Rib angle bulge

Introduction For the diagnosis of retroperitoneal abscess, physical examination revealed perirenal abscess, tenderness of ridge rib bulging, lumbar muscle spasm, and depressed edema in the waist skin. Retroperitoneal abscess refers to a localized purulent infection that occurs in the retroperitoneal space. It occurs often in the abdominal organs, retroperitoneal organs, spinal or twelfth rib infection, pelvic retroperitoneal abscess, and bacteremia. Abscess can invade and mediastinum, flow down the femoral canal into the thigh, or penetrate into the abdominal cavity, gastrointestinal tract, pleura, bronchus, and even form a chronic persistent fistula. Retroperitoneal abscess is clinically far less common than abdominal abscess. If it cannot be diagnosed and treated effectively, it can often induce multiple organ dysfunction syndrome (MODS) and cause death.

Cause

Inflammation or perforation secondary to the retroperitoneal organ, especially the part of the digestive tract in the anterior retroperitoneal space. Part of secondary to blood-borne infections, a small number of causes are unknown.

1. 2/3 of the biliary perforation of the common bile duct is located in the retroperitoneal space. The stone incarceration compresses the common bile duct wall to cause necrosis, or the gallbladder resection and common bile duct exploration to damage the common bile duct, which can cause bile leakage and cause biliary Retroperitoneal abscess.

2. Duodenal trauma or posterior wall ulcer perforation Most of the duodenum is located in the retroperitoneal position. After suffering from injury or perforation of ulcers, such as delayed diagnosis and treatment, a large amount of digestive juice can accumulate in the retroperitoneal space and secondary infection causes retroperitoneal Abscess. Surgical exploration of missed diagnosis of duodenal injury and improper treatment of duodenal rupture can cause duodenal fistula and lead to serious infection of the retroperitoneal space. In addition, endoscopy or intubation (including nasal bile duct drainage) may also cause minimally invasive posterior duodenum, especially in endoscopy, it is inevitable that torsion, compression, etc., more likely to cause different degrees of duodenum Trauma, duodenal fluid may leak into the peritoneum, leading to infection of the retroperitoneal space.

3. Colitis, perforation, ascending colon and descending colon are located in the retroperitoneum. Inflammation and traumatic perforation can cause retroperitoneal infection and often form retroperitoneal abscess.

an examination

Related inspection

Urinary white blood cells (WBC, LEU)

1. History:

The patient should be asked whether there is a history of the relevant organ or site or a history of trauma, and whether there is a cause of bacteremia. Systemic poisoning symptoms such as chills, high fever, sweating, weakness, and weight loss for unknown reasons. The most prominent symptom is abdominal or low back pain, which is directly related to the abscess area, sometimes the pain can be alleviated by bending the thigh or lying to the healthy side. May be accompanied by frequent urination, urgency, dysuria and other symptoms.

2. Physical examination:

The body temperature is retained by heat, and the physical flexion can be passive flexion. Abdominal palpation, anal or vaginal diagnosis can be found in the abdominal wall of the tender mass, generally no rigidity. If there is a perirenal abscess, the ridge bulge has tenderness, lumbar muscle spasm, and depressed skin edema in the waist. If the lumbosacral muscle is involved, there will be flexion of the spine and flexion of the thigh in the ipsilateral side. When it is straight, there is pain. Occasionally, drainage of sinus and subcutaneous emphysema can be seen. When the infection is diffuse and severe, the abdomen is obvious, and even ambiguity, lethargy, jaundice and shock occur.

3. Laboratory inspection:

White blood cell counts and neutrophil classification are often significantly increased. Urine routine is normal, but there may be pyuria, proteinuria and bacteriuria in the perirenal abscess. X-ray abdominal plain film can show a soft tissue block on the affected side, the kidney shadow is blurred and the edge of the psoas muscle is blurred. Sometimes there is gas-liquid level in the abscess, the spine is curved, and the bowel is paralyzed. It can also be seen that the lumbar vertebrae or ribs are damaged, the diaphragm is raised, and the pleural effusion. A barium meal examination can be found in the fistula or into the sinus. B-ultrasound and CT examination can clearly identify the retroperitoneal effusion. If necessary, the B-ultrasound can be positioned or guided by fine needle puncture, which can confirm the diagnosis.

Differential diagnosis

1. Peritonitis: Peritonitis is inflammation of the peritoneal and visceral peritoneum of the abdominal wall, which can be caused by bacteria, chemical and physical damage. According to the pathogenesis, it can be divided into primary peritonitis and secondary peritonitis. Acute suppurative peritonitis involving the entire abdominal cavity is called acute diffuse peritonitis.

2, underarm abscesses, where any pus accumulates under the diaphragm is called underarm abscess. Underarm abscess is the most important type of abdominal abscess. It is a serious complication of peritonitis. When an infection forms an abscess under the armpit, it must be treated by surgical drainage.

The underlying peritoneal lymphatic network is rich, so the infection is easy to lead to the underarm, and the underarm abscess can be secondary to infection in any part of the body. Most are complications of abdominal purulent infection. Common in acute appendicitis perforation, perforation of gastroduodenal ulcer, and acute inflammation of the liver and gallbladder, these often complicated right axillary infection. Extraperitoneal axillary abscess, mostly from the liver abscess, according to statistics, about 25 to 30% of the underarm infection will develop into an abscess, the rest can be self-dissipated, this is because the peritoneum of the upper abdominal cavity has strong resistance . Most of the pathogens causing abscesses are from the gastrointestinal tract, of which E. coli, anaerobic infections account for about 40%, streptococcus infections account for 40%, and staphylococcal infections account for about 20%. But most are mixed infections.

3, pelvic abscess: pelvic cavity is located in the lowest part of the peritoneum, inflammatory exudate in the abdominal cavity is easy to accumulate here, is the most common complication of intra-abdominal infection.

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