Symptom >> Surgical >> General Surgery

A soft lump in the lower back that grows slowly

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Acquired lumbosacral stagnation occurs mostly in elderly and thin people. Most patients have no special symptoms. Only a slowly enlarged mass is seen at the waist. The mass of the mass is soft and easy to repay. When standing, the mass is obvious, disappearing in the prone position; local feeling of bulging or pulling.

Cause

Cause

(1) Causes of the disease:

1. Anatomical factors: The lack of muscle protection in the waist triangle is a congenital factor that causes lumbosacral, accounting for about 19% of the lumbosacral.

2. Trauma: About 26% of the acquired pathogenic factors are caused by traumatic and procedural causes, because the wounds in the lower back or partial incisions (such as after nephrectomy) cause poor healing of the lumbar triangle.

3. Increased intra-abdominal pressure: accounted for 55% of lumbosacral cases, mainly chronic cough, long-term constipation, poor urination and other reasons for increased intra-abdominal pressure, induced the disease.

4. Lumbar muscle atrophy: such as lumbar muscle atrophy caused by sequelae of polio, or obesity muscle atrophy, the muscle and fascia protection is further reduced, the waist triangle area is weaker.

(2) Pathogenesis:

The waist triangle is the weak area of the abdominal wall. It consists of a lower waist triangle gap and an upper waist triangle gap.

Lower waist triangle (Petit's triangle): located below the waist, the lower boundary is sputum, the outside is the posterior margin of the external oblique muscle, and the inner boundary is the leading edge of the latissimus dorsi. The underside of the triangle is the intra-abdominal oblique muscle with a superficial fascia on the surface. This triangle is one of the weak areas of the posterior wall of the abdomen due to the lack of sufficient muscle level.

Upper waist triangle (Grynfeltt-Lesgaft's triangle): Located in the angle between the 12th rib and the erector spinae, in the upper front of the lower waist triangle. The inner boundary is the outer edge of the spine, and the upper boundary is the base of the triangle. It consists of the 12th rib and the lower edge of the lower serratus. The outside is the posterior edge of the internal oblique muscle. The base of the triangle is the aponeurosis at the beginning of the transverse abdominis muscle. The anterior subcostal nerve is in front of it, and the inferior phrenic nerve and the inguinal nerve are crossed. The top is the latissimus dorsi. The biggest weakness of this triangle is below the 12th rib, where there is only the transverse fascia without the latissimus dorsi.

When the wound occurs, or the healing is poor after the lumbar surgery, or the disease causes muscle degeneration, the protection of the muscles and fascia is further reduced, causing major defects in the originally existing anatomical weak area, when the intra-abdominal pressure increases. Even the abdominal viscera is separated from the two gaps to form the lumbosacral. Because the upper lumbar triangle is relatively constant and the gap is large, the upper lumbar lumbosacral lumbosacral is more common, and the lumbosacral sputum content is mostly small intestine and colon.

Examine

an examination

Related inspection

CT examination general radiography

Examination of the soft mass of the waist that slowly increases:

1. X-ray examination: X-ray gastrointestinal sputum angiography of the lateral lumbosacral patient, visible small intestine or colon into the lumbar mass, is a special means of auxiliary examination.

2. CT scan: lumbosacral and partial defects can be found.

Diagnosis

Differential diagnosis

Symptoms of complication of soft masses that slowly increase in the waist:

Lumbar disc herniation: also known as lumbar disc herniation or nucleus pulposus, when the waist of the labor or sports activities suffered from twisting and impacting, lifting heavy objects, excessive force, overwork and other injuries caused by intervertebral disc fiber rupture, The nucleus pulposus tissue emerges from the rupture port, stimulating or compressing the spinal nerve roots and causing pain in the lower back and leg.

Acute abscess in the appendix: The main diagnostic marker for the sinus sinus and the hair follicle is the acute abscess of the appendix. The main diagnostic markers of sinus sinus and sacral hair follicles are acute abscesses in the appendix or chronic sinus that are secreted. Local inflammatory sinus is present. The sinus cavity is seen in the midline. The sinus is easily diagnosed by symptoms and signs. .

Lumbar mass: Kidney cancer is manifested in the waist, and the lumbar mass is one of the three major warnings of kidney cancer. If you have a waist mass on your body, you should get enough attention because of kidney cancer. It is as common as other diseases and is not easy to catch. Therefore, when the waist mass appears, you should go to the hospital immediately to prevent the kidney cancer from being diagnosed and treated promptly. Kidney cancer lesions are enlarged to a considerable extent that the mass can be felt (or seen) from the waist or upper abdomen. About 20% to 30% of patients have this symptom. When the lateral position is taken, the mass is easier to touch, and sometimes the mass can be seen moving up and down with the breathing. If the mass adheres to the surrounding tissue, the mass is fixed and cannot be pushed, which is late. If there is a disease of the waist mass, seek medical advice in a timely manner, and do not wait until the bag is fast adhering to the surrounding tissue. It is a great possibility that the kidney cancer is advanced, so the symptoms should be sooner rather than later. Renal cell carcinoma, also known as renal cell carcinoma, originates from renal tubular epithelial cells and can occur in any part of the renal parenchyma, but the above and lower levels are more common, and a few invade the whole kidney; the left and right kidneys have equal chances of attack, and bilateral lesions account for 1%~2%.