The functions of the omentum in humans. Blood supply of the greater omentum

The peritoneum behind the falciform ligament from the lower surface of the diaphragm wraps onto the diaphragmatic surface of the liver, forming coronary ligament of the liver, lig. coronarium hepatis, which at the edges looks like triangular plates called triangular ligaments , lig. triangulare dextrum et sinistrum. From the diaphragmatic surface of the liver, the peritoneum bends through the lower sharp edge of the liver onto the visceral surface; from here it extends from the right lobe to the upper end right kidney, forming lig. hepatorenale, and from the gate - to the lesser curvature of the stomach in the form of a thin lig. hepatogastricum and on the part of duodeni closest to the stomach in the form lig. hepatoduodenal . Both of these ligaments are duplications of the peritoneum, since in the area of ​​the hilum of the liver there are two layers of peritoneum: one going to the hilum from the anterior part of the visceral surface of the liver, and the second from its posterior part. Lig. hepatoduodenal and lig. hepatogastricum, being a continuation of one another, constitute together small seal , omentum minus. On the lesser curvature of the stomach, both layers of the lesser omentum diverge: one layer covers the anterior surface of the stomach, the other covers the posterior surface. At the greater curvature, both layers converge again and descend in front of the transverse colon and loops small intestine, forming front plate greater omentum, omentum majus. Having gone down, the leaves of the greater omentum are folded back up at a greater or lesser height, forming its posterior plate (the greater omentum thus consists of four leaves). Having reached the transverse colon, the two leaves that make up the posterior plate of the greater omentum fuse with the colon transversum and with its mesentery and together with the latter, then go back to the margo anterior of the pancreas; from here the leaves disperse; one is up, the other is down. One, covering the anterior surface of the pancreas, goes up to the diaphragm, and the other, covering the lower surface of the gland, passes into the mesentery of the colon transversum.

In an adult, with complete fusion of the anterior and posterior plates of the greater omentum with the colon transversum on the tenia mesocolica, 5 leaves of the peritoneum are thus fused: four leaves of the omentum and the visceral peritoneum of the intestine.

Let's follow now course of the peritoneum from the same leaf of the anterior abdominal wall, but not in the upward direction to the diaphragm, but in the transverse direction . From the anterior abdominal wall, the peritoneum, lining the side walls of the abdominal cavity and moving to the posterior wall on the right, surrounds the caecum with its vermiform appendix on all sides; the latter receives the mesentery - mesoappendix. The peritoneum covers the colon ascendens from the front and sides (mesoperitoneally), then bottom part the anterior surface of the right kidney, passes in the medial direction through m. psoas and ureter and at the root of the mesentery of the small intestine, radix mesenterii, bends into the right leaf of this mesentery. Having supplied the small intestine with a complete serous cover, the peritoneum passes into the left layer of the mesentery; at the root of the mesentery, the left leaf of the latter passes into the parietal leaf of the posterior abdominal wall, the peritoneum covers further to the left the lower part of the left kidney and approaches the colon descendens, which belongs to the peritoneum, as well as the colon ascendens (mesoperitoneal); then the peritoneum on the side wall of the abdomen again wraps onto the anterior abdominal wall.

Peritoneum behind the falciform ligament from the lower surface of the diaphragm it wraps onto the diaphragmatic surface of the liver, forming the coronary ligament of the liver, lig. coronarium hepatis, which at the edges looks like triangular plates called triangular ligaments, lig. triangulare dextrum et sinistrum. From the diaphragmatic surface of the liver, the peritoneum bends through the lower sharp edge of the liver onto the visceral surface; from here it extends from the right lobe to the upper end of the right kidney, forming lig. hepatorenal, and from the gate - to the lesser curvature of the stomach in the form of a thin lig. hepatogastricum and on the part of duodeni closest to the stomach in the form lig. hepatoduodenal. Both of these ligaments are duplications of the peritoneum, since in the area of ​​the hepatic hilum there are two layers of peritoneum: one going to the hilum from the anterior part of the visceral surface of the liver, and the second from its posterior part. Lig. hepatoduodenal and lig. hepatogastricum, being a continuation of one another, together they form the lesser omentum, omentum minus. On the lesser curvature of the stomach, both layers of the lesser omentum diverge: one layer covers the anterior surface of the stomach, the other covers the posterior surface. At the greater curvature, both layers converge again and descend down in front of the transverse colon and loops of the small intestine, forming the anterior plate of the greater omentum, omentum majus. Having gone down, the leaves of the greater omentum are folded back up at a greater or lesser height, forming its posterior plate (the greater omentum thus consists of four leaves). Having reached the transverse colon, the two leaves that make up the posterior plate of the greater omentum fuse with the colon transversum and its mesentery and, together with the latter, then go back to the margo anterior of the pancreas; from here the leaves disperse; one is up, the other is down. One, covering the anterior surface of the pancreas, goes up to the diaphragm, and the other, covering the lower surface of the gland, passes into the mesentery. colon transversum.

In an adult with complete fusion of the anterior and posterior plates greater omentum with colon transversum on tenia mesocolica Thus, 5 layers of the peritoneum are fused: four leaves of the omentum and the visceral peritoneum of the intestine.

Let us now trace the course of the peritoneum from the same layer of the anterior abdominal wall, but not in the upward direction to the diaphragm, but in the transverse direction. From the anterior abdominal wall, the peritoneum, lining the side walls of the abdominal cavity and moving to the posterior wall on the right, surrounds the caecum with its vermiform appendix on all sides; the latter receives the mesentery - mesoappendix. The peritoneum covers colon ascendens in front and from the sides, then the lower part of the anterior surface of the right kidney, passes in the medial direction through m. psoas and ureter and at the root of the mesentery of the small intestine, radix mesenterii, bends into the right leaf of this mesentery. Having supplied the small intestine with a complete serous cover, the peritoneum passes into the left layer of the mesentery; at the root of the mesentery, the left leaf of the latter passes into the parietal leaf of the posterior abdominal wall, the peritoneum covers further to the left the lower part of the left kidney and approaches the colon descendens, which belongs to the peritoneum, as well as the colon ascendens; then the peritoneum on the side wall of the abdomen again wraps onto the anterior abdominal wall. For the purpose of easier assimilation of complex relationships, the entire peritoneal cavity can be divided into three areas, or floors: 1) the upper floor is bounded above by the diaphragm, below by the mesentery of the transverse colon, mesocolon transversum; 2) the middle floor extends from the mesocolon transversum down to the entrance to the small pelvis; 3) the lower floor begins from the line of entry into the small pelvis and corresponds to the pelvic cavity, which ends downward in the abdominal cavity.

Almost all organs human body covered with a thin transparent fabric, which prevents friction against each other, performs a trophic function, adsorbs excess fluid and helps maintain a constant internal environment. This tissue is called peritoneum, and in some places, such as along the front surface of the intestine, it forms something like an apron.

Large and small seal

In the process of evolution, man stood on his feet, and this made his stomach and internal organs defenseless. In order to reduce their possible trauma, an additional organ was formed. The greater omentum is a duplicate of the peritoneum (four layers), which starts from the lateral surface of the stomach and descends to the transverse colon. This area is called the gastrointestinal ligament by anatomists. Vessels and nerves pass through it. The free edge of the oil seal goes down and, like an apron, covers the hinges small intestine. The duplication of the peritoneum also goes behind the transverse colon, intertwining with the mesentery and then with the parietal peritoneum.

The space between the sheets of connective tissue is filled with fatty tissue. This provided the specific name for the organ - the greater omentum. The anatomy of the lesser omentum is somewhat different from the structure of its “bigger” brother. The lesser omentum consists of three ligaments that pass into one another:

• hepatoduodenal (starts from the porta hepatis to the horizontal branch duodenum);
• hepatogastric (from the liver to the lesser curvature of the stomach);
• ligament of the diaphragm.

Omental bag

This big gap formed by the peritoneum. Anteriorly, the bag is limited by the posterior wall of the stomach, the lesser and greater omentum (gastrointestinal ligament). Posteriorly there is a parietal layer of the peritoneum, a section of the pancreas, the lower pole of the kidney and the adrenal gland. Above is the caudate lobe of the liver, and below is the mesentery of the transverse colon.

