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Dull pain and soreness in the lower abdomen

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction The dull pain and soreness of the lower abdomen is one of the clinical manifestations of abdominal hernia. Interparietal hernia is a special form of inguinal hernia. It is characterized by the fact that the abdominal organs do not descend through the abdominal tube, but Through the intra-abdominal ring into the abdominal wall between the various levels. Inguinal hernia, ovarian cysts, abdominal masses, incarcerated inguinal hernia, and abdominal wall spasm can cause dull pain and soreness in the lower abdomen. In addition, the dull pain and soreness of the lower abdomen may also be caused by excessive blockage of the body's garbage in the intestines, which can be alleviated by eating laxative food.

Cause

Cause

(1) Causes of the disease

The etiology of inguinal hernia sac rupture into the abdominal wall to form the intercondylar wall is still unclear. The comprehensive literature may be related to the following factors.

1. Stenosis or occlusion of the normal passage of the fistula: Stenosis or occlusion of the normal passage of the fistula is more common in patients with testicular hypoplasia. In addition to testicular abnormalities, testicular dysplasia and other factors, abnormal anatomical abnormalities, mechanical obstruction, fascia covering the scrotum entrance, and sheath-like protrusions not entering the inguinal canal are also the main factors leading to its occurrence. Because the testicular insufficiency is accompanied by a stenosis of the sacral process and thus the inguinal hernia, during the progression of the sputum, due to the stenosis of the inguinal canal and the outer ring and the presence of hard tissue, etc., the normal channel of the sputum is occluded. The inguinal canal cannot be covered by a narrow or hard tissue and can be pushed into the abdominal wall to form an intercondylar wall. Some scholars believe that when the abdominal pressure suddenly increases, the abdominal organs forcefully expand the sac neck, and a large amount of sputum contents are released. When the neck of the sac is retracted, the contents of the sputum cannot be returned, and the sudden increase in the contents of the sputum is strongly stimulated and causes the abdominal oblique muscle, the transverse abdominis muscle and the transverse fascia fascia to contract to close the inguinal canal, and the contents of the sputum fail to enter. The normal passage enters between the peritoneum and the muscle, or forms the anterior abdominal wall.

2. Inappropriate ankle compression: If the ankle strap is not pressed at the inner ring mouth, but is pressed below the inner ring mouth, when the intra-abdominal pressure is increased, the ankle block can protrude but cannot enter the inguinal canal through the normal passage of the ankle. The scrotum, but protruding into the abdominal wall tissue.

3. Improper resetting: When the inguinal hernia is incarcerated and the squeezing method is used, the contents of the sputum are forcibly squeezed through the inner ring due to improper resetting, and the abdominal cavity is not fully retracted at the neck of the sac, forming a peritoneum. Front gap . Moreover, frequent and improper manual reduction can cause weak and slack tissue around the wall of the sac and the inner ring of the abdomen, and it is easy to induce sputum between the abdominal wall.

(two) pathogenesis

According to the way in which the sac is sneaked in, the abdominal wall sputum is divided into three types:

1. Preperitoneal hernia The sac is located between the peritoneum and the transverse abdominis muscle. The intestine is invaded at the neck of the sac, where the bulge protrudes into the abdominal cavity, and the peritoneum is separated from the muscle. 20%.

2. Interstitial hernia The sac is located between the muscles of each layer, between the transverse abdominis and the internal oblique muscles, or between the internal oblique and the external oblique aponeurosis, accounting for about 60%.

3. External ablique musculoaponeurotic hernia of abdomen The sac is located outside the aponeurosis of the external oblique muscle, accounting for about 20%. The position of the interstitial sac can be between the transverse transverse fascia and the transverse abdominis muscle, between the transverse abdominis muscle and the internal oblique muscle, or between the intra-abdominal oblique muscle and the external oblique muscle aponeurosis. A small number of abdominal wall spasms may exist simultaneously with the inguinal hernia (with two ankle rings or double ankles).

