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Sample records for abdominal wall hernias

  1. Abdominal wall hernia and pregnancy

    Jensen, K K; Henriksen, N A; Jorgensen, L N

    2015-01-01

    PURPOSE: There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. METHODS: A literature search was undertaken in Pub......Med and Embase in combination with a cross-reference search of eligible papers. RESULTS: We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery...... of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported...

  2. Mesh repair of hernias of the abdominal wall

    2003-01-01

    textabstractA hernia of the abdominal wall is a permanent or intermittent protrusion of abdominal contents outside the abdominal cavity through a defect in the abdominal wall. Approximately 75% of all hernias occur in the inguinal region. Other types of hernias of the ventral abdominal wall are incisional, umbilical, epigastric and Spigelian hernia. In chapter 1 an overview of hernias of the abdominal wall is described. The incidence, clinical implications and treatment options and their comp...

  3. Bullhorn hernia: A rare traumatic abdominal wall hernia

    Bimaljot Singh

    2015-01-01

    Full Text Available Traumatic abdominal wall hernia (TAWH is rare despite the high prevalence of blunt abdominal trauma. Bullhorn hernia occurs as a result of a direct blow to the abdominal wall by the horn of a bull, which disrupts the muscles and fascia and leads to hernia formation. We report a rare case of bullhorn TAWH in a 70-year-old patient who presented with swelling at the left lumbar region. The patient was managed by immediate surgical intervention. A surgeon must have high index of suspicion for the diagnosis of this condition as missed hernias in this setting pose a high risk of strangulation and gangrene.

  4. Connective tissue alteration in abdominal wall hernia

    Henriksen, N A; Yadete, D H; Sørensen, Lars Tue

    2011-01-01

    The aetiology and pathogenesis of abdominal wall hernia formation is complex. Optimal treatment of hernias depends on a full understanding of the pathophysiological mechanisms involved in their formation. The aim of this study was to review the literature on specific collagen alterations in abdom...

  5. Mesh repair of hernias of the abdominal wall

    W.W. Vrijland (Wietske)

    2003-01-01

    textabstractA hernia of the abdominal wall is a permanent or intermittent protrusion of abdominal contents outside the abdominal cavity through a defect in the abdominal wall. Approximately 75% of all hernias occur in the inguinal region. Other types of hernias of the ventral abdominal wall are inci

  6. Abdominal Wall Hernias: Various Imaging Features Correlated with the Anatomy of Abdominal Wall at MDCT

    Kim, Shin Young; Shin, Hyeong Cheol; Kim, Sang Won; Kim, Il Young; Kim, Young Tong [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2009-07-15

    Abdominal wall hernias are a common condition. However, they may develop acute complications and require surgical correction in most cases. Hence, the correct radiological examination is requisite for an accurate diagnosis. A multi-detector row CT (MDCT) provides an accurate identification of the anatomy of the abdominal wall, precise hernia type, and helps in the detection of early signs of complication. We report various imaging features of abdominal wall hernias via a MDCT.

  7. Traumatic abdominal wall hernia: A case report and literature review

    Osama S. Al Beteddini

    2016-01-01

    Conclusion: Traumatic abdominal wall hernia presents a diagnostic as well as a therapeutic challenge. The therapeutic approach is governed by a multitude of factors emphasizing the need of a patient-tailored, case by case management plan.

  8. Lateral abdominal wall hernia following blunt trauma - a rare case

    Michael Walsh; Antony Pittathankal; Nnamdi Nwaejike

    2009-01-01

    The presence of superficial bruising, no abnormal signs on abdominal examination and a negative FAST scan of the abdomen may not be enough to rule out intra-abdominal pathology. We report on the usefulness of CT in diagnosing a post-traumatic abdominal wall hernia.

  9. Criteria for definition of a complex abdominal wall hernia

    Slater, N.J.; Montgomery, A.; Berrevoet, F.; Carbonell, A.M.; Chang, A.; Franklin, M.; Kercher, K.W.; Lammers, B.J.; Parra-Davilla, E.; Roll, S.; Towfigh, S.; Geffen, E. van; Conze, J.; Goor, H. van

    2014-01-01

    PURPOSE: A clear definition of "complex (abdominal wall) hernia" is missing, though the term is often used. Practically all "complex hernia" literature is retrospective and lacks proper description of the population. There is need for clarification and classification to improve patient care and allo

  10. Classification of primary and incisional abdominal wall hernias

    F.E. Muysoms (Filip); M. Miserez; F. Berrevoet; G. Campanelli (Giampiero); G.G. Champault; E. Chelala; U.A. Dietz; H.H. Eker (Hasan); I. El Nakadi; P. Hauters; M. Hidalgo Pascual; A. Hoeferlin; U. Klinge; A. Montgomery; R.K.J. Simmermacher; M.P. Simons; M. Śmietański; C. Sommeling; T. Tollens; T. Vierendeels; A. Kingsnorth

    2009-01-01

    textabstractPurpose: A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable. Methods: Several membersof the EHS

  11. [Abdominal wall closure by incisional hernia and herniation after laparostoma].

    Mischinger, H-J; Kornprat, P; Werkgartner, G; El Shabrawi, A; Spendel, S

    2010-03-01

    As hernias and abdominal wall defects have a variety of etiologies each with its own complications and comorbidities in various constellations, efficient treatment requires patient-oriented management. There is no recommended standard treatment and the very different clinical pictures demand an individualized interdisciplinary approach. Particularly in the case of complicated hernias, the planning of the operation should focus on the problems posed by the individual patient. Treatment mainly depends on the etiology of the hernia, immediate or long-term complications and the efficiency of individual repair techniques. Abdominal wall repair for recurrent herniation requires direct closure of the fascia generally using the sublay technique with a lightweight mesh. It is still unclear whether persistent inflammation, mesh dislocation, fistula formation or other long-term complications are due to certain materials or to the surgical technique. With mesh infections it has been shown to be advantageous to remove a polytetrafluoroethylene (PTFE) mesh, while the combination of systemic and local treatment appears to suffice for a polypropylene or polyester mesh. Heavier meshes in the sublay position or plastic reconstruction with autologous tissue are indicated as substitutes for the abdominal wall for giant hernias, repeated recurrences and large abdominal wall defects. A laparostoma is increasingly more often created to treat septic intra-abdominal processes but is very often responsible for a complicated hernia. If primary repair of the abdominal wall is not an option, resorbable material or split skin is used for coverage under the auspices of a planned hernia repair.

  12. Traumatic abdominal wall hernia in two adults: a case series

    Agarwal Nitin

    2009-06-01

    Full Text Available Abstract Introduction Traumatic hernia of the abdominal wall is a rare entity. A large proportion of reported cases are in children with a particular type of injury, i.e. from a handlebar injury. In adults, the presentation can vary substantially and the diagnosis is difficult. We present two cases in adults, with widely varying presentations and management. Case presentations A 40-year-old woman from rural north India presented with a low-velocity blunt injury to the lower abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin, and was hemodynamically stable. An emergency mesh repair of the defect was performed, and she recovered well. A 38-year-old man from rural north India presented with blunt trauma to the abdomen following a motor vehicle accident. He was stable, with a central abdominal parietal wall swelling and bruising. A computed tomography scan revealed herniation of bowel loops in the area with minor intra-abdominal injuries. A laparotomy, resection-anastomosis of the ischemic bowel, and primary repair of the defect was performed and he recovered well. Conclusion Following blunt abdominal trauma, particularly high-velocity injuries, a high index of suspicion must be reserved for parietal wall swellings, as missed hernias in this setting have a high risk of strangulation. Computed tomography is the best aid to diagnosis. Management of each case needs to be individualized.