The omental bursa has a cavity called the foramen of Winslowi. The significance of this organ, like the rest of the omentum, boils down to the fact that in case of wounds abdominal cavity it closes the damage, preventing infection from spreading throughout the body, and also prevents the eventualization of organs. If an inflammatory process occurs, such as appendicitis, the omentum adheres to the visceral peritoneum and limits the organ or part of it from the rest of the abdominal cavity.

Removing the oil seal

Removal of the greater omentum is not an independent operation, but part of the treatment oncological diseases intestinal tube. This step is done with the aim of destroying all metastases that are in large quantities found in the thickness of the peritoneum. It is not advisable to remove them one by one.

An important feature is that it is opened with a wide longitudinal incision to provide good access to the surgical wound. If the greater omentum is removed through a transverse approach, there is a danger of leaving the affected area and causing a relapse of the disease. There will be no consequences for the body after the removal of this organ.

Omental tumors

There is such a thing as primary tumors of the omentum. They can be benign (lipomas, angiomas, fibromas, etc.) and malignant (sarcomas, endotheliomas, cancer). Secondary formations manifest themselves as metastases from the stomach or intestines, as well as any other organ. IN terminal stage diseases, the greater omentum is densely covered with altered lymph nodes and neoplasms. It takes the form of a wrinkled ridge and is easily identified by deep palpation of the abdominal wall. This phenomenon can cause intestinal obstruction.

Benign tumors of the omentum are quite rare. They do not cause discomfort to patients, so they can reach significant sizes. Difficult to diagnose: no specific symptoms, markers and any other indicators. From malignant tumors Sarcomas are the most common. They manifest themselves as intoxication syndrome, as well as stool retention and weight loss. These warning signs should prompt the doctor to think about cancer.

Tight omentum syndrome

Large diameter oil seals appear due to developing inflammatory process. Parts of the organ fuse with the peritoneum in various areas of the abdominal cavity and stretch it. Such adhesions can develop after surgical intervention, for chronic inflammation of the genitourinary system.

Stretching of the omentum causes pain and disrupts the patency of the intestinal tube. Most often, patients complain of constant pain in the navel and above the womb after eating, as well as bloating and vomiting. A characteristic symptom The disease is an increase in pain if the patient tries to bend back. The final diagnosis is made after ultrasound examination, computed tomography, radiographs. The ideal option for diagnosis is laparoscopic surgery. If necessary, access can be expanded and adhesions removed.

Omental cyst

The cyst occurs due to obstruction lymphatic vessels or as a result of the growth of an obliterated area lymphoid tissue, which is not related to common system. These cysts resemble thin round sacs filled with clear liquid. Their size can vary from five millimeters to several centimeters. The disease does not manifest itself in any way, but when the formation reaches a significant size, it can be felt through the anterior abdominal wall.

Treatment of this pathology is exclusively surgical. The cysts and the omental area are removed, preserving most of it. The prognosis for such patients is favorable.

The abdominal cavity is a space delimited above by the diaphragm, in front - by the rectus muscles and aponeuroses of the oblique and transverse abdominal muscles, on the sides - by the muscular parts of these muscles, behind - by the lumbar part of the spine, the psoas major muscle, latissimus dorsi and quadratus lumborum muscles, below - by the iliacus bones and pelvic diaphragm.

The abdominal cavity includes the peritoneal cavity and the retroperitoneal space. The peritoneal cavity is a collection of slit-like spaces between the abdominal organs lined by the peritoneum and the abdominal wall; contains a small amount of serous fluid. In men, the peritoneal cavity is closed, in women it communicates with external environment through the openings of the fallopian tubes.

Retroperitoneal space - part of the abdominal cavity located between the parietal peritoneum and intra-abdominal fascia, extending from the diaphragm to the small pelvis; filled with fatty and loose connective tissue with organs, vessels, nerves and lymph nodes located in it.

The peritoneum is a serous membrane that covers some organs of the abdominal cavity and lines its walls from the inside; has a barrier function, the ability to secrete serous fluid and resorb liquid and suspended matter. The visceral and parietal peritoneum are distinguished. Visceral peritoneum is the part of the peritoneum that covers the organs located in the abdominal cavity. Parietal peritoneum is the part of the peritoneum that lines the inner surface of the abdominal wall.

The abdominal cavity contains an omentum, greater and lesser. The greater omentum is a duplicate of the peritoneum, descending from the greater curvature of the stomach, covering the loops of the small intestine and fused with the transverse colon. The lesser omentum is also a duplicate of the peritoneum, but extending from the lower surface of the liver to the lesser curvature of the stomach and duodenum. Behind the lesser omentum and stomach is the omental bursa, which is part of the peritoneal cavity and communicates with it through the omental opening (its diameter is 14-45 mm). The shape and size of the omental bursa are subject to significant individual variability. X-ray diagnosis of extra-organ diseases of the abdominal cavity is carried out both using survey fluoroscopy and radiography, and using special X-ray examination techniques (omentography, peritoneography, pneumoperitoneography, pneumo-retroperitoneum, etc.).

Abscess anorectal- localized in the tissue surrounding the anal part of the rectum and anus. Occurs with subcutaneous or submucosal paraproctitis (see), is one of the main signs of fistulas of this localization. More often it is located strictly behind the anal canal, therefore, on fistulograms in a direct projection, the cavity is always superimposed on the intestine (anorectal ruler). On lateral fistulograms it is revealed under the intestine. It communicates with the latter using a short fistulous tract. The abscess can also be located in front of the rectum. Then its cavity almost always has the shape of an elongated oval. Sometimes the abscess surrounds the intestine on all sides, with pus accumulating in the tissue surrounding the anal canal.

A. appendicular- localized in the peritoneal cavity or in retrocecal tissue, occurs as a complication of acute appendicitis. On a plain X-ray of the abdominal cavity, it is manifested by the presence of an additional shadow in the lower right quadrant and small horizontal levels of fluid in the cecum and terminal ileum. When contrasting the intestine, a filling defect or deformation of the medial wall of the cecum is determined; the terminal ileum is narrowed and displaced medially and superiorly. The folds of the mucous membrane of the cecum are preserved, but can be pushed laterally and brought closer together. Hypermotility of the cecum and ascending colon is often observed.

A. retroperitoneal- localized in the retroperitoneal space. Occurs with pancreatitis, damage to the posterior wall of the duodenum, paranephritis, etc. It manifests itself as symptoms of the underlying disease. It is difficult to establish using conventional x-ray examination techniques. The retroperitoneal abscess obscures the outer contour of the large psoas muscle, causes scoliosis lumbar region spine in the opposite direction from the abscess, disappearance of the contours of pre-abdominal fat, changes in the diaphragm. Needle biopsy and angiography help in diagnosis. On angiograms, the afferent vessels are located in the form of a rim around the perimeter of the abscess, thereby emphasizing its boundaries. In the parenchymal phase, an avascular zone is observed, bordered by a hypercontrast strip of uneven thickness.

A. ischiorectal- localized in the tissue of the ischiorectal space. Occurs with deep paraproctitis (see). The main radiological sign of fistulas of the same name. Diagnosed using fistulography. The shape of the abscess cavity is often round or triangular, the contours are uneven and unclear.

A. interintestinal- localized in the abdominal cavity between the intestinal loops. Occurs with limited purulent peritonitis. Most often located in the center of the abdominal cavity medially from the colon between the intestinal loops. In each case of suspected interintestinal abscess, it is necessary to conduct a contrast study of the gastrointestinal tract, starting with the stomach, and carry it out in stages with an interval of 20-30 minutes. In this case, you should pay attention to the location and fixation of the loops of the small intestine, while the barium suspension passes through them. If there is an abscess between the intestinal loops, they are swollen with gas and displaced, as if an empty space is formed. The swollen loops of the small intestine surrounding the abscess are fixed, their contours adjacent to the abscess are uneven, since the loops are usually involved in the process. If there is gas and liquid in the abscess cavity, diagnosis is greatly facilitated.

A. pelviorectal- localized in the retroperitoneal tissue of the small pelvis near the rectum. Occurs with deep paraproctitis (see), can be observed with acute appendicitis and purulent salpingitis. On a plain radiograph G pelvis (after emptying the bladder), limited darkening can be detected between the symphysis and gas-inflated intestinal loops. Unlike the accumulation of free fluid, this shadow does not move when the patient’s body position changes. A contrast study of the intestine establishes the extraintestinal location of the abscess, determining the exact location and its size based on the displacement of the rectum. Ureterocystography (displacement of the ureters and depression on the walls of the bladder) serves the same purpose. Against the background of darkness, you can sometimes see horizontal liquid levels of varying sizes.

