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Abstract: The presence of lumbar and abdominal pain with wasting needs to be alerted to retroperitoneal fibrosis, which clinically manifests as lumbar and abdominal pain with abdominal distention, weakness, decreased appetite, hematuria, oliguria, and lower limb edema. The patient in this article came to the clinic with symptoms of lumbar and abdominal pain with abdominal distension, weakness and loss of appetite, etc. After performing abdominal CT examination, the initial diagnosis was retroperitoneal fibrosis. After hormonal drug treatment, the patient’s condition was controlled and the symptoms of lumbar and abdominal pain and wasting were relieved.
Basic information】Male, 76 years old
Disease Type】 Retroperitoneal fibrosis
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】March 2022
Treatment plan】Medication (injectable methylprednisolone sodium succinate + methylprednisolone tablets)
Treatment Period】2 days of inpatient treatment, 1 month of outpatient follow-up
Effectiveness】The disease was controlled, appetite was restored, and the pain in the lower back and abdomen was relieved.
I. Initial consultation
A few months ago, a patient came to our hospital with lumbar and abdominal pain, accompanied by abdominal distension, fatigue, and decreased appetite. He indicated that he had only lumbar and abdominal pain 5 years ago, mainly intermittent pain, and thought it was due to overexertion, but the symptoms were not relieved after rest, and self-administered pain medication (specific medication unknown) was not effective, and the pain symptoms increased significantly 1 month ago. After observing the patient’s overall condition, he was found to have a poor complexion and poor spirit. Later, a preliminary examination was performed, and the patient was found to have a mass in the abdomen, and the pain was obvious when pressing on the abdomen. A CT examination of the abdomen was performed and revealed a soft tissue mass shadow visible in the retroperitoneum that encircled the lower abdominal aorta and iliac artery, involved the ureter and inferior vena cava, and could encircle one or even both renal hilar structures, which subsequently led to dilatation of the renal pelvis and calyces. The patient was initially diagnosed with retroperitoneal fibrosis, and was admitted to the hospital for further consultation and treatment.
II. Treatment history
After admission, the patient continued to improve routine blood, glucose, lipid, liver and kidney function, C-reactive protein and other tests, and the results showed that the patient’s hematocrit was increased and C-reactive protein was elevated, thus considering the presence of infection. To further clarify the diagnosis, pathological histological examination was considered, and the patient was clearly identified as having retroperitoneal fibrosis through the results of retroperitoneal puncture biopsy.
The patient was then treated symptomatically and given injectable methylprednisolone sodium succinate, and was hospitalized for 2 days. After observing that the patient had no adverse reactions during the drug administration, all indications were normal, and the condition was controlled, the patient was discharged and the drug was adjusted to oral methylprednisolone tablets.
III. Treatment effect
After a series of examination and medication for 2 days, the patient indicated that the symptoms of lumbar and abdominal pain and abdominal distension had been relieved to a certain extent and the condition was initially controlled, so the patient was discharged and advised to change to oral methylprednisolone tablets and to follow the doctor’s prescription for regular medication. The patient reported that her appetite was gradually restored and her lumbar and abdominal pain had been largely relieved, and the patient’s mass was reduced after a repeat CT examination.
IV. Notes
We are glad that the patient’s condition was controlled and the pain was relieved after treatment, but since the drugs used by the patient after discharge belonged to the glucocorticoid class, the patient and his family still should not take it lightly and should pay attention to the following points in daily life.
1, should closely monitor their own blood pressure, pulse, maintain emotional stability, do not engage in physical labor, more bed rest, to ensure adequate sleep.
2, the patient in taking drugs, if there is a white face, limb pain, abdominal pain and other symptoms, should promptly contact the doctor for treatment, do not stop the drug or change the drug dose without authorization. And regular review to understand the condition of the disease, and adjust the medication at the appropriate time.
3, family members should accompany the patient more often, actively channel the patient’s emotions, pay attention to the patient’s mental state, and avoid aggravating the patient’s psychological burden.
4, patients should pay attention to a light daily diet, avoid spicy and stimulating food, eat more fresh vegetables, and actively supplement nutrients, especially high-quality protein.
5. Patients should exercise appropriately, and it is recommended to take a walk after meals, not to do strenuous exercise to enhance physical fitness.
V. Personal insight
Retroperitoneal fibrosis is due to local fibrous tissue cell proliferation and chronic inflammatory infiltration in the retroperitoneum, resulting in fibrous tissue encapsulation and compression of retroperitoneal organs and important tissue structures, thus causing a series of diseases and symptoms. The etiology of this disease is not clear, and the main symptoms are pain in the back of the lower back, hematuria, oliguria, lower limb edema and other manifestations of retroperitoneal organ compression as the disease progresses, and later abdominal distention, decreased appetite, weakness and general wasting.
After the diagnosis of retroperitoneal fibrosis, the patient was more cooperative and compliant with the treatment. During the treatment period, she followed the doctor’s prescriptions and took her medication on time and reviewed regularly, and the treatment effect was good. In addition, if a patient is diagnosed with retroperitoneal fibrosis, it is recommended to go to a regular hospital and not to take medication on your own to avoid delaying the disease.