  13. Abdominal wall reconstruction for large incisional hernia restores expiratory lung function

    Jensen, Kristian K; Backer, Vibeke; Jorgensen, Lars N

    2016-01-01

    BACKGROUND: Respiratory complications secondary to intermittent intra-abdominal hypertension and/or atelectasis are common after abdominal wall reconstruction for large incisional hernias. It is unknown if the respiratory function of this patient group is affected long term or impairs activities...... of daily living. We hypothesized that abdominal wall reconstruction for large incisional hernia would not lead to improved, long-term pulmonary function or respiratory quality of life. METHODS: Eighteen patients undergoing open abdominal wall reconstruction with mesh for a large incisional hernia...... wall reconstruction showed a significantly greater improvement of percent predicted peak expiratory flow compared with patients undergoing colorectal resection. CONCLUSION: Abdominal wall reconstruction for large incisional hernia improved long-term expiratory lung function. Respiratory quality of life...

  14. Abdominal wall hernias-A local manifestation of systemically impaired quality of the extracellular matrix

    Henriksen, Nadia A; Mortensen, Joachim H; Lorentzen, Lea

    2016-01-01

    BACKGROUND: Throughout life, inguinal hernia develops in approximately every fourth man, some of whom develop multiple hernias. If patients at risk of developing multiple hernias could be identified by a serologic biomarker, treatment might be able to be tailored and improved. Evidence suggests...... that abdominal wall hernia formation is associated with altered collagen metabolism. The aim of this study was to evaluate biomarkers for type IV and V collagen turnover in patients with multiple hernias and control subjects without hernia. METHODS: Venous blood was collected from 88 men (mean age, 62 years...

  15. WSES guidelines for emergency repair of complicated abdominal wall hernias

    M. Sartelli (Massimo); F. Coccolini (Federico); G.H. van Ramshorst (Gabrielle); G. Campanelli (Giampiero); V. Mandala; L. Ansaloni (Luca); E.E. Moore (Ernest); A. Peitzman (Andrew); G.C. Velmahos (George ); F.A. Moore (Fredrick); A. Leppaniemi (Ari); C.C. Burlew (Clay); W.L. Biffl (Walter); K. Koike (Kaoru); Y. Kluger (Yoram); G.P. Fraga (Gustavo); C.A. Ordonez (Carlos); S. Di Saverio (Salomone); F. Agresta; B. Sakakushev (Boris); I. Gerych (Igor); I. Wani (Imtiaz); M.D. Kelly (Michael ); C.A. Gomes (Carlos); M.P. Faro Jr (Mario); K. Taviloglu (Korhan); Z. Demetrashvili (Zaza); J.G. Lee (Jeong ); N. Vettoretto (Nereo); G. Guercioni (Gianluca); C. Tranà (Cristian); Y. Cui (Yijun); K.Y.Y. Kok (Kenneth); W.M. Ghnnam (Wagih); A.E.S. Abbas (Ashraf El-Sayed); N. Sato (Norio); S. Marwah (Sanjay); M. Rangarajan (Muthukumaran); O. Ben-Ishay (Offir); A.R.K. Adesunkanmi (Abdul Rashid); H.A. Segovia Lohse (Helmut); J. Kenig (Jakub); V. Mandalà (Vincenzo); A. Patrizi (Andrea); R. Scibé (Rodolfo); F. Catena (Fausto)

    2013-01-01

    textabstractEmergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergenc

  16. Experimental modeling hernia of anterior abdominal wall with abdomino-visceral obesity

    KHAYITOV ILKHOM

    2016-01-01

    Improve the results of treatment of patients with postoperative ventral hernias, and based on the study of changes in the anterior abdominal wall of the experimental method of modeling To achieve this goal the first objective of the study was to develop an adequate experimental model of postoperative ventral hernias.

  17. Adult abdominal hernias.

    Murphy, Kevin P

    2014-06-01

    Educational Objectives and Key Points. 1. Given that abdominal hernias are a frequent imaging finding, radiologists not only are required to interpret the appearances of abdominal hernias but also should be comfortable with identifying associated complications and postrepair findings. 2. CT is the imaging modality of choice for the assessment of a known adult abdominal hernia in both elective and acute circumstances because of rapid acquisition, capability of multiplanar reconstruction, good spatial resolution, and anatomic depiction with excellent sensitivity for most complications. 3. Ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment, whereas MRI is beneficial when there is reasonable concern that a patient\\'s symptoms could be attributable to a hernia or a musculoskeletal source. 4. Fluoroscopic herniography is a sensitive radiologic investigation for patients with groin pain in whom a hernia is suspected but in whom a hernia cannot be identified at physical examination. 5. The diagnosis of an internal hernia not only is a challenging clinical diagnosis but also can be difficult to diagnose with imaging: Closed-loop small-bowel obstruction and abnormally located bowel loops relative to normally located small bowel or colon should prompt assessment for an internal hernia.

  18. European Hernia Society guidelines on the closure of abdominal wall incisions

    Muysoms, F E; Antoniou, S A; Bury, K

    2015-01-01

    BACKGROUND: The material and the surgical technique used to close an abdominal wall incision are important determinants of the risk of developing an incisional hernia. Optimising closure of abdominal wall incisions holds a potential to prevent patients suffering from incisional hernias...... and for important costs savings in health care. METHODS: The European Hernia Society formed a Guidelines Development Group to provide guidelines for all surgical specialists who perform abdominal incisions in adult patients on the materials and methods used to close the abdominal wall. The guidelines were developed...... using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II...

  19. Sir Ganga Ram Hospital classification of groin and ventral abdominal wall hernias

    Chowbey Pradeep

    2006-01-01

    all abdominal wall hernias and is a final classification that predicts the expected level of difficulty for an endoscopic hernia repair.

  20. Restoration of abdominal wall integrity as a salvage procedure in difficult recurrent abdominal wall hernias using a method of wide myofascial release.

    Levine, J P; Karp, N S

    2001-03-01

    The management of primary and recurrent giant incisional hernias remains a complex and frustrating challenge even with multiple alloplastic and autogenous closure options. The purpose of this study was to develop a reconstructive technique of restoring abdominal wall integrity to a subcategory of patients, who have failed initial hernia therapy, by performing superior and lateral myofascial release. Over a 1.5-year period, 10 patients with previously unsuccessful treatment of abdominal wall hernias, using either primary repair or placement of synthetic material, were studied. The patients had either recurrence of the hernia or complications such as infections requiring removal of synthetic material. The hernias were not able to be treated with standard primary closure techniques or synthetic material. The average defect size was 19 x 9 cm. Each patient underwent wide lysis of bowel adhesions releasing the posterior abdominal wall fascia to the posterior axillary line, subcutaneous release of the anterior abdominal wall fascia to a similar level, and complete removal of any synthetic material (if present). The abdominal domain was reestablished by releasing the laterally retracted abdominal wall. The amount of available abdominal wall tissue was increased by wide release of the cephalic abdominal wall fascia overlying the costal margin and the external oblique fascia and muscle laterally. If needed, partial thickness of the internal oblique muscle and its anterior fascia were also released laterally to perform a tension-free primary closure of the defect. All repairs were closed with satisfactory functional and aesthetic results. All alloplastic material was removed. Fascial release was limited so as to close only the hernia defect without tension. No significant release of the rectus sheath and muscle was needed. Good, dynamic muscle function was noted postoperatively. All repairs have remained intact, and no further abdominal wall hernias have been noted on follow-up.