A. subphrenic- localized in the subphrenic space of the abdominal cavity. As a rule, this is a complication of purulent inflammatory processes in the abdominal organs. Clinically manifested necessarily pain syndrome and high hectic body temperature (38-40°), increased ESR and leukocytosis. The patient is in a forced position: semi-sitting or on the sore side with the hips brought toward the stomach. Subdiaphragmatic abscess can be gasless or gaseous.

A gasless abscess is radiologically diagnosed on the basis of indirect symptoms: high standing, limited mobility or complete immobility of one of the domes of the diaphragm, the presence of a small reactive effusion in pleural cavity, the appearance of disc-shaped atelectasis, foci of pneumonia in the basal parts of the lungs. If a gasless abscess is localized in the middle or on the left, the diagnosis is somewhat easier: a contrast study of the stomach and colon can be performed, which in this case are shifted in the direction opposite to the abscess. The significant size of the abscess causes intense darkening under the diaphragm. On the right it merges with the shadow of the liver, on the left it is visible more clearly, and there one can also detect deformation of the gas bladder and body of the stomach and pushing down the splenic flexure of the large intestine. With abscesses of medial localization, the outlines of the intermediate leg of the diaphragm are blurred due to inflammatory infiltration.

Subdiaphragmatic gas abscess occurs most often on the right. It is diagnosed by identifying a gas bubble under the diaphragm with a horizontal fluid level that moves easily. When the patient's position changes, the gas bubble always occupies a horizontal position within the cavity, the contours of the arch of which are even. The right dome of the diaphragm is usually raised, limited in mobility, and effusion is detected in the pleural cavity. The diaphragm is unevenly thickened, looks as if fringed due to the deposition of fibrin (see Diaphragmatitis).

A left-sided abscess is detected during examination in a lateroposition with mandatory contrasting of the stomach and colon. Reactive changes from the diaphragm, pleura and basal parts of the lungs are usually located on the left. An important symptom is a medial and downward displacement of the stomach or its stump, as well as the splenic angle of the colon. Depending on the location of the abscess (front or back), a corresponding displacement of the stomach in the opposite direction is noted. With a midline location, the horizontal fluid level is determined at the level of the xiphoid process under the shadow of the heart and usually corresponds to the accumulation of pus in the cavity of the lesser omentum. If the accumulations of pus in the omental bursa are large, the stomach may shift upward and anteriorly to the left. IN in rare cases a total subdiaphragmatic abscess is formed, which occupies the entire diameter of the abdominal cavity in the subphrenic space. Wherein reactive changes can be expressed on both sides. In some cases, the air that has entered the abdominal cavity during surgery is encysted, forming irregular shape cavities localized on the right and left in the anterior abdominal cavity.

A. subhepatic- localized in the peritoneal cavity between the lower surface of the liver and the intestinal loops. Occurs as a result of limited purulent peritonitis. It is very difficult to recognize, especially if there is no gas in the cavity. The shadow of the infiltrate is located at the lower contour of the liver, merging with its image, the lower contour becomes unclear, the shadow of the liver seems to increase. There is always local flatulence of the duodenum and colon. Intestinal loops containing gas border the infiltrate from below and from the side. On x-ray in the direct projection, blurred outlines of the upper pole of the right kidney and the contour of the lumbar muscle are determined, and in the lateral projection, the “light strip” between the liver and the muscles of the abdominal wall is darkened as a result of hyperemia and edema. In some cases, there is a displacement of the transverse colon downward and the stomach to the left. Reactive changes in the diaphragm, pleura and lungs are less pronounced than with subphrenic abscesses.

A. retrouterine- localized in the rectal cavity of the abdominal cavity. Complication of adnexitis (see) or, less commonly, purulent appendicitis (see).

A. prevesical- localized in the tissue located anterior to the bladder. Occurs, as a rule, as a result of paracystitis (see).

Ascites- abdominal dropsy, characterized by the accumulation of transudate in the abdominal cavity. Most often occurs due to venous stagnation in system portal vein(cirrhosis of the liver, extrahepatic block of the portal vein), in the system of the inferior vena cava (see Constrictive pericarditis), as well as due to right ventricular failure (see), common causes causing the accumulation of fluid in tissues and cavities (nephrosis, etc.) , damage to the peritoneum by a malignant tumor (cancerous contamination, mesothelioma) and tuberculosis (see). Free fluid in the abdominal cavity when the patient is in an upright position accumulates in it lower parts, causing them an intense uniform darkening, shaped like a crescent. When positioned horizontally, they can be located not only in the lateral sections of the abdomen, but also between the loops of intestines and push them apart, as well as along the walls of other internal organs, forming in the pictures uniform darkening of a ribbon-like, triangular or polygonal shape, corresponding to the places of fluid accumulation.

Adhesive disease- a syndrome caused by the presence of adhesions in the peritoneal cavity formed as a result of previous illnesses, injuries or surgical operations. Characterized by frequent attacks of relative intestinal obstruction. X-ray signs of the adhesive process are limited or absent displacement of intestinal loops during palpation and changes in the position of the patient’s body, disruption of the normal configuration of the intestine with a preserved, albeit deformed, relief of the mucous membrane, varying degrees of narrowing of the lumen, and slower passage of barium suspension. In this case, deformation of the organs adjacent to the intestine is noted. Adhesive process often causes twisting, bending and fusion of the affected parts of the intestine with neighboring organs (see Payra syndrome).

Mesentery dorsal common- developmental anomaly: preservation of the dorsal mesentery in all parts of the intestine, which causes its excessive mobility. Diagnosed by X-ray with intestinal contrast.

Omental bursitis- inflammation of the omental bursa. It occurs rarely, mainly after palliative operations on the stomach or duodenal perforations. Clinically manifested by symptoms of peritonitis (see). The X-ray picture is variable and depends on the direction of spread of fluid in the omental bursa and the severity of the adhesive process. On plain radiographs abdomen in the upper floor of the abdominal cavity an oval or round shadow of soft tissue intensity is determined. Its dimensions change if the patient is examined in horizontal position. When contrasting the gastrointestinal tract, a displacement of the stomach is detected upward, to the right and neutral, the greater curvature of the organ is arched, repeating the features of the shape of the palpable formation. Sometimes the pushing back of the stomach is more pronounced along one of its walls (backstage symptom). The depressed walls retain elasticity and peristalsis, and the relief of the mucous membrane in this area is smoothed. Loops of jejunum, transverse colon and its splenic angle may be pushed down. With the gastrohepatic variant of omental bursitis, the stomach is often pushed to the left, anteriorly or posteriorly. The degree of displacement depends on the amount of fluid in the omental bursa. The formation of a pathological internal fistula between the omental bursa and a hollow organ (for example, stomach, colon) leads to the occurrence of hydropneumoperitoneum of the omental bursa, in which the level of liquid with a gas bubble above it is determined in its projection. If the adhesive process is pronounced, limited accumulation of liquid and gas is possible.

Hematoma- limited accumulation of blood in tissues with the formation of a cavity containing liquid or coagulated blood.

G. retroperitoneal- localized in the retroperitoneal tissue. A consequence of injury or a complication of chronic diseases (aneurysms of the abdominal aorta, renal artery, etc.). On plain radiographs of the abdominal cavity, the following signs are most often revealed: darkening of the lumbar region with the disappearance of the contours of one or both kidneys, absence of contours of the psoas major muscle, reflex bloating of the stomach, loops of the small and large intestines.

G. rudimentary- located in the rectouterine cavity.

G. perinephric- localized in the perinephric tissue. Formed as a result of injury to the kidney (see) or adjacent organs (see Retroperitoneal hematoma).

G. pelvic- localized in the pelvic tissue. It is more often observed when the rectum is damaged and causes its displacement and compression. Characteristic is the presence of retroperitoneal emphysema (see).

Hemoperitoneum- accumulation of blood in the peritoneal cavity. Diagnosed using survey and targeted radiography of the abdominal cavity. When lying on the back, blood accumulates in the lateral parts of the abdomen and gives intense ribbon-like shadows with a clear outer and polycyclic inner contour. The width of the darkening depends on the amount of blood in the abdominal cavity and can reach several centimeters. If there is little blood, laterography is indicated.

