradually becomes dull and diffuses, making diagnosis more difficult. If the contents are large omentum and intestinal fistula, there may be deep pain. Once incarcerated or strangulated, the pain becomes severe and there are gastrointestinal symptoms such as nausea and vomiting.

2. Signs

The outer wall of the abdominal wall is the main sign. Because the semilunar hernia is a paralysis between the abdominal wall, the hernia sac is mostly under the aponeurosis of the external oblique muscle. The shape of the sac is mostly flat and the diameter is rarely more than 2cm. It is not easy to find during the physical examination, but there is more fixed tenderness in the pupil. Sometimes accompanied by abdominal pain. For those who are small or have difficulty to reach, they can stand on their positions, press hard and then press on the bulging protrusions. The sputum can disappear with a squeak and can touch the edge of the ring hole.

If the pain in the patient's crotch region and the abdominal wall mass can be confirmed, especially if the compression block can be retracted and can reach the edge of the ankle ring, and the method of increasing the intra-abdominal pressure can aggravate the pain in the crotch region, then there is almost no diagnosis. difficult. However, because the defect may be located under the sacral membrane of the complete external oblique muscle, the shape of the block is mostly flat, not easy to touch, or the block is located at a certain distance from the half moon line, so the diagnosis is often difficult. Although the tenderness at the simple pupil is not enough to make a diagnosis, it can be suggested that the site of the prolapse (the position of the ankle ring or the defect) is more or less helpful for diagnosis. B-ultrasound and CT scans may help to confirm the diagnosis.

Differential diagnosis

Identification:

1, the lower left abdomen can touch the tender mass: can be seen in ulcerative colitis, rectum, sigmoid cancer. Rectal, sigmoid schistosomiasis granuloma, left oocysts and so on.

2, the left upper abdominal cystic mass has tenderness: the left upper abdominal cystic inflammatory mass has obvious tenderness, such as the middle part of the abdomen touched the mass of the stomach or pancreatic tumor, cyst or intragastric stones.

3, upper abdomen mass: upper abdominal lesions caused by various reasons, palpation has mass. Common in liver cirrhosis, chronic pancreatitis, stomach cancer, gallbladder cancer and other diseases.

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