  1. Isometric abdominal wall muscle strength assessment in individuals with incisional hernia: a prospective reliability study

    Jensen, K. K.; Kjær, Michael; Jorgensen, L. N.

    2016-01-01

    Purpose To determine the reliability of measurements obtained by the Good Strength dynamometer, determining isometric abdominal wall and back muscle strength in patients with ventral incisional hernia (VIH) and healthy volunteers with an intact abdominal wall. Methods Ten patients with VIH and ten...... healthy volunteers with an intact abdominal wall were each examined twice with a 1 week interval. Examination included the assessment of truncal flexion and extension as measured with the Good Strength dynamometer, the completion of the International Physical Activity Questionnaire (IPAQ) and the self...

  2. Laparoscopic repair of abdominal wall hernia: one-year experience

    Kavic, Michael S.

    1993-05-01

    In this study, 101 consecutive laparoscopic transabdominal preperitoneal hernia repairs (LTPR) were performed in 62 patients by a single surgeon. The series was begun in April 1991, and involved repair of 49 direct, 41 indirect, 4 femoral, 3 umbilical, 3 sliding, and 1 incisional hernias. Twelve cases were bilateral, eleven hernias were incarcerated, and fifteen hernias were recurrent. There were no intraoperative complications, and none of the procedures required conversion to open surgery. Patients experienced the following postoperative complications: transient testicular pain (1), transient anterior thigh paresthesias (2), urinary retention requiring TURP (1), and hernia recurrences (2). Follow up has ranged from 4 - 15 months and initial results have been encouraging.

  3. Prosthetic abdominal wall hernia repair in emergency surgery: from polypropylene to biological meshes

    Campanelli G

    2008-12-01

    Full Text Available Abstract The use of nonabsorbable prosthetic materials such as polypropylene, polyester, and ePTFE, have expanded and are now widely used in reparative surgery for abdominal wall hernias. There are still difficulties to find correct indication for prosthetic implant in emergency hernia surgery: as a matter of fact there is still a great debate if to use non-absorbable prostheses in potentially or truly infected operating fields [e.g. after intestinal resections]. All these problems can be avoided with the use of absorbable prosthetic materials such as those composed of lactic acid polymers or lactic and glycolic acid copolymers: however, the use of these absorbable prosthesis exposes the patient to a rapid and inevitable hernia recurrence. It is important to remember that prosthetic repair has been proven to have a significant less risk of recurrence than repair with direct sutures. Recently, new "biologic" prosthetic materials have been developed and proposed for the clinical use in infected fields. These materials can be called "remodeling" for the way by which they are replaced after their placement within the patient. The "remodeling" process is made possible through a process of incorporation, where a reproduction of a site-specific tissue similar to the original host tissue is created.

  4. Abdominal wall healing in incisional hernia using different biomaterials in rabbits

    Ana Letícia Gomes Aramayo

    2013-04-01

    Full Text Available PURPOSE: To investigate abdominal wound healing using specific biomaterials in incisional hernias. METHODS: Incisional hernias were produced in 40 rabbits, after that they were reoperated with or without the use of meshes: PREMILENE® (PPL, ULTRAPRO® (UP, PROCEED® (PCD or repairing without mesh (TRANSPALB. After 30 days a macroscopic and microscopic study of the part withdrawn from the abdominal wall was performed. RESULTS: Macroscopic: adhesion Area: PPL> UP and PCD (p = 0.031. Vascularization: PPL> UP and PCD (p = 0.001. PPL groups (p = 0.032 and PCD (p PPL, UP and TRANSPALB (p = 0.010; eosinophils: PPL> UP, and TRANSPALB PCD (p = 0.010; granulation tissue: PPL and PCD> UP and TRANSPALB (p TRANSPALB (p UP (p = 0.009 and TRANSPALB (p TRANSPALB (p PCD and TRANSPALB (p <0.001. CONCLUSION: All types of meshes caused the formation of adhesions. The UP and PCD groups showed lower area and vascularization of the adhesions. The PPL and PCD groups showed higher meshes shrinkage and there was a predominance of acute inflammatory process in the PCD group.

  5. Laparoscopic morgagni hernia repair using single-site umbilical and full-thickness abdominal wall repair: Technical report of two cases

    Martin L van Niekerk

    2013-01-01

    Full Text Available Single incision laparoscopic surgery is used in many centres for routine cases such as appendisectomy, splenectomy and cholecystectomy. Morgagni hernias are uncommon and account for 1-2% of all congenital diaphragmatic hernia. We report our first laparoscopic repair of two Morgagni hernias, using a single umbilical incision and full-thickness abdominal wall repair with standard straight laparoscopic instruments. Operative time was short and compared favourably with the laparoscopic repair.

  6. Laparoscopic Morgagni hernia repair using single-site umbilical and full-thickness abdominal wall repair: technical report of two cases.

    van Niekerk, Martin L

    2013-01-01

    Single incision laparoscopic surgery is used in many centres for routine cases such as appendectomy, splenectomy and cholecystectomy. Morgagni hernias are uncommon and account for 1-2% of all congenital diaphragmatic hernia. We report our first laparoscopic repair of two Morgagni hernias, using a single umbilical incision and full-thickness abdominal wall repair with standard straight laparoscopic instruments. Operative time was short and compared favourably with the laparoscopic repair.

  7. Economics of abdominal wall reconstruction.

    Bower, Curtis; Roth, J Scott

    2013-10-01

    The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias.

  8. Traumatic abdominal hernia complicated by necrotizing fasciitis.

    Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa

    2014-11-01

    Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption.

  9. Case report of traumatic abdominal wall hernia following blunt motorcycle handlebar injury and review of the literature.

    Ogundiran, T O; Obamuyide, H A; Adesina, M A; Ademola, A F

    2012-01-01

    A 25-year-old man, riding a motorcycle, rammed into a moving car at a T junction and sustained a blunt lower-right abdominal injury with the handlebar of his motorbike. He developed a swelling at the point of impact for which he presented in hospital 10 days later. Clinical assessment revealed a healthy young man with a soft, nontender reducible swelling over the lateral half of the right inguinal area. A diagnosis of acute traumatic hernia was made. Abdominal ultrasonography revealed a wide-necked defect in the anterior abdominal wall over the right inguinal area with protruding bowel loops beneath an intact skin. He was planned for herniorrhaphy but has defaulted since then.

  10. Abdominal wall endometriosis.

    Upadhyaya, P; Karak, A K; Sinha, A K; Kumar, B; Karki, S; Agarwal, C S

    2010-01-01

    Endometriosis of abdominal wall scar following operation on uterus and tubes is extremely rare. The late onset of symptoms after surgery is the usual cause of misdiagnosis. Scar endometriosis is a rare disease which is difficult to diagnose and should always be considered as a differential diagnosis of painful abdominal masses in women. The diagnosis is made only after excision and histopathology of the lesion. Preoperative differentials include hernia, lipoma, suture granuloma or abscess. Hence an awareness of the entity avoids delay in diagnosis, helps clinicians to a more tailored treatment and also avoids unnecessary referrals. We report a case of abdominal endometriosis. The definitive diagnosis of which was established by histopathological studies.