Hydropneumoperitoneum- accumulation of fluid and air or gas in the peritoneal cavity. On radiographs there is a horizontal level at the boundary of two media: gas and liquid. When examining in the lateroposition, you can detect an additional symptom of the presence of fluid in the peritoneal cavity - a symptom of floating intestinal loops.

Abdominal hernia- a hernia in the formation of which the abdominal organs are involved. Occurs in 3-4% of the population. In a hernia, it is customary to distinguish between the hernial orifice, the hernial sac and the contents of the hernia. A hernial orifice is a natural or acquired as a result of injury or surgery opening in the abdominal wall through which hernial contents protrude. The hernial orifices are most often the inguinal (inguinal hernia) and femoral canals (femoral hernia), an extended umbilical ring ( umbilical hernia) etc. The hernial sac is part of the parietal layer of the peritoneum, which protrudes through the hernial orifice. The contents of the hernial sac can be any of the abdominal organs. More often there are loops of the small intestine, less often - the omentum, mobile parts of the colon, bladder, etc. To clarify the nature of the hernial contents, an X-ray examination with contrast of the intestines or bladder and their subsequent radiography are often used.

Douglas abscess- a limited accumulation of pus in the rectovesical cavity in men or in the rectouterine cavity in women. Characterized by pain in the lower abdomen, increased body temperature, leukocytosis, and the presence of a painful infiltrate in the pelvis (see Pelviorectal abscess).

The stomach is sharp- a clinical concept that combines a number of acute diseases of the abdominal organs that are subject to urgent surgical intervention. Common to all acute diseases is abdominal pain, the localization and intensity of which depend on the cause that caused it. In cases where clinical examination data do not allow us to confidently establish the nature of the pathology that caused the development of acute abdomen syndrome, urgent X-ray examination is resorted to. It can be used to detect free gas or liquid in the abdominal cavity (see Hemoperitoneum. Pneumoperitoneum), signs intestinal obstruction(see), symptoms acute bleeding(see) etc.

Appendicular infiltrate- infiltrate that developed during appendicitis (see). On survey photographs it appears as a gentle shadow in the area where the appendix is ​​located. During irrigoscopy, rigidity and flattening of the dome of the cecum are clearly revealed, often along the inferomedial contour; sometimes a semi-oval or flat marginal filling defect is determined. When studying the relief of the mucosa after emptying the colon from a barium suspension, its changes are not determined, but the extraintestinal location of the infiltrate is more clearly revealed. The angiographic picture is the same as with post-appendiceal infiltrate (see).

Post-appendicular infiltrate- infiltration that occurred after appendectomy. On a targeted radiograph it gives a gentle shadow, and on angiography it has typical signs of an inflammatory process: hypervascularization without atypia, elongation of the arteries, low-intensity homogeneous staining.

Calcification of mesenteric lymph nodes- deposition of calcium salts in the lymph nodes. It is observed mainly when they are affected by tuberculosis, but can occur when typhoid fever, dysentery, chronic appendicitis and other diseases. On a radiograph, calcification of the mesenteric lymph nodes appears as multiple inhomogeneous, speckled shadows, approximately circular in shape. The shadows are loose, crumbly, and fragmented. The localization of such nodes corresponds to the position of the mesentery and is determined in the direction from the right sacroiliac joint obliquely to the left upward to the left edge of the body of the second lumbar vertebra. Most often, calcified lymph nodes are identified in the left part of the abdomen, less often - on both sides, on the right, in the center of the abdominal cavity. On an X-ray of the abdomen in a direct projection, the shadows of the nodes are localized near the spine, which is typical for them. If the abdomen is examined with a trochoscope, the calcified mesenteric lymph nodes are easily displaced upon palpation. Their shadows on radiographs taken at different times appear in different positions, which is also very characteristic of them.

Greater omentum cyst- a consequence of blockage of the lymphatic pathways and proliferation of lymphatic tissue. Like a mesenteric cyst, it has a thin wall and often contains serous fluid. Diagnosed using omentography and x-ray examination of the intestine. The loops of the latter cyst are displaced, and not moved apart, as with ascites (see).

Hemorrhage- accumulation of blood spilled from vessels in tissues or cavities of the body.

K. intraperitoneal- hemorrhage into the slit-like spaces between the abdominal organs lined by the peritoneum and the abdominal wall. It is observed mainly in traumatic injuries of the abdominal organs (see), wounds of the abdomen (see) and its organs (see Hemoperitoneum). An important diagnostic method is abdominal angiography, which detects deformations, displacements, broken arteries, contrast defects in the parenchymal phase, etc.

Abdominal lymphoma- the general name for tumors arising from the lymphoid tissue of the abdominal cavity (see Lymphosarcoma of the abdominal cavity. Lymphosarcomatosis of the abdominal cavity).

Lymphosarcoma of the abdominal cavity- a malignant tumor of immature lymphoid cells of the lymphatic system of the abdominal cavity. Manifested by enlarged retroperitoneal and mesenteric lymph nodes. Large conglomerates of mesenteric lymph nodes cause the formation of multiple marginal filling defects in adjacent intestinal loops. As a result, its contours become scalloped, the lumen is uneven, and fluid accumulates in it. In this case, symptoms of emptiness and marginal usuration of the contours of the contrasted small intestine are common. In isolated cases, the area of ​​transition from the duodenum to the jejunum is displaced downward. Sometimes, with a significant increase in the retroperitoneal lymph nodes, a slight displacement of the stomach to the right and anteriorly is noted. Lymphosarcoma is characterized by a low level of vascularization. Blood supply to tumor nodes is carried out by short, thin, tortuous arteries that arise directly from the aorta and form a subtle, delicate vascular network in the lesion. Limited stenosis of the common hepatic artery may be observed in the form of constrictions, alternating with areas that have a normal lumen, an arched displacement of the trunk of the superior mesenteric artery anteriorly, a violation of the architectonics of the small arteries of the pancreas, displacement and compression of the branches of the portal vein and other changes in the visceral vessels.

Lymphosarcomatosis of the abdominal cavity- a generalized form of lymphosarcoma, characterized by multiple lesions of the lymph nodes, and subsequently – damage to the liver and spleen. Enlarged lymph nodes cause the intestinal loops to move apart, forming “voids” in the abdominal cavity. Due to compression of the intestinal loops, their lumen can narrow, and in the pre-stenotic sections, expand, which contributes to a long-term retention of barium suspension. The relief of the intestinal mucosa is often preserved. To determine the location of the pathological formation, inflating the colon with air (pneumocolonography) is often used.

Lipoma perirenal- lipoma located in the perirenal fatty tissue. It can displace the kidney to the opposite side of the retroperitoneal space. Diagnosed using pneumoretroperitoneum, tomography and urography.

Abdominal liposarcoma- a malignant tumor that develops from the adipose tissue of the abdominal cavity. For diagnosis, pneumoperitoneum, pneumoretroperitoneum, angiography, etc. are used. Angiography is especially valuable, which allows in 70-75% of cases to identify the angiographic symptom complex of malignancy: newly formed vessels, tumor contrast, infiltration of individual vessels. In liposarcoma, more often than in other tumors, the newly formed vessels are more or less uniform in structure and course. Typically, an uneven distribution of thin, arachnoid, convoluted, devoid of their ordinal branches, poorly contrasted newly formed vessels is observed, forming an irregular network in the lesion. With hypervascularization of the tumor, newly formed vessels can often have multiple saccular and fusiform expansions and chaotic distributions, which gives the vascular pattern a looping character. An excess number of such vessels occurs, as a rule, along the periphery of the tumor, while hypo- or avascular areas are noted in its center. Retroperitoneal liposarcomas sometimes form an extensive avascular zone. Signs of tumor infiltration of blood vessels are their usuration and uneven narrowing, occlusion (mainly veins).

