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根据解剖学记载位于盲肠后位的阑尾,其根部或整体常被腹后壁腹膜所覆盖,处于腹膜外位,当其发炎时由于腹后壁腹膜不如腹前壁腹膜敏感,所以转移痛的部位不很确切、加以阑尾部位较深,腹部检查时腹壁肌肉可无明显肌紧张,压痛和反跳痛也不典型,故易延误诊断。阑尾破溃后可在腹后壁进入腰大肌间隙,形成腰大肌周围脓肿,并可沿髂腰筋膜后间隙向上、向下蔓延.由于患者多为仰卧位,脓肿可向上蔓延形成肾周围脓肿(见图1A)或腹后壁脓肿(见图1B)。这种脓肿向腹腔外穿破时,常在腹后壁结构较为簿弱的腰三角(图2
According to the anatomy of the posterior appendix in the cecum, the root or the whole is often covered by the peritoneum of the posterior abdominal wall, in the extraperitoneal position, when the inflammation of the abdominal wall due to abdominal peritoneal abdominal wall is not as sensitive as the anterior abdominal wall, so the site of pain transfer Not very exact, to the appendix deep, abdominal examination can be no obvious abdominal muscle tension, tenderness and rebound tenderness is not typical, it is easy to delay diagnosis. Appendiceal rupture in the abdominal wall into the psoas muscle space, the formation of psoas around the abscess, and can be along the iliac spine fascia gap up, down spread.Because the patient is mostly supine position, the abscess can spread upward formation of kidney Abscesses around the abdomen (see Figure 1A) or abscesses (see Figure 1B). This abscess to peritoneal perforation, often in the ventral posterior wall structure is relatively weak waist triangle (Figure 2