  11. EuraHS: The Development of an international online platform for registration and outcome measurement of ventral abdominal wall Hernia repair

    F.E. Muysoms (Filip); G. Campanelli (Giampiero); G.G. Champault; A.C. DeBeaux; U.A. Dietz; J. Jeekel (Hans); U. Klinge; F. Köckerling; V. Mandala; A. Montgomery; S. Morales Conde (S.); W. Puppe; R.K.J. Simmermacher; M. Śmietański; M. Miserez

    2012-01-01

    textabstractBackground Although the repair of ventral abdominal wall hernias is one of the most commonly performed operations, many aspects of their treatment are still under debate or poorly studied. In addition, there is a lack of good definitions and classifications that make the evaluation of st

  12. Closure of the abdominal wall at the umbilicus and the development of umbilical hernias in a group of foals from birth to 11 months of age.

    Enzerink, E; van Weeren, P R; van der Velden, M A

    2000-07-08

    The closure of the body wall defect at the umbilicus was studied in relation to the development of umbilical hernias in a group of 44 normal foals, 25 of which were followed from birth until five months of age, and 19 from birth until 11 months of age. At birth, 19 of the foals had a defect in the body wall at the umbilicus that was termed a 'palpable umbilical ring'. In 18 of them this defect disappeared within four days, but in the other the ring did not close and a hernial sac with abdominal contents was palpable. This foal was considered to be the only foal to have a truly congenital umbilical hernia. Twelve foals developed an umbilical hernia between five and eight weeks of age. The prevalence of umbilical hernias was much higher than in other studies, possibly owing to the prospective nature of the study.

  13. Open and laparo-endoscopic repair of incarcerated abdominal wall hernias by the use of biological and biosynthetic meshes

    René H Fortelny

    2016-02-01

    Full Text Available Introduction: Although recently published guidelines recommend against the use of synthetic non-absorbable materials in cases of potentially contaminated or contaminated surgical fields due to the increased risk of infection [1, 2], the use of bio-prosthetic meshes for abdominal wall or ventral hernia repair is still controversially discussed in such cases. Bio-prosthetic meshes have been recommended due to less susceptibility for infection and the decreased risk of subsequent mesh explantation. The purpose of this review is to elucidate if there are any indications for the use of biological and biosynthetic meshes in incarcerated abdominal wall hernias based on the recently published literature.Methods: A literature search of the Medline database using the PubMed search engine, using the keywords returned 486 articles up to June 2015. The full text of 486 articles was assessed and 13 relevant papers were identified including 5 retrospective case cohort studies, 2 case controlled studies, 6 case series.Results: The results of Franklin et al [23, 24, 25] included the highest number of biological mesh repairs (Surgisis® by laparoscopic IPOM in infected fields which demonstrated a very low incidence of infection and recurrence (0,7% and 5,2%. Han et al [26] reported in his retrospective study the highest number of treated patients due to incarcerated hernias by open approach using acellular dermal matrix (ADM® with very low rate of infection as well as recurrences (1,6% and 15,9. Both studies achieved acceptable outcome in a follow up of at least 3,5 years compared to the use of synthetic mesh in this high-risk population [3]Conclusion:Currently there is a very limited evidence for the use of biological and biosynthetic meshes in strangulated hernias in either open or laparo-endoscopic repair. Finally, there is an urgent need to start with randomized controlled comparative trials as well as to support registries with data to achieve more

  14. Preoperative steroid in abdominal wall reconstruction

    Jensen, Kristian Kiim; Brøndum, Tina Lee; Belhage, Bo;

    2016-01-01

    INTRODUCTION: Preoperative administration of high-dose glucocorticoid leads to improved recovery and decreased length of stay after abdominal surgery. Even so, studies on administration of glucocorticoids for patients undergoing abdominal wall reconstruction (AWR) for giant ventral hernia repair ...

  15. Abdominal Wall Hernia in Complex Patients incidences, risk factors and timing of repair

    J. Verhelst (Joost)

    2016-01-01

    markdownabstractThis thesis consists of two parts: __part 1__ describes a new prosthesis for the treatment of large and complex incisional hernia. Furthermore the natural course and consequences of conservative treatment are described; __part 2__ focusses on three complex groups of patients wit

  16. Indications and Outcomes of the Components Separation Technique in the Repair of Complex Abdominal Wall Hernias: Experience From the Cambridge Plastic Surgery Department

    Adekunle, Shola; Pantelides, Nicholas M.; Hall, Nigel R.; Praseedom, Raaj; Malata, Charles M.

    2013-01-01

    Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (range: 30-80). Patients were referred from a variety of specialties, often as a last resort. The commonest indication for CST was herniation following abdominal surgery. All operations except 1 were jointly performed with general surgeons (for bowel resection, stoma reversal, and hernia dissection). The operations lasted a mean of 5 hours (range: 3-8 hours). There were no major intra- and postoperative problems, except in 1 patient who developed intra-abdominal compartment syndrome, secondary to massive hemorrhage. All patients were satisfied with the cosmetic improvement in their abdominal contours. None of the patients have developed a clinical recurrence after a mean follow-up of 16 months (range: 3-38 months). Conclusions: The components separation technique is an effective method of treating large recalcitrant hernias but appears to be underutilized in the United Kingdom. The management of large abdominal wall defects requires a multidisciplinary approach, with input across a variety of specialities. Liaison with plastic surgery teams should be encouraged at an early stage and the CST should be more widely considered when presented with seemingly intractable abdominal wall defects. PMID:24058718

  17. Application of biologic mesh in hernia and abdominal wall surgery%生物补片在疝和腹壁外科的应用

    李基业

    2012-01-01

    Biologic meshes have been used to repair abdominal wall hernia and defect for more than 10 years, and a number of clinical experience of the use of biologic mesh has been accumulated. The majority of surgeons have the opinion that biologic mesh provides an important and new tool for repair of hernia and defect of the abdominal wall, especially for the contaminated and infected fields. Most of the clinical results showed the short-term outcome of the repair of hernia and defect using biologic mesh is satisfactory, and long-term outcome need to be further investigated. A multicenter, prospective, randomized control trial should be conducted to make sure the relationship of both the types of biologic mesh and the mesh placement to the results of treatment, and the different effect of biologic mesh for repairing hernia and defect with and without contaminated and infected fields.%生物补片用于修补腹壁疝及缺损已10余年,积累了一定的临床经验.多数术者认为生物补片为外科医生修复腹壁疝和腹壁缺损、特别是有污染和感染的病人提供了重要的工具.大部分临床结果表明生物补片修补疝和腹壁缺损近期效果良好,远期效果有待进一步观察研究.对于生物补片种类与治疗效果关系,补片放置方法与治疗效果的关系,污染、感染情况下与清洁状况下使用生物补片效果差别,需要多中心、前瞻性随机对照研究.

  18. Hérnia traumática da parede abdominal Traumatic abdominal hernia

    Alexandre Cruz Henriques

    1999-10-01

    Full Text Available A rare case of blunt traumatic abdominal hernia is presented in which jejunal loops herniated through the abdominal wall. The patient had a serious motor vehicle accident seven years ago, while wearing the seat belt. He developed a traumatic hernia in the anterior lateral abdominal wall, which was operated, and relapsed after some months. The patient was reoperated and we observed the unattachment of the anterior lateral abdominal musculature from the ilium crest. After the hernial sac treatment, the defect was solved with the use of a polypropylene mesh. The postoperative evolution was good and four months later there were no signs of recurrence. Traumatic abdominal hernia remains a rare clinical entity, despite the increase in blunt abdominal trauma. Traumatic abdominal wall hernia falls into two general categories: small lower quadrant abdominal defects, typically the result of blunt trauma with bicycle handlebars, and larger abdominal wall defects related to motor vehicle accidents. The diagnosis may be often established by the physical examination alone. Conventional radiology and computerized tomography usefulness have been proved. In the vast majority of cases, early repair is recommended. The appropriate treatment is the reduction of the herniated bowel into the abdomen, the debridment of nonviable tissues, and a primary tension free closure of the detect.