Mesadenitis- inflammation of the lymph nodes of the intestinal mesentery. Can be acute or chronic. Acute mesadenitis is characterized by rapid development and manifests itself as cramping, less often constant pain in the lower right quadrant of the abdomen or around the navel, increased body temperature. Chronic mesadenitis is usually of tuberculous etiology, manifested by short-term periodic abdominal pain of uncertain localization, pain along the mesentery of the small intestine, sometimes constipation or diarrhea. X-ray examination reveals a disorderly arrangement of loops of the small intestine, persistent ileospasm or infiltrative-ulcerative changes in the ileocecal part of the intestine. With a long-term caseous process, a survey image can reveal calcifications in the lymph nodes of the abdominal cavity. Most often they are located to the right of the III-IV lumbar vertebrae or in the right iliac region. Using angiography, a disturbance in the branching of the portal vessels is determined in the form of changes in the angles of fusion of individual veins and their arcuate curvature.

Sclerosing mesenteritis- inflammation of the mesentery, accompanied by fibrosis, wrinkling of the mesentery and the formation of adhesions between the loops of the small intestine. Clinical picture not pathognomonic and rarely allows for a correct diagnosis. Patients' complaints include malaise, abdominal pain, vomiting, diarrhea or constipation, and a mild increase in temperature. When palpating the abdomen, a thickened mesentery can be detected. During an X-ray examination, the separation of intestinal loops is determined with the formation of voids formed by a thickened and wrinkled mesentery. The lumens of the loops of the small intestine are often narrowed; their walls have persistent impressions with no serration along the contour of the deformed section of the intestine.

Abdominal mesenchymoma- a tumor arising from several derivatives of mesenchyme (fatty, fibrous, vascular and loose connective tissue). Can be benign or malignant. Angiography has great diagnostic capabilities. The tumor is characterized by an incomplete malignancy syndrome, and the severity and frequency of angiographic signs are directly dependent on the size and location of the tumor. The malignancy of the process can only be established if the volume of the lesion is sufficiently large. The tumor vascular shadow itself appears as scattered, small branches, forming a faintly noticeable atypia of angioarchitecture in the lesion. Large vascular lines - the abdominal aorta, the inferior vena cava, the iliac vessels are displaced and arched. The branching of parietal and visceral vessels is disrupted. The latter are close to each other or, conversely, fan-shaped, which depends on the location, size, and direction of growth of the tumor. At the same time, the area of ​​distribution of individual vessels and the number of their peripheral branches increases. If tumor process limited, mild vascular changes are detected in the flanks of the retroperitoneal space. A slowdown in blood circulation in the lesion and “staining” of the tumor are essentially the main indicators of the malignancy of the process.

Mesoilitis- inflammation of the ileal mesentery, manifested by symptoms of enteritis (see) or colitis. Often complicated by partial intestinal obstruction.

Mesosigmoiditis- inflammation of the mesentery of the sigmoid colon, manifested by symptoms of colitis.

Peritoneal mesothelioma- a tumor developing from the peritoneal mesothelium. It can have localized (pedunculated or broad-based) and diffuse forms. The clinical picture of the initial stage of the tumor is very unclear. Symptoms appear when the function of the abdominal organs is impaired due to the growth of a tumor into them. Patients complain of discomfort and abdominal pain without clear localization, nausea, sometimes loss of appetite, intermittent diarrhea and constipation. Gradually, fluid with a large amount of protein accumulates in the abdominal cavity, but does not always contain tumor cells. If the form of peritoneal mesothelioma is localized, the tumor can be palpated in the abdomen. However, diagnosis is extremely difficult. With the help of pneumoperitoneum and peritoneography, in a localized form, a semi-oval or polycyclic formation can be detected on the parietal peritoneum With clear contours on a wide base adjacent to inner surface abdominal cavity. During X-ray examination of the digestive tract, the relief of the mucous membrane is usually preserved. Laparoscopy and laparotomy are also used for diagnostic purposes.

Violation of mesenteric circulation- diagnosed by contrast examination of the intestines and blood vessels (aortography, celiacography, upper and lower mesentericography). Direct radiological signs are: expansion and thickening of the folds of the intestinal mucosa, thickening of the entire intestinal wall as a manifestation of edema due to With eating disorders. Specific radiological symptoms include the identification of submucosal hemorrhages (symptoms of depression, fingerprint and pseudotumor) and the presence of gas in the intestinal wall or portal vein system. With thrombosis of the mesenteric veins, plain radiographs of the abdominal cavity reveal a symptom of a rigid loop. If the swelling of the wall of the affected area of ​​the small intestine is pronounced, its lumen narrows and on radiographs the gas in this section of the intestine appears in the form of one or two narrow crescent-shaped strips, localized close to each other and separated by a darkening stripe, which is caused by the walls of the adjacent intestines. When the patient's position changes, the localization and configuration of these strips of gas are preserved, the distance between them does not change. This indicates the rigidity of the intestinal wall, its fixation and the absence of fluid both inside the lumen of the narrowed area and between the loops. Dynamic observation indicates an increase in the degree of edema of the wall and folds of the intestinal mucosa, and rigidity of the contours of the affected area. The presence of gas in the form of long narrow or irregularly shaped strips and bubbles in the thickness of the intestinal wall is a serious sign of gangrene. Gas in the portal vein system is determined in the form of radially diverging stripes of clearing against the background of the shadow of the liver. Indirect radiological signs of impaired mesenteric circulation are symptoms of functional intestinal obstruction (see). To identify the reason why mesenteric circulation is impaired, it is advisable to first do general aortography, and then, if necessary, selective upper or lower mesentericography. Angiographic symptoms are partial or complete absence of contrast in one of the abdominal arteries, retrograde contrast of its branches, and the presence of collateral circulation. With arterial thrombosis, signs of atherosclerosis are usually observed: uneven contours of the vessel, uneven narrowing of the lumen. In the case of embolism, signs of arterial atherosclerosis are usually absent and the “break” line of the vessel appears convex.

Omentite- inflammation of the omentum. For diagnosis, omentography is used, which consists of introducing colloidal solutions or suspensions of radiopaque substances into the abdominal cavity. Enlargement of the omentum due to inflammatory infiltration is detected. Clinically, acute omentitis manifests itself as symptoms acute abdomen(cm.). Chronic inflammation omentum, as a rule, is a consequence of acute omentitis, but sometimes has a specific (usually tuberculous) character. In this case, the affected area of ​​the omentum thickens due to the development of connective tissue and the formation of adhesions with the abdominal organs (see Adhesive disease).

Metastatic abdominal tumor- localized most often in the lesser and greater omentum, mesentery of the small and large intestines. During a routine X-ray examination of the digestive tract, displacement (compression) is observed. internal organs, and urography can reveal obstruction and disruption of the dynamics of emptying the urinary organs. With the help of pneumo-retroperitoneum, it is possible to establish the retroperitoneal localization of the tumor and clarify its relationship with surrounding organs. IN advanced cases this diagnostic method is ineffective, since gas injected into the retroperitoneal space does not penetrate to the affected side. Angiography determines changes in the course and nature of branching of the parietal branches of the aorta, lumbar and lower intercostal arteries, their lengthening, expansion, and increase in the number of ordinal branches; individual vessels go around the tumor nodes, thereby emphasizing their contours. Sometimes it is possible to identify a network of small newly formed vessels, “staining” of nodes without their clear outlines, disruption of the architectonics of the ascending lumbar veins, pronounced collateral circulation and discharge of blood into the inferior vena cava.

About. n. neurogenic- a tumor emanating from nerve trunks, most often from Schwann membrane cells and elements of their connective tissue membranes, from the ganglia of the sympathetic nervous system, located mainly on both sides of the abdominal aorta.

It does not appear clinically for a long time. Reaching large sizes, displaces and compresses neighboring organs, causing disruption of their function. As a rule, it is avascular and is characterized by symptoms of displacement and infiltration of vascular lines and adjacent anatomical formations. Often located paravertebrally and intimately connected with the aorta and inferior vena cava. A slight deflection and unevenness of the wall of the contrasted aorta, and occasionally a narrowing of its lumen at this level, are detected. And from the inferior vena cava, as a rule, there is a clear violation of the patency and integrity of the vascular walls. Marginal defects, deformation of the trunk of the inferior vena cava, and contrasting of collaterals transporting blood into the azygos vein system are revealed. In common forms of malignant tumors, along with damage to the inferior vena cava, the common iliac vein may be involved in the pathological process. Then there is an asymmetrical narrowing in a limited area, expansion of the veins below the site of infiltration vascular wall, outflow of contrasted blood through deep venous collaterals through the sacral and ascending lumbar veins into the azygos vein. At the same time, there is a reflux of contrasted blood into the iliac vessels of the opposite side, which are not affected by the tumor process. Direct germination into the kidney or ureter is also typical, which causes deformation of their contours and disruption of the dynamics of emptying the upper urinary tract.

