What causes omentum inflammation

Important design principles Try once to put two clear plastic bags or cling film on top of each other and move them towards each other. This will hardly be possible because the two sheets are stuck together tightly. Try again by applying a little water between the sheets. Imagine that the cling film is even more stable and tear-resistant, and that the liquid film itself is produced and filled with defense cells. Then you will have understood one of the most important construction principles in the human body. You will find this principle wherever organs are moved against each other. In joints you find the synovial membrane (synovia) and synovial fluid. On the outside of joints, where the skin has to move over the bone (e.g. on the elbow), are found the bursa. But the internal organs also have to move against each other. The entire chest cavity and the lungs are covered with such a thin “film”, the pleura. In the chest area there is also a negative pressure in the space between the two foils, which keeps the lungs apart. The peritoneum The entire abdominal area is also completely covered with such a "foil", both on the abdominal wall side and on the intestines The structure is called the peritoneum or peritoneum. This peritoneum covers a total area of ​​1.6 - 2 square meters, produces approx. 50 ml of fluid per day, contains a large number of pain sensors and is full of immune cells (e.g. white blood cells). The peritoneum is able to rapidly seal injuries, as well as absorb (absorb) fluid and return it to the bloodstream. If inflammation develops in the abdomen (e.g. appendicitis), the peritoneum tries to fight off the inflammation. Liquid is produced to “rinse”, white immune cells are increasingly released into the abdomen and the natural adhesive fibrin is produced. In this phase, during an ultrasound examination in the abdomen, the so-called “free” fluid is found, an indirect sign of inflammation in the abdomen. If the peritoneum cannot “cope” with the inflammation, the blood vessels in the peritoneum multiply, producing the above Factors are increased and pus and so-called fibrin coatings develop. The patient has peritonitis, peritonitis. This is associated with massive pain due to the pain sensors embedded in the abdominal membrane. The large network (greater omentum) The peritoneum has a helper in the abdominal cavity for defending against inflammation. Starting from the transverse part of the large intestine and from the stomach, a fat apron measuring approx. 40 x 30 cm covers the entire front of the abdomen. Doctors call this fat apron the “big net”, Latin omentum majus. This is easy to move and is therefore excellently able to cover and mask inflammation. Consequences of peritonitis or injury As a result of the defense measures, the large mesh and the peritoneum can stick to one another. Scars and adhesions develop. The most common cause of such adhesions are abdominal surgery. Despite multiple attempts with various drugs and substances, surgery has not yet succeeded in avoiding such adhesions. They do not always occur, and adhesions appear less frequently in minimally invasive procedures. Adhesions are often found after appendectomy, gastric and intestinal ruptures and after gynecological operations. The adhesions may restrict the movement of the bowel, which could result in kinks and constrictions. Sometimes you can find strands of growth that pull like a cord through the abdomen (braids). These can constrict the intestine so tightly that it becomes wedged. An intestinal obstruction occurs. Symptoms An acute entrapment of intestinal loops in the abdominal area is noticeable through an acute pain event. There are also strong cramps. Chronic adhesions make themselves noticeable through recurring pain in a constant place. There may be irregular stool and cramps. Both constipation and diarrhea are possible. Diagnostics The adhesions themselves can hardly be visualized and recognized. The ultrasound can sometimes show the restricted mobility of the intestine. In an acute situation, an X-ray image of the abdominal cavity and, if necessary, a computer tomogram can help in addition to the ultrasound in order to reliably prove an intestinal obstruction. X-ray images with contrast medium show a delayed transport of the contrast medium through the intestine, under certain circumstances narrowing and “congestion” of the contrast medium can be detected. Therapy If adhesions are proven, an operative solution of these adhesions is necessary. The best procedure, if possible, is the laparoscopic minimally invasive procedure. In some cases, emergency surgery is required in the case of acute complaints with intestinal obstruction (ileus).
The great network: omentum majus
Typical adhesions in the lower abdomen after gynecological surgery, fatty tissue has grown together with the abdominal wall
Broad adhesions in the right upper abdomen, a loop of intestine is firmly attached to the abdominal wall. Previous operation: removal of the gallbladder via incision in the case of an ulcerated gallbladder
Peritonitis with pus and fibrin in the abdomen; Cause: “ruptured appendix” Immediate operation after admission, patient complained of pain for 48 hours and did not go to the doctor
Extensive adhesion of the large network with the anterior abdominal wall after gastric surgery
Typical, frequent adhesions in the right lower abdomen after appendectomy, there are gaps in which the intestine can become trapped
Cord-like adhesions in the area of ​​the right groin after an inguinal hernia operation, so-called Rutkow technique
Tender adhesions in the right groin region after inguinal hernia operation, Shouldice technique. The thin peritoneum is recognizable through the delicate intergrowth. It covers the entire abdomen as a thin layer.
© Dr. med. J. Ladra 2013
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