  19. 16-Slice CT Diagnostic Value in Adult Non- traumatic Abdominal Wall Hernia%成人非创伤性腹壁疝的16层螺旋CT诊断价值

    丁长青; 孙迎迎; 史志卫; 王文生; 谢光彤

    2012-01-01

    目的:探讨成人非创伤性腹壁疝的16层螺旋CT诊断价值。方法:回顾性分析手术或临床随访证实的37例成人非创伤性腹壁疝16层螺旋CT资料。结果:腹壁切口疝13例,股沟斜疝10例,腰疝4例,半月线疝3例,壁造瘘口疝3例,白线疝2例,脐疝2例。疝囊直径小于5cm者23例,6~10cm者11例,大于10cm者3例。疝内容可为大网膜、肠管甚至邻近的器官。结论:多层CT及后处理是非创伤性腹壁疝较佳的诊断方法,可为进一步手术治疗提供可靠依据。%Objective: To investigate 16 layer spiral CT diagnosis value in adult non traumatic abdominal wall hernia. Methods: A retrospective analysis of 37 cases data of adult non traumatic abdominal wall hernia confirmed by operation or clinical follow-up with 16 slice spiral CT. Results: Abdominal wall incisional hernia in 13 cases, inguinal indirect hernia in 10 cases, lumbar hernia in 4 cases, spigelian hernia in 3 cases, abdominal wall stoma hernia in 3 cases, white line hernia in 2 cases, umbilical hernia in 2 cases. Hernia sac diameter less than 5 cm in 23 cases, 6-10 cm in 11 cases, greater than 10 cm in 3 cases. The hernial contents are the greater omentum, bowel and adjacent organs. Conclusion: It is a better diagnosis method with multi-layer CT and post-processing for non traumatic abdominal wall hernia, which could provide a reliable basis for further treatment.

  20. Intraperitoneal tension-free repair of a small midline ventral abdominal wall hernia: randomized study with a mean follow-up of 3 years.

    Bensaadi, Hocine; Paolino, Luca; Valenti, Antonio; Polliand, Claude; Barrat, Christophe; Champault, Gérard

    2014-01-01

    Funding received from Cousin Biotech, Wervicq Sud, France, and CR Bard Inc., Cranston, RI. The aim of this prospective randomized study was to determine the long-term recurrence and complication rates after small abdominal wall hernia repair with two different bilayer prostheses. Hernia repair using prosthetic mesh material has become the preferred method of repair, because the recurrence rates are much lower than with conventional repair techniques. The use of a hernia bilayer patch, composite expanded polytetrafluoroethylene (ePTFE)-polypropylene, with intraperitoneal placement behind the hernia defect, through a small incision, may be efficient, safe, and cost-effective. This study is a randomized, single-institution trial, including 83 selected consecutive patients with primary (umbilical, epigastric) or incisional anterior abdominal wall defects from 2 to 5 cm. Hernia repair was performed by direct local access in ambulatory surgery; the prosthesis used was a circular bilayer with an inner face in ePTFE to avoid bowel adhesion. One group was treated with a Ventralex® Hernia Patch (Bard USA). The second group was treated with a Cabs'Air® Composite (Cousin Biotech France), which was delivered with two to four fixation sutures and a balloon to properly deploy the mesh intraperitoneally. Patients' characteristics and operative and postoperative data were prospectively collected. The primary outcome was late recurrence. Secondary outcomes included, pain, discomfort and quality of life before and after (3 months) surgery using the SF-12 questionnaire, patient-surgeon satisfaction, and early and late complications. Among 98 patients, 83 were included in the study protocol between January 2007 and August 2011. The two groups were comparable according to pre- and intraoperative data. According to surgeon experience, placement of the Cabs'Air® device was significantly faster (P = 0.01) and easier. At 3 months, there was significantly less pain and less discomfort for

  1. O uso do pneumoperitônio progressivo no pré-operatório das hérnias volumosas da parede abdominal Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias

    José Guilherme Minossi

    2009-06-01

    .CONTEXT: Correction of voluminous hernias and large abdominal wall defects is a big challenge in surgical practice due to technical difficulties and the high incidence of respiratory and cardiovascular complications. OBJECTIVES: To present the authors experience with inducing progressive pneumoperitoneum preoperative to surgical treatment of voluminous hernias of the abdominal wall. METHODS: Retrospective study of six patients who presented voluminous hernias of the abdominal wall and were operated after installation of a pneumoperitoneum. The procedure was performed by placing a catheter in the abdominal cavity at the level of the left hypochondrium with ambient air insufflation for 10 to 15 days. RESULTS: Four of the six patients were female and two male. Ages ranged from 42 to 62 years. Hernia duration varied from 5 to 40 years. Four patients had incisional, one umbilical, and one inguinal hernias. Mean pneumoperitoneum time was 11.6 days. There were no complications related to pneumoperitoneum installation and maintenance. All hernias were corrected without technical difficulties. The Lichtenstein technique was used to correct the inguinal hernia, peritoneal aponeurotic transposition for one of the incisional hernias, with the rest corrected using polypropylene mesh. One death and one wall infection were observed post operatively. No recurrences were reported until now, in 4 to 36 months of follow-up. CONCLUSION: Preoperative progressive pneumoperitoneum is a safe and easy executed procedure, which simplifies surgery and reduces post-operative respiratory and cardiovascular complications. It is indicated for patients with hernias that have lost the right of domain in the abdominal cavity.

  2. 老年腹外疝50例临床诊疗体会%Clinical effects in tension-free hernioplasty for hernias of abdominal wall

    赵付全

    2015-01-01

    Objective To summarize the clinical features,diagnosis and treatments of abdominal wall, so as to help the surgeons avoid mistakes in practice.MethodsClinical data of 50 patients with hernias of abdominal wall treated from January 2009 to January 2014 were retrospectively analyzed. And differential diagnosis and treatment were discussed.ResultsThe 50 patients were cured. without recurrence during from in half a year to 5 years follow-up.ConclusionBy asking medical history, physical examination, radiological examination, To maintain a high degree of vigilance and less misdiagnosis. The methods of tention-free hernioplasty is reliable,with less pain,quicker recovery, lower recurrent rate,and Simple operation,Especially suitable fo primary hospitals.%目的:总结腹外疝的临床特征和诊疗方法,以减少临床工作中的失误。方法回顾性分析2009年1月~2014年1月我院收治的腹股沟疝患者50例的临床资料,并进行鉴别诊断及治疗讨论。结果50例患者均治愈出院。随访6个月~5年均无复发。结论询问病史、体格检查、放射学检查是诊断腹外疝的基础,保持高度警惕少误诊,无张力疝修补术疗效可靠,恢复快,复发率低,且操作简单,尤其适宜在基层医院推广。

  3. 腹腔镜与开放式腹壁切口疝补片修补术的对比研究%Comparison study of open and laparoscope patch herniorrhaphy on abdominal wall incisional hernia