About. n. inorganic- is rare, ranges from 0.03 to 0.3 % all neoplasms. The source of its development can be: the walls limiting the abdominal cavity; tissues and anatomical formations located between the organs of the abdominal cavity and retroperitoneal space; tissues of embryonic origin, for example, the rudiments of the genitourinary organs, etc. Tumors can be benign and malignant, but a clear line between them cannot be drawn, since relapses after their removal occur in 70% of cases, regardless of whether elements of malignancy are present or absent.

Clinical picture of non-organ tumors, especially in early stages development, rather poor and uncertain and can be observed in a wide variety of processes in the organs of the abdominal cavity and retroperitoneal space. When the tumor reaches a significant size, general and local symptoms diseases. The first include an unreasonable increase in temperature, general weakness, progressive emaciation, the second - gastrointestinal discomfort, a feeling of heaviness, pain in the abdomen, back, sometimes radiating to the leg, the presence of a tumor detected in the abdomen, dysuric disorders.

Radiological signs depend on the location of the tumor and the research technique used. If the tumor is located in the epigastric region, then by contrasting the digestive tract, it is possible to obtain indicators of indirect symptoms of the disease: displacement of the stomach upward, to the right, to the left, deformation of the posterior wall of the stomach with an increase in the retrogastric space, narrowing of the lumen of the stomach, limitation of its displacement, dysfunction of the organ. Combined urography and cholecystography reveal renal dysfunction on the affected side, deformation cavity system, rotation and displacement of the kidney, change in shape, upward and sideways displacement, limited mobility, blurred contours, impairment due to compression of the contractile and concentrating ability of the gallbladder. When the tumor is localized predominantly in the mesogastric region, one can detect displacement of the jejunal loops to the side, upward, forward, blurring of their contours, narrowing of the lumen with impaired patency and limited mobility. Possible displacement various departments colon, restriction of their mobility, deformation of the contours, even narrowing of the lumen with impaired patency. In the conditions of pneumocolonography and pneumogastrography, it is often possible to identify the lumpy outlines of a tumor, causing deformation and unevenness of the contours of the stomach and colon. Pneumoretroperitoneum has great diagnostic potential. Using tomography for pneumoretroperitoneum, the size and contours of the tumor are well determined. Lymphograms reveal central and marginal filling defects in lymph nodes, an increase in their size, a block of lymph flow paths at the level of the lesion, a displacement of the chain of lymph nodes and vessels, a change in lymphangioarchitecture. When the tumor is localized in the pelvis, in some cases it is possible to obtain a darkening of the iliac region with unclear contours. The common form of a non-organ malignant tumor is usually not surrounded by gas, or there is only a partial “envelopment” of it in pneumo-retroperitoneum. Often, tumors of this location cause displacement of the distal parts of the ureters, blurring of their contours and suprastenotic expansion of the lumen, as well as deformation of the bladder, lymphatic vessels and nodes.

Along with general x-ray semiotics, some non-organ tumors have their own characteristics (see Lymphosarcoma of the abdominal cavity. Liposarcoma of the abdominal cavity. Mesenchymoma of the abdominal cavity. Peritoneal mesothelioma. Retroperitoneal tumor. Neurogenic tumor of the abdominal cavity. Abdominal sarcoma. Teratoblastoma of the abdominal cavity).

Retroperitoneal tumor- clinically manifests itself late, often reaching large sizes. Sometimes it is discovered by chance when palpating the abdomen or when there is a feeling of heaviness in the abdomen due to a large tumor, or when symptoms occur. neighboring organs: nausea, vomiting, constipation, bloating and even intestinal obstruction, urination disorder. TO late symptoms include an increase in body temperature due to tumor disintegration, as well as signs caused by impaired venous and lymphatic outflow (ascites, dilatation of the saphenous veins of the abdomen, congestion in lower limbs and etc.).

If the tumor is localized predominantly in the epigastric region, it causes a displacement of the stomach upward and to the right or left, deformation of its posterior wall with a narrowing of the lumen and an increase in the retrogastric space. Characterized by the absence of a clear outline of the contours of the tumor, the absence of signs of displacement of the colon, the expansion of the kidney shadow due to its flattening (compression from front to back), and the medial displacement of the contour of the lumbar muscle.

Localization of processes in the mesogastric region is accompanied by displacement (spreading) of the loops of the small intestine, as well as various parts of the colon laterally, upward, anteriorly, restriction of their mobility, narrowing of the lumen and impaired patency of compressed areas of the intestine.

Retroperitoneal tumors, located predominantly in the hypogastric region, push the descending colon anteriorly and medially, expand the sigmoid colon and compress the rectosigmoid colon. When the process is localized in the small pelvis, displacement of the cecum, sigmoid and rectum is determined, accompanied by a narrowing of their lumen and limited displacement (see Non-organ tumor of the abdominal cavity).

Plain radiography of the abdomen and urography are extremely valuable in diagnosis. After this, a contrast study of the digestive tract is performed, and, if necessary, angiography.

Transfemoral aortography has great diagnostic capabilities. It allows you to determine the size, contours and blood supply of the tumor, its relationship to the aorta and large arteries. Accumulation usually speaks in favor of a malignant nature contrast agent like small lakes or puddles (see Inorganic tumor).

Paracolite- inflammation of the fiber located in the retroperitoneal space behind the ascending and descending colons. Radiologically, it is manifested by deformation of these sections and the lack of their displacement; a change in the relief of the mucous membrane and the presence of intestinal dyskinesia are possible.

Parametritis- inflammation of the parametrium, which can be lateral, posterior and anterior. With lateral parametritis, the process is localized between the leaves of the broad ligament to the right and (or) left of the uterus, with posterior parametritis - between the uterus and bladder. Diagnosed using X-ray pneumopelviography in combination with metrography.

Paraproctitis- inflammation of the tissue located near the rectum and anus. There are acute and chronic paraproctitis, diffuse (pararectal phlegmon) and limited with the formation of abscesses. Chronic paraproctitis is characterized by fistulas (see).

Paracystitis- inflammation of the tissue located near the bladder. The process can be localized in the retropubic space and behind the bladder, then it is called prevesical and retrovesical paracystitis, respectively, which can be acute or chronic. Cystograms reveal symptoms of compression of the bladder from the outside by inflammatory infiltrate, which leads to various types bladder deformities. Polycystography is very valuable, allowing one to find out the cause of urination problems.

Periadnexit- inflammation of the peritoneum covering the uterine appendages (see Adnexitis).

Periappendicitis- inflammation of the peritoneum covering the appendix; causes adhesive process in appendicitis (see).

Perivisceritis subhepatic- adhesive peritonitis (see), localized on the lower surface of the liver and on the surface of nearby organs.

Perigastritis- inflammation of the peritoneum covering the stomach. More common is adhesive perigastritis, which is characterized by the development of adhesions, disturbances in the shape and motility of the stomach.

Perihepatitis- inflammation of the peritoneum covering the liver and its fibrous membrane (capsule). If perihepatitis is nodous, small fibrous areas are formed, serous - it thickens and thickens fibrous membrane liver, if sclerosing, its sclerosis and hyalinosis develop. There is also cancerous perihepatitis, which is observed in liver or peritoneal cancer. With pneumoperitoneum, diffuse adhesions are found that fix the liver.

Periduodenitis- inflammation of the peritoneum covering the duodenum and (or) tissues adjacent to back wall intestines. With diffuse periduodenitis, the process is distributed evenly over the entire outer surface of the duodenum, with supramesenteric periduodenitis, it is localized in the area of ​​the proximal part of the intestine above the place of its intersection with the root of the mesentery of the transverse colon, with submesenteric periduodenitis - in the area of ​​the distal part of the duodenum below the place of its intersection with the root mesentery of the transverse colon. Radiographs reveal deformation of the duodenum, displacement, fixation and narrowing of its lumen. Periduodenitis of ulcerative origin causes characteristic changes in the bulb in the form of a trefoil, a candle flame, an hourglass with the formation of narrowings and diverticulum-like protrusions (pockets). Its contours are uneven, jagged, and displacement is limited.

