Surgical retroperitoneal diseases

Injuries
Injuries of the retroperitoneal space are divided into sharp (penetrating) and blunt (non-penetrating).

Sharp penetrating injury
Sharp injuries of the retroperitoneum are usually caused by sharp objects (gunshot wounds, stab wounds by a knife). Subsequently, bleeding into the retroperitoneal space develops.


 * Clinical picture

Bleeding into the retroperitoneum is often caused by injury to the kidneys, aorta, pancreas, and inferior vena cava. Depending on the intensity of the injury, hemorrhagic shock develops. Abdominal and back pain is present with minor bleeding and the development of the intestinal motility malfunction with paralytic ileus is also possible. Ultrasonography, CT, excretory urography, possibly arteriography are indicated. Subsequently, emphasis is placed on monitoring the patient's overall condition, including blood count checks.


 * Therapy

Sharp penetrating injuries of the retroperitoneum are indicated in the vast majority for surgical revision. The type of surgery depends on the extent and location of the injury.

Blunt non-penetrating injury
Blunt non-penetrating injuries are often combined with injuries to other organs of the abdominal cavity or are part of polytrauma, for example in traffic accidents.


 * Clinical picture

The symptoms depend on the severity of the injury to the individual organs. Bleeding into the retroperitoneal space may follow the injury. If there is a serious aortic injury, hemorrhagic shock develops and the affected person dies in a short time. Other frequent causes of bleeding into the retroperitoneal space include traumatic damage to the pelvic skeleton.


 * Therapy

A surgical solution is usually indicated in case of major bleeding or if damage to the retroperitoneal organs is suspected. In the case of bleeding that has no clinical signs and does not worsen, a conservative procedure can be chosen with continuous monitoring of vital signs and rigorous monitoring of the patient's overall condition.

Idiopathic retroperitoneal fibrosis
Morbus Ormonde, or idiopathic retroperitoneal fibrosis, is a disease whose cause is still unknown. A pathological immune reaction of the organism or a reaction to the long-term administration of analgesics is considered to be the main factor. The disease begins to manifest itself in the area of ​​the sacroanal retroperitoneum with subsequent proximal spread. Damaged (fibrous) tissue compresses blood vessels, nerves and ureters. Rarely, the fibrous tissue can progress even higher and affect the kidneys, stomach and duodenum.


 * Clinical picture

The main symptoms include renal symptomatology due to the oppression of the ureters. The disease manifests clinically as ureterohydronephrosis with reduction of the renal parenchyma. Patients report long-term pain in the lumbar region. On ultrasonography dominates the image of dilation of the upper parts of the ureters and renal pelvis.


 * Therapy

The initial stages can be treated with corticoids or immunosuppressants. A surgical solution is necessary If the disease progresses. During the surgery, both ureters are freed and transposition into the peritoneal cavity is performed. In a very advanced condition it is sometimes necessary to proceed to unilateral or bilateral nephrectomy.

Inflammatory diseases
The most common causes of inflammation are processes spreading from organs located in the retroperitoneum (pancreas, urinary system, appendix, duodenum and large intestine).

Cysts
They arise as a result of inflammatory diseases of some retroperitoneal organs (pancreas), after injuries or as a result of bleeding into the retroperitoneal space. The treatment is surgical and consists of the opening and subsequent drainage of the cystic formation.

Tumors
We distinguish between primary (arising from the tissues of the retroperitoneum) and secondary (metastatic) tumors of the retroperitoneum.


 * Primary tumors

Primary tumors of the retroperitoneum are most often neurogenic, mesodermal, or from embryonic remnants of the urogenital system. They are both malignant and benign. Mesenchymal tumors are the most common. Benign mesenchymal tumors of the region include lipomas, fibromas, hemangiomas and lymphangiomas. Malignant tumors include, for example, liposarcomas and fibrosarcomas. Retroperitoneal tumors of neurogenic origin can be schwannomas and neuroblastomas.


 * Secondary tumors

Secondary tumors most often occur as lymphogenic metastases of almost all malignant tumors. The therapy of secondary tumors depends mainly on the location and histological nature. They are mostly sensitive to cytostatics and radiation treatment.