    白东; 张健; 周忠笑

    2011-01-01

    目的 比较开放手术及腹腔镜补片修补腹壁切口疝的手术效果,探讨腹腔镜腹壁切口疝修补术的价值.方法 回顾分析56例腹壁切口疝患者的临床资料.根据手术方式分为腹腔镜组(24例)和开放组(32例),对2组切口疝类型、腹壁缺损大小、手术时间、术后并发症、术后疼痛评分、术后住院时间、复发率等进行对比分析.结果 2组手术时间、术后并发症发生率、术后复发率比较均无显著性差异.腹腔镜组术后疼痛评分、术后住院时间和手术出血量均明显少于开放组.结论 腹腔镜腹壁切口疝修补术是安全可行的.它可以从腹腔内在原切口薄弱区添加一个MESH,修复缺损,加强腹壁,避免切开原切口,避免分离腹壁组织,具有创伤小、住院时间短、恢复快等优点,符合力学原理,是修补腹壁切口疝的理想术式,特别对于巨大腹壁切口疝优于开放式腹壁切口疝补片修补术.%Objective It is to compare the operation effect of open surgery and laparoscope patch herniorrhaphy on abdominal wall incisional hernia and approach the value of laparoscope abdominal wall incisional hernia herniorrhaphy. Methods The clinical data of 56 patients with abdominal wall incisional hernia who were in our hospital from January 2004 to January 2010 were analyzed retrospectively. The patients were divided into laparoscope group ( 24 cases ) and open group ( 32 cases ) according operation manner. The type of incisional hernia, abdominal wall defect size , operation time , postoperative complications, postoperative pain score, postoperative hospitalization time and recurrence rate of the two groups were compared and analyaed. Results There were all no significant differences on operation time, postoperative complications incidence rate and postoperative recurrence rate hetween the two groups. The postoperative pain score, postoperative hospitalization time and operation hemorrhage quantity in

  4. Congenital Abdominal Wall Defects

    Risby, Kirsten; Jakobsen, Marianne Skytte; Qvist, Niels

    2016-01-01

    complications were seen in five (15%) children: four had detachment of the mesh and one patient developed abdominal compartment syndrome. Mesh related clinical infection was observed in five children. In hospital mortality occurred in four cases (2 gastroschisis and 2 omphalocele) and was not procedure......OBJECTIVE: To evaluate the clinical utility of GORE® DUALMESH (GDM) in the staged closure of large congenital abdominal wall defects. MATERIALS AND METHODS: Data of patients with congenital abdominal wall defects managed with GDM was analyzed for outcome regarding complete fascial closure; mesh...

  5. 腹壁切口疝并发肠梗阻的易感因素分析%The Risk Factor Analysis of Incision Hernia of Abdominal wall Complicat-ed with Intestinal Obstruction

    阴秦; 李波; 李长江; 张麒; 马兰

    2013-01-01

    目的探讨腹壁切口疝并发肠梗阻的易感因素及预防措施。方法对照研究同期切口疝和切口疝并发肠梗阻的病例。结果年龄和导致腹内压增高因素,差异均具显著(P<0.05),性别、手术类型因素差异尤为显著(P<0.01)。结论重视对于易感因素的控制就可以有效预防切口疝并发肠梗阻的发生。%Objective To explore the predisposing factor and prevention of intestinal obstruction caused by incision hernia of abdominal wall .Methods Compared these patients with a group of patients with incision hernia without intestinal obstruction synchronization .Results The difference of age ,and some agents result in increasing of intraabdominal pressure were significant ( P<0 .05 ) .The difference of sex and tipe of oper-ation were significant especially ( P<0 .01 ) .Conclusion Thinking highly of controlling these predisposing factors were effective measures to prevent intestinal obstruction caused by incision hernia of abdominal wall .

  6. INDICATIONS AND CHOICE OF TECHNOLOGY FOR POLYMERIC MATERIALS IMPLANTATION IN THE ABDOMINAL WALL FOR PREVENTION AND TREATMENT OF POSTOPERATIVE VENTRAL HERNIAS

    B. S. Sukovatykh

    2016-01-01

    Full Text Available The absolute indication for primary covering a laparotomic wound with a synthetic prosthesis is complicated anatomic and functional insufficiency. There are relative indications for this surgery, such as old age, III–IV degree of obesity, repeated laparotomy in location of the same scar, covering a laparostoma in patients treated with programmed sanation of the abdominal cavity and laparotomy in patients treated with radiology or chemotherapy methods. Lowering of functional activity of ribosomal genes is a reason of the anterior abdominal cavity weakness, its progress causes lowering in skin and aponeuroses composition I–III types of collagen. We examined the speed of growing and differentiation of connective tissue after implantation endoprosthesis made of lavsan, polypropylene, polyvinylidene fluoride, polytetrafluoride ethylene. It was proved that the polyvinylidene fluoride mesh had the best biocompatibility. The progress of wound implantation process could be predicted by dynamics of cytokine profile, temperature, leukocyte and exudative reactions of a patient. The best insensitiveness to infection belonged to a standard polypropylene endoprosthesis, it could be used for covering a hernia defect in patients with strangulated hernias. The fact that urine poured into the operation wound during urinary system surgery combined with lateral hernias of abdomen was not a contraindication for endoprosthesis.

  7. Acute acalculous cholecystitis after abdominal wall repair (Rives-Stoppa)

    Reurings, Jurrian C; Diaz, Ruben P D; Penninga, Luit

    2014-01-01

    -old man who developed AAC after abdominal wall repair with mesh (Rives-Stoppa procedure) 1 day after discharge from the hospital. To the best of our knowledge, this is the first paper to report AAC after abdominal incisional hernia repair. Although it is known to be more common in critically ill patients...

  8. 胃肠外科与疝和腹壁外科相互影响并发展%Mutual influence and development between Gastrointestinal surgery and hernia and abdominal wall surgery

    陈双

    2015-01-01

    The aim of this article is to expound on the crossing and influence each other of gastrointestinal surgery and abdominal wall hernia surgery.Although these two departments are independent respectively, but due to the existence of association among anatomy, physiology and pathology, so they are also overlapping.First of all, the abdominal wall and digestive tract are interdependent, and the abdominal wall provides "protection" for gut.In case of large abdominal wall defect, intra-abdominal viscera, breathing,circulation system and spine will change accordingly.In addition,when intra-abdominal pressure increases due to various reasons,laparotomy is an effective way.But laparotomy is not an easy case, but a crisis.One of the most difficult problems is "enteroatmospheric fistulae".Therefore, to avoid serious complications after laparotomy, the concept of planned ventral hernia is proposed.When life safety is threatened by inter-abdominal hypertension, planned abdominal wall hernia is the style to save life.This is a kind of concept of innovation, and is the concrete practice of the theory of damage control surgery.For a planned abdominal wall hernia patient, it is better to wait and watch, and after making a comprehensive assessment, multidisciplinary collaboration mode should be applied to ensure the safety of surgery.%本文阐述了胃肠外科与疝和腹壁外科间的相互交叉与影响.这两个专科虽已分别独立,但由于解剖、生理和病理存在着相关性,两个科之间又相互交叉.首先,与消化道相互依存,腹壁的完整性为消化道提供"保护".若腹壁发生较大缺损,腹腔内脏器和呼吸、循环系统及脊柱都会发生相应的变化.另外,临床上由于种种原因出现腹内压升高或腹腔内高压(ACS)时,开放腹腔是行之有效的办法.但开放腹腔并不是一劳永逸,而是危机重重,其中最棘手的是"肠管空气瘘".因此,要避免开放腹腔后严重的并发症,有人又提出"计划