Congenital periduodenitis- a developmental anomaly characterized by the presence of strands in the abdominal covering of the duodenum, externally resembling multiple inflammatory adhesions.

Pericolitis- inflammation of the peritoneum covering the colon. Accompanied by deformation and change in the normal position of the intestine, a violation of its mobility, the formation of kinks, narrowing of the lumen, slowing down the passage of contents, and flatulence. In this case, neighboring loops of intestine can be fixed with adhesions. Fusion of the intestine with the anterior abdominal wall or adjacent organs is also possible. When the touching walls of two adjacent loops are soldered, they can form a double-barreled gun that does not straighten during irrigoscopy (see Payra syndrome).

Perimetritis- inflammation of the peritoneum covering the uterus. May be adhesive and exudative. Adhesive perimetritis is characterized by the formation of adhesions between the uterus and neighboring organs. Adhesions are well diagnosed using X-ray pneumopelviography. Exudative perimetritis is manifested by the presence of exudate in the abdominal cavity (see Symptom of free fluid).

Perisalpingitis- inflammation of the peritoneum covering the fallopian tube.

Perisalpingoophoritis- inflammation of the peritoneum covering the fallopian tube and ovary (see Adnexitis).

Perisigmoiditis- inflammation of the peritoneum covering the sigmoid colon.

Perityphlitis- inflammation of the peritoneum covering the cecum, with the formation of infiltrate or adhesions (see Typhlitus. Typhlocolitis).

Peritonitis- inflammation of the peritoneum, which can be local and general. With local peritonitis, the process is localized only in some part of the peritoneal cavity. General peritonitis is a generalized, diffuse, diffuse peritonitis that has spread to the entire surface of the peritoneum. According to the nature of the exudate, peritonitis is hemorrhagic, purulent, serous, fibrinous, and according to the clinical course - acute and chronic. Acute peritonitis begins suddenly and develops quickly. As an independent disease it occurs very rarely. Chronic peritonitis develops gradually over a long period of time. Acute peritonitis can be a complication of appendicitis (appendicular peritonitis), the result of perforation of a typhoid ulcer, more often of the small intestine in typhoid fever (typhoid peritonitis), inflammation of the internal female genital organs (genital peritonitis), develop when infected bile enters the abdominal cavity, for example in the case of perforated cholecystitis (bile peritonitis), with septicopyemia with purulent metastases in the peritoneum (septic peritonitis), with closed and open damage abdominal organs, thrombosis and thromboembolism in the vessels of the intestinal mesentery, etc.

The clinical picture of the initial stage of acute peritonitis is characterized by increased body temperature, dry tongue, increased heart rate, abdominal pain, nausea, vomiting, and tension in the walls of the abdominal cavity. Subsequently, the heart rate increases, it becomes thread-like, the tongue becomes dry (like a brush), and bloating appears. X-ray diagnosis of diffuse peritonitis is based on detecting signs of functional intestinal obstruction and free fluid in the abdominal cavity. In addition, bloating of the stomach, intestinal loops, and the presence of small intestinal arches with rounded ends (in the absence of fluid in the intestinal lumen) or with unclear horizontal fluid levels located at the same height are detected. The intestinal wall is thickened due to edema, its contours are unclear. Free fluid is found in the pelvis and lateral canals. A darkening stripe appears between the swollen intestinal loops. Typically homogeneous darkening of the abdominal cavity, preventing the differentiation of anatomical details (see Acute abdomen).

If the amount of free fluid in the abdominal cavity is small, it is often very difficult to detect. In such cases, peritoneography is recommended. In the initial stage of peritonitis, free fluid is detected as small accumulations in the abdominal cavity. The injected water-soluble contrast agent is absorbed unevenly (locally), the phenomena of intestinal paresis are poorly expressed. The contrast agent appears in urinary tract after 10-12 minutes, and is present in the abdominal cavity up to 2-4 hours after administration. In the second stage of peritonitis, large accumulations of free fluid are observed; the injected contrast agent remains in the abdominal cavity as a depot for several hours; the absorption function of the peritoneum is severely impaired. The latter is confirmed by the late appearance of contrast in the urinary tract - 2-4 hours after administration. Symptoms of intestinal obstruction are more pronounced. However, due to the absorption of the contrast agent through the wall of the colon, it is contrasted and clearly visible on radiographs. In the third, terminal stage, intestinal obstruction worsens, a significant amount of free fluid is detected in the abdominal cavity, and absorption of the contrast agent from the abdominal cavity completely stops.

With limited peritonitis, there is an inflammatory infiltrate (see) or an abscess (see) in the abdominal cavity. Chronic peritonitis often occurs as perivisceritis, adhesive peritonitis, causing deformation of the abdominal organs. The types of adhesive peritonitis are fibrous and sclerosing. With fibrous peritonitis, fibrous adhesions form in the form of extensive cords and bridges in the abdominal cavity, with sclerosing peritonitis - dense cicatricial adhesions.

Cancerous peritonitis- disseminated peritoneal cancer, characterized by the formation of numerous small plaques and nodules, usually of metastatic origin.

Syphilitic peritonitis- chronic peritonitis due to syphilis, characterized by the formation of gummas on the peritoneum. In addition to clinical and radiological signs of chronic peritonitis, the fact of the disease, the patient with syphilis and a positive Wasserman reaction are important for diagnosis.

Tuberculous peritonitis- chronic adhesive or exudative peritonitis with peritoneal tuberculosis. With exudative peritonitis in the peritoneal cavity there is a serous effusion and millet-like rashes on the peritoneum, with adhesive peritonitis there is an abundance of dense adhesions between the intestinal loops. There is also a nodular-tumor-like form of tuberculous peritonitis. It is characterized by large nodular tumor-like formations - a consequence of extensive adhesions between intestinal loops, the greater omentum and the parietal peritoneum.

Tuberculous peritonitis occurs without a clear clinical picture. In patients with weight loss, vague abdominal pain (sometimes cramping or dull), dyspeptic disorders, and a tendency to diarrhea appear. Patients often have a fever, but afebrile course also occurs. IN initial stages palpation of the abdomen reveals very little disease. The dry form of tuberculous peritonitis is established on the basis of the general picture of the disease and the presence of tuberculosis in another location in the patient. An X-ray contrast study determines the fixation of the loops of the small intestine and the ileocecal part of the intestine, the presence of gas in it; sometimes its individual loops are swollen and deformed. The exudative form is easier to recognize, especially in children (see Peritonitis). When palpable tumor-like formations appear, the diagnosis is greatly facilitated. Positive serological tests and laparoscopy help establish the diagnosis.

Peritransversite- inflammation of the peritoneum covering the transverse colon (see Transversitis).

Pericholecystitis- inflammation of the peritoneum covering the infero-posterior and lateral surfaces of the gallbladder, and (or) the connective tissue separating its anterosuperior surface from the liver. X-ray diagnostics is based on the characteristics of the position, shape, size and motor activity of the bladder. If the process is adhesive, the shape of the gallbladder changes and the mobility of the gallbladder is impaired. When the gallbladder is adhesively with the liver, its bottom is pulled up and out, with the duodenum - to the left, with the colon - down. Adhesions cause various deformations of the gallbladder and uneven contours. In the case of pericholecystitis, the acquired deformation of the gallbladder changes as it contracts and is stretched by adhesions, and with variant shapes, the contours of the bladder are smooth, clear, with smooth transitions, and mobility is not impaired. Adhesions cause uneven contours, usually with pointed projections, and limit the mobility of the bladder. Evacuation of bile from the bladder is slowed down. With pericholecystitis, the adjacent sections of the intestine can be deformed, which is clearly determined during their combined simultaneous examination; the position of the bubble in the event of a change in the position of the body of the subject does not change and there is a limitation of its passive displacement, etc.

Pyoperihepatitis- purulent inflammation of the peritoneum covering the liver and its fibrous capsule. Clinically manifested by pain in the right hypochondrium, high body temperature, symptoms of peritoneal irritation and perihepatitis (see Subphrenic abscess. Subhepatic abscess).

Pyopneumoperihepatitis- pyoperihepatitis, in which there is an accumulation of pus and gas in the peritoneal cavity; occurs most often when the stomach or duodenum is perforated.