Examine

an examination

Related inspection

Gastrointestinal CT examination

Abdominal wall hernia - clinical manifestations: Some patients have a history of inguinal hernia. After the incarceration, the patient or the doctor will manually reset the treatment. After the reduction, the sputum block "disappears", but the symptoms of abdominal pain still exist and progressively worse. Physical examination showed signs of intestinal obstruction, the position of the testicles on the oblique side increased, and the mass of the lower abdomen touched the mass and tenderness. A small number of patients may have symptoms of intestinal obstruction such as paroxysmal abdominal pain, bloating, cessation of bowel movements, etc. after a sudden forced breath or severe cough, but no sputum is released, and there is a tender mass near the inner ring of the lower abdomen.

The clinical manifestations of this disease are not specific, can be asymptomatic or blurred symptoms, such as abdominal dull pain and soreness. It is rare to see a doctor because of symptoms. Sometimes the small mass is not easy to reach in the muscular layer, and the ventral nucleus is rarely missed by the doctor.

Abdominal wall fistula-assisted examination

1. X-ray examination: X-ray or abdominal film has signs of intestinal obstruction.

2. B-ultrasound: It is suggested that there is abnormal intestinal fluid echo near the inner ring of the lower abdomen.

Diagnosis

Differential diagnosis

Differential diagnosis of dull pain and soreness in the lower abdomen:

1. Lower abdominal tenderness: The pain that occurs when the abdominal tenderness is pressed from the shallow to the deep.

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

3, lower abdominal pain: lower abdominal pain is a common symptom of women, mostly caused by gynecological diseases. Various gynaecological conditions should be considered based on the nature and characteristics of lower abdominal pain.

4, local pain in the lower abdomen: local pain in the lower abdomen. It is often expressed as having a tender point, and the tenderness is limited to a little. Clear and fixed tenderness points are important signs of abdominal organ lesions. Such as: tenderness point of peptic ulcer, in the middle or left side of the xiphoid process, the penetrating point of the posterior wall penetrating ulcer is in the 6th to 10th thoracic vertebrae or both sides of the back; acute pancreatitis tenderness point, in The middle or the left side of the upper abdomen; the tender point of the gallbladder lesion (the gallbladder point), located at the junction of the right rectus abdominis rim and the rib arch; the appendicitis tender point (the appendix point, McBurney point), located in the right anterior superior iliac spine The outer 1/3 of the umbilical cord and the inner 2/3 junction; in the renal and urinary tract lesions, at the 10th rib front end (quarter rib point), the umbilical horizontal line at the outer rectus abdominis (upper ureteral point), before The intersection of the upper spine line with the perpendicular line through the pubic tuberosity (middle ureteral point), the outer edge of the spine and the lower edge of the 12th posterior rib (the rib ridge or the rib ridge), and the 12th posterior rib lower edge There is tenderness at the intersection of the outer edge of the psoas muscle (the waist point or the rib waist).

5, lower abdominal cramps: abdominal cramps are often caused by the muscles of the abdominal tube-like organs do not follow the strong peristaltic contraction of human will. Under normal circumstances, the pipe-like organs in the human body are constantly squirming. For example, the stomach is constantly moving and contracting to digest food, pushing the chyme into the small intestine, the small intestine is constantly squirming, absorbing nutrients and moisture, and allowing intestinal contents to the large intestine. Pushing, the large intestine is also constantly squirming while absorbing moisture and excreting waste; the gallbladder and bile duct are also creeping and contracting, storing and secreting bile according to the needs of the human body. Normal peristaltic contraction does not cause abdominal pain, but if you want to overcome the obstruction in the pipeline, it is necessary to strengthen the contraction, and the strong and severe contraction will cause abdominal cramps. Organs capable of producing abdominal cramps include the stomach and intestine (including the appendix), the cystic duct, the hepatic duct, the common bile duct, the pancreatic duct, the ureter, the uterus or the fallopian tube, and the kidney.