  9. Clinic triag experience in expert out-patient of hernia and abdominal wall surgery%疝和腹壁外科专家门诊患者就诊及护士分诊分析

    白淑媛; 李晓霞

    2014-01-01

    Objective To investigate the value and significance of nurses working in Expert Out-patient of Hernia and Abdominal Wall Surgery.Methods 1 026 cases of hernia patients who visited to our out-patient between January 201 1 and December 201 1 ,were analyzed to summarize the nurse service and triage work.Results With enthusiastic service,orderly triage working and good patient communication,out-patient work of hernia and abdominal wall surgery was well performed.Conclusion Good occupation morality and nurse-patient relationship establishment,have a positive effect to expert out-patient service.%目的:分析护士工作在疝和腹壁外科专家门诊中的价值与意义。方法通过分析2011年1~12月,首都医科大学附属北京朝阳医院接诊的1026例疝病患者,对其门诊护士服务及分诊工作进行总结分析。结果通过护士热情的服务、秩序井然的开展分诊工作,与患者开展良好的语言沟通,促进疝和腹壁外科工作的顺利开展。结论护士拥有良好的职业道德,建立良好的护患关系,对专家门诊工作有一定积极作用。

  10. [Diagnostics and surgical correction of postoperative myofascial defects of lateral abdominal wall and lumbar region].

    Brekhov, E I; Iurasov, A V; Gribunov, Iu P; Repin, I G; Alekseev, A K; Cherniaeva, N A; Zhitnikov, G V

    2009-01-01

    Myofascial defects of lateral abdominal wall and lumbar region occur chiefly after lumbotomy--the most popular access in urosurgery. Meanwhile lumbotomy remains one of the most traumatic accesses through the lateral abdominal wall. Myofascial defects were diagnosed in 48,9% of operated patients with lumbotomy. Of them true postoperative hernias were found in 35,3%; neuropathic hernias - in 13,6%. Since 2002 the originally developed method of lateral abdominal wall reconstruction had been used for the treatment of such patients. The immediate and long-term results (maximal follow-up period 5 years) showed no hernia recurrence or complications in 26 operated patients.

  11. Risk factors and prognosis of peritoneal dialysis patients complicated with abdominal wall hernia%腹膜透析合并腹壁疝的危险因素及预后

    徐天; 谢静远; 张春燕; 黄晓敏; 任红; 陈楠

    2012-01-01

    Objective To investigate the risk factors and outcome of the peritoneal dialysis (PD) patients with abdominal wall hernia. Methods We recruited 436 PD patients from Shanghai Ruijin Hospital. Baseline characteristics and follow-up data were recorded. The participants were divided into group A (normal group, n = 409) and group B (hernia group, n = 27) based on whether abdominal wall hernia occurred. Logistic regression analysis was performed. Results The rate of hernia was 6.2% (30 events). The incidence of hernia was 0.054 times/patient-year, and the average time of first hernia was 21.86 ±27.58 weeks after PD. Among the hernia patients, 22 were inguinal hernia (81.48%), 2 were incisional hernia (7.4%), 2 were umbilical hernia (7.4%), and 1 was multiple hernia (3.7%). Patients with diabetes (27.62% vs. 22.22%), polycystic kidney disease (1.5% vs. 0) and laparoscopic implantation of catheter (8.31% vs 18.51%) were similar between the two groups. Patients in group A were younger (59.33 ± 17.73year vs 65.07 ± 13.27year), and had less males (54.27% vs 85.16%), less abdominal surgery history (19.32% vs. 37.04%), and higher body mass index (BMI) (22.53±3.52 vs. 20.96 ± 2.38) than group B (P<0.05). The two groups were similar in baseline characteristics, except that patients in group B had lower serum creatinine (545.50 ± 338.75 μmol/L vs. 697.00 ± 370.50 μmol/L) and triglycerides (0.98 ± 0.92 mmol/L vs. 1.56 ± 1.24 mmol/L) than group A. Serum creatinine (OR=0.993, P =0.040) and triglyceride (OR=0.084, P =0.040) were negatively correlated with hernia. Conclusion Inguinal hernia is the most common type of abdominal wall hernia in PD patients. Previous abdominal surgery, smaller body size, older male and poor nutritional status were the risk factors for PD patients complicated with hernia.%目的 分析腹膜透析(peritoneal dialysis,PD)合并腹壁疝人群的临床特点及影响其预后的相关危险因素. 方法 入选上海交通大学医学

  12. Pain following the repair of an abdominal hernia

    Hansen, Mark Berner; Andersen, Kenneth Geving; Crawford, Michael Edward

    2010-01-01

    Pain and other types of discomfort are frequent symptoms following the repair of an abdominal hernia. After 1 year, the incidence of light to moderate pain following inguinal hernia repair is as high as 10% and 2% for severe disabling chronic pain. Postoperative chronic pain not only affects......, psychosocial characteristics, and surgical procedures) related to the postoperative pain conditions. Furthermore, the mechanisms for both acute and chronic pain are presented. We focus on inguinal hernia repair, which is the most frequent type of abdominal hernia surgery that leads to chronic pain. Finally...... the individual patient, but may also have a great impact on relatives and society, and may be a cause of concern for the responsible surgeon. This paper provides an overview of the anatomy, surgical procedures, and disposing factors (age, gender, ethnicity, genotype, previous hernia repair, pain prior to surgery...

  13. Indications and Outcomes of the Components Separation Technique in the Repair of Complex Abdominal Wall Hernias: Experience From the Cambridge Plastic Surgery Department

    Adekunle, Shola; Pantelides, Nicholas M.; Hall, Nigel R; Praseedom, Raaj; Malata, Charles M.

    2013-01-01

    Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (ra...

  14. 3D mesh with abdominal wall suspension in transabdominal preperitoneal hernia repair:a series of 71 cases%3D 补片腹壁悬吊法经腹腹膜前疝修补术71例

    苏海龙; 于文涛; 穆林松; 隋武; 林洋; 王云慧

    2015-01-01

    Objective To analyze the clinical effectiveness of 3D mesh with abdominal wall suspension in transabdominal preperitoneal hernia repair (TAPP).Methods A total of 71 cases of inguinal hernia who underwent TAPP using 3D mesh with abdominal wall suspension in Yantai Yuhuangding Hospital from January 2011 to July 2014 were retrospectively analyzed,in order to summarize the operation skills and clinical experience.Results All cases in this series were performed under laparoscopy.The operating time was 50 to 100 minutes in unilateral hernia operation,and 90 to 140 minutes in bilateral hernia operation. With little intraoperative bleeding and no drainage,the patients were discharged in 2 to 5 days.1 case of epigastric artery injury occurred during the operation,meanwhile,the laparoscopic bleeding suture was performed.Postoperative inguinal or scrotal seroma was found in 5 cases,which were gradually self-absorbed in 1 month of observation.After a mean follow-up of 6 months (range 1 to 12 months),no recurrence and no abnormal sensation in groin were observed.Conclusion 3D mesh with abdominal wall suspension in TAPP is relatively safe,effective,more economical and easy to perform,and it is suitable for surgeons,who just begin to learn laparoscopic hernia repair.%目的:分析3D 补片腹壁悬吊法经腹腹膜前疝修补术(TAPP)的临床疗效。方法回顾性分析2011年1月至2014年7月,山东烟台青岛大学附属烟台毓璜顶医院采用腹壁悬吊法固定3D 补片行 TAPP 术71例的临床资料,总结手术要点及临床体会。结果本组患者均在腹腔镜下完成,单侧疝手术时间50~100 min,双侧疝手术时间90~140 min,术中出血极少,均未置引流,术后2~5 d 出院。术中腹壁下动脉损伤1例,行腹腔镜下缝扎止血,术后发生腹股沟区或阴囊血清肿5例,经观察1个月余,均逐渐自动吸收;无腹股沟区感觉异常,术后随访1~12个月,平均6

  15. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

    Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E

    1991-01-01

    There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.

  16. Abdominal wall closure after a stomal reversal procedure.

    López-Cano, Manuel; Pereira, José Antonio; Villanueva, Borja; Vallribera, Francesc; Espin, Eloy; Armengol Carrasco, Manuel; Arbós Vía, María Antonia; Feliu, Xavier; Morales-Conde, Salvador

    2014-01-01

    The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.

  17. Clinical Statistic Analysis in Tension-free Repair of Abdominal Wall Hernias in 165 Cases%165例腹外疝无张力修补术的临床统计分析

    冯文清

    2011-01-01

    To discuss the clinical effect on tension-free repair of abdominal wall hernias and its application value,clinical data on 165 cases of tension-free repair of abdominal wal1 hernias were compared as well as the application of their main modus operandi,such as Litchtenstein operation,Rutkow and IPOM(intraperitoneal onlay mesh) operation in the applied situation,respectively.The results show that all the sufferers of 165 cases didn't recrudesce in from half year to four years after the operation.There are no obvious statistic difference in hospital days,incidence rate of complication,recurernce rates between 102 side Lichtenstein operation,59 side Rutkow operation and 102 side IPOM operation,but there are obvious statistic differences in material costs,operation fees and the total expenditures of treatment in hospital(P〈0.05).To compare with the traditional repair of abdominal wal1 hernias,tension-free one has more credible curative effect,with less pain after operation,quicker recovery and lower recurrent rate.Litchtenstein operation is simpler,with lower expenditure and wider indications than Rutkow and IPOM ones,which is especially feasible for promotion in primary hospitals.%为了探讨腹外疝无张力修补术的临床疗效、运用价值,对比分析了165例无张力修补术的临床资料及其主要术式的应用情况.结果显示:165例腹外疝患者行无张力疝修补术后随访6~48个月均无复发;102例/侧Lichtenstein手术5、9例/侧Rutkow手术和12例/侧IPOM手术在住院天数、并发症发生率、复发率等方面的统计学差异并不明显(P〉0.05);材料费、手术费以及总治疗费用差异均达到显著水平(P〈0.05).与传统腹外疝修补术相比,无张力修补术疗效可靠,术后疼痛轻,恢复快,复发率低;其中,Lichtenstein手术较RutkowI、POM手术费用更低,且操作简单、适应症宽,尤其适合在基层医院推广.

  18. Prosthetics and Techniques in Repair of Animal's Abdominal Wall.

    Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled

    2016-01-01

    The management of abdominal wall repair continues to present a challenging problem, especially in the repair of major defects. Many abdominal wall defects can be repaired by primary closure; however, if the defect is large and there is a tension on the closure of the wound, the use of prosthetic materials becomes indispensable. Many studies have been performed with various materials and implant techniques, without the comparison of their degrees of success, based on sound meta-analysis and/or inclusive epidemiologic studies. This review covered the effectiveness of recent advances in prosthetic materials and implant procedures used in repair of abdominal wall, based on biomechanical properties and economic aspects of reconstructed large abdominal wall defects and hernias in animals. The presented results in this review helped to reach treatment algorithms that could maximize outcomes and minimize morbidity.

  19. 腹腔镜腹壁切口疝无张力修补术21例回顾%Laparoscopic Tension-free Hernioplasty for Abdominal Wall Incisional Hernia:A Review of 21 Cases

    李由; 冷蔚

    2015-01-01

    目的:探讨腹腔镜腹壁切口疝无张力修补术的有效性及安全性。方法回顾分析2008年2月至2014年5月我院21例患者行腹腔镜腹壁切口疝无张力修补术的临床资料。结果21例(100%)均顺利完成手术;2例中转开腹,1例腹腔内粘连广泛无法分离,1例肠管与腹壁及切口粘连致密无法分离。手术时间58~172 min,平均105min。术后住院8~13d,平均9.2 d。术后16例(76.19%)腹壁钉合区域腹壁疼痛,无长期慢性疼痛:8例(38.09%)发生浆液肿;无手术死亡、切口感染、补片感染及肠瘘发生。随访5~50个月,平均14个月,无1例复发。结论腹腔镜腹壁切口疝无张力修补术具有疗效可靠,创伤小,恢复快,术后并发症少等优点。%Objective To investigate the effectiveness and security of laparoscopic tension-free hernioplasty for abdominal wall incisional hernia. Methods The clinical data of 21 patients with abdominal ineisional hernia who underwent laparoscopic tension-free hernioplasty from Feb 2008 to May 2014 were analyzed retrospectively. Results The operation of 21 patients (100% )were conducted successfully,while 2 cases were converted to open surgery because of extensively intraperitoneal adhesion (1 case)and dense adhesion between bowel and incision(1 case). The operation duration was 58 ~ 172 min(average 105 min). Postoperative hospital stay was 8 to 13 d(average 9. 2 d). Abdominal wall pain occurred in 16 patients(76. 19% ),and no compli-cation of chronic pain was found,seroma occurred in 8 patients(38. 09% ). No death, intestinal fistula,incision or mesh infection occurred postoperatively. No recurrence occurred after 5 to 50 months(average l4 months)follow-up. Conclusion Laparoscopic tension-free hernioplasty for abdominal wall incisional hernia has the advantages of reliable curative effect,less trauma,quicker re-covery and fewer complications.

  20. Staged abdominal closure with intramuscular tissue expanders and modified components separation technique of a giant incisional hernia after repair of a ruptured omphalocele

    Yukihiro Tatekawa

    2016-07-01

    Full Text Available In patients with omphalocele, several different techniques are performed for repair of the abdominal wall defect. We present the case of a staged abdominal closure of a giant incisional hernia after repair of a ruptured omphalocele. At birth, skin flap coverage associated with silo formation occurred, but the abdominal wall defect remained, resulting in a giant abdominal hernia. To expand the layers of the abdominal wall, tissue expanders were placed between the bilateral internal oblique and transverses abdominis muscles. Postoperatively, a modified components separation technique was performed. The abdominal wall was closed in the midline. Upon closure of the skin in the midline, bilateral relaxing incisions were performed, covering the remaining defect with artificial dermis. At the age of one year and 7 months, the patient had no recurrent incisional hernia nor any wound complications.

  1. The Femoral Hernia-a rare hernia and its treatment

    Andreas Hoeferlin

    2009-01-01

    @@ Introduction Hernias age protrusions through weak areas of our abdominal wall.The most common hernia is Inguinal Hernia in men.A rather rare hernia is the Femoral Hernia,a protrusion into the femotal canal next to the blood vessels in our groin (Picl).

  2. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance.

    Stensby, J Derek; Baker, Jonathan C; Fox, Michael G

    2016-02-01

    The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries.

  3. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance

    Stensby, J.D. [University of Virginia, Department of Radiology and Medical Imaging, 1218 