Pneumoperitoneum- the presence of free gas in the abdominal cavity, which accumulates in its most highly located parts, therefore, to identify it, a polypositional study must be performed. The optimal position for diagnosing pneumoperitoneum is the lateroposition on the left side due to the presence in the image of a sharp contrast between the gas in the form of a segment, crescent or triangle and the abdominal wall, liver and diaphragm. Such laterograms usually reveal even a small amount of gas. With the patient in an upright position, as a rule, it is also possible to detect free gas in the abdominal cavity, but such a position is not always possible in some cases due to the general serious condition of the victim. In order for the gas to have time to rise under the diaphragm, it is recommended to begin the study a few minutes after the patient is transferred to vertical position. On a plain X-ray of the abdomen, gas appears as a narrow crescent under one or two domes of the diaphragm.

Free gas in the abdominal cavity can appear due to a closed injury or wound of the abdomen, perforation of a hollow organ (stomach, intestines), as well as its artificial introduction for diagnostic or therapeutic purposes.

Pneumoren- presence of gas in the perinephric space.

Pneumoretroggeritoneum- presence of air or gas in the retroperitoneal space. For diagnostic purposes, gas is injected into the retroperitoneal space in order to contrast the organs located there (see Retroperitoneal emphysema).

Penetrating abdominal wound- mechanical effect on abdominal tissue, in which the resulting wound channel communicates with the abdominal cavity. X-ray diagnosis in the acute period is based on identifying symptoms of pneumoperitoneum (see) and hemoperitoneum (see), blurred images of parenchymal organs (liver, spleen, kidneys), as well as the presence foreign bodies in the abdominal cavity.

Abdominal sarcoma- a malignant tumor developing from mesenchymal elements. Its X-ray picture resembles mesenchymoma (see). Angiography reveals signs of vascular infiltration, occlusion of individual parietal branches of the abdominal aorta and iliac arteries. Moreover, along with the jagged contours of the walls, the trunk of the vessel is narrowed, elongated, devoid of its ordinal branches, has a forced arrangement and often weak contrast. In large veins, marginal defects of varying lengths with unclear and uneven contours are found. The area of ​​the vein exposed to infiltration is also contrasted less intensely. With the occlusion of small veins of the retroperitoneal space, hypo- and avascular zones are formed, which have different lengths and practically correspond to the size of the neoplasms.

Free abdominal gas symptom- a narrow crescent-shaped strip of clearing between the liver and the diaphragm detected during an X-ray examination of the abdomen (see Sickle symptom) or an accumulation of gas in the upper lateral abdomen on laterograms in the form of a segment, crescent or triangle (see Pneumoperitoneum).

Symptom of free fluid in the abdominal cavity- darkening of various types detected during X-ray examination, caused by the accumulation of liquid contents in the lateral sections of the abdomen, between the loops of the intestines and along the walls of other organs in the form of ribbon-shaped, triangular or polygonal shadows with the patient in a horizontal position and intense uniform darkening in the lower abdomen, resembling in shape crescent, in a vertical position.

Splanchnoptosis- displacement of internal organs downward compared to their normal position. With splanchnoptosis of a functional nature, sluggish peristalsis of the entire gastrointestinal tract, prolonged retention of the contrast agent in the stomach and intestines, and flatulence are observed.

Abdominal teratoma- a tumor-like formation that occurs as a result of a violation of the formation of abdominal tissues in the embryonic period of development. Consists of one or more mature tissues. It can grow and develop in parallel with the growth of the body. Radiologically, in some cases it appears as a very typical, even pathognomonic picture - shadows of teeth, areas of bone, in others - round-shaped formations with areas of calcification.

Abdominal bruise- closed mechanical damage to the tissues of the abdomen and abdominal organs without visible disruption of their anatomical integrity. Presents significant diagnostic difficulties. An emergency X-ray examination should be gentle on the patient and carried out as quickly as possible with maximum efficiency. The choice of volume and technique should be individual, depending on the general condition of the victim. During a survey X-ray examination of patients with closed injury abdomen, the most common signs of a bruise are: the presence of gas in the abdominal cavity or retroperitoneal space; fluid (blood) in the abdominal cavity or retroperitoneum, swelling of the stomach and intestines and their displacement; deformation and displacement of parenchymal organs, violation of the position, shape and function of the diaphragm.

Retroperitoneal fibrosis- proliferation of fibrous connective tissue in the retroperitoneal space, for example as a result of inflammation. Pyeloureterography reveals narrowing of the ureter, usually at the level of its middle third, expansion of the pelvis and cups, and delayed release of contrast agent during urography (see Ormond's disease. Periureteritis).

Retroperitoneal emphysema- presence of air or gas in the retroperitoneal space. On an x-ray, free gas is detected in the form of individual small bubbles or stripes located near the damaged area of ​​​​the intestine or along the psoas major muscle. If there is a lot of gas, then severe emphysema develops not only in the retroperitoneal tissue, but also in the mediastinum. Then it is called dissecting interstitial emphysema (see Pneumoretroperitoneum).

Stuffing box I Stuffing box

a wide and long fold of the splanchnic (visceral) peritoneum (See Peritoneum), between the layers of which there is loose connective tissue, rich in blood vessels and fatty deposits. Large S., consisting of 4 layers of peritoneum, starts from the greater curvature of the stomach, is fixed to the transverse colon and, covering the intestine in front, descends in the form of an apron ( rice. ). Performs protective function for injuries and inflammatory diseases abdominal organs, for example with Appendicitis e. Small S. - doubled peritoneum stretched between the liver, top part duodenum and lesser curvature of the stomach. Large S. is often used to cover sutures during operations on the stomach and intestines, as well as for tamponade of wounds of the liver and spleen. Acute inflammation large S. (epiploitis) can occur as a result of its infection, twisting or injury; accompanied by symptoms of an acute abdomen (See Acute abdomen).

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STUFFING BOX- (omentum, epiploon), large hollows of the peritoneum, going from one organ of the abdominal cavity to another and consisting of leaves of the peritoneum, large and small peritoneal sacs (Fig. 1). Usually C, i.e., the layers of the peritoneum, covers the vascular pedicle, ... ... Great Medical Encyclopedia

Fat fold in the peritoneum * * * (Source: “United Dictionary of Culinary Terms”) Omentum Omentum fat fold in the peritoneum. Dictionary of culinary terms. 2012… Culinary dictionary

In engineering, a seal is a sealed gap between a moving and a stationary part (for example, a piston rod and a cylinder). An oil seal with soft (asbestos, felt, rubber) and hard (e.g. metal) packings is used...

OIL SEAL, oil seal, male 1. A section of the peritoneum rich in fat deposits from the stomach to the lower part of the abdominal cavity (anat.). 2. A type of food from this part of the animal’s body (kul.). 3. A lubricating device at the piston that prevents steam from escaping... ... Dictionary Ushakova

Seal, device, gap, gasket Dictionary of Russian synonyms. omentum noun, number of synonyms: 9 belly (29) ... Synonym dictionary

stuffing box- a, m. sale adj. outdated Loving greasy. Well, how can I go to the mazurka with him as an officer! It would be a key fob for a watch! Dad winced, barking: Oil seal. White beginning of the century. // Star. Arbat 40… Historical Dictionary of Gallicisms of the Russian Language

In anatomy, a wide and long fold of the visceral layer of the peritoneum in mammals and humans, part of the mesentery. Connective tissue oil seal is rich blood vessels and adipose tissue. Protective organ of the abdominal cavity... Big Encyclopedic Dictionary

SEALING, huh, husband. (specialist.). 1. Fat fold in the peritoneum. 2. A part that hermetically closes the gap between the moving and stationary parts of the machine. | adj. omental, oh, oh. Ozhegov's explanatory dictionary. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 … Ozhegov's Explanatory Dictionary

- (omentum), a wide and long fold of the visceral layer of the peritoneum of mammals, in which there is a loose connective tissue, tissue rich in blood vessels and fatty deposits. Large S. double fold of the dorsal mesentery of the stomach, consisting of 4 leaves, ... ... Biological encyclopedic Dictionary

- (Stuffing box, stuffing gland) a part for sealing the gaps between holes and parts moving in them in order to prevent the leakage of liquid or gas. Compaction is achieved through various packings. Samoilov K.I. Marine... ...Marine Dictionary

A sealing device for rods, rods and tubes where they pass through an opening in the wall (lid) separating two spaces with unequal pressure. C. a critical part that serves to prevent the passage (leakage) of steam, water... ... Technical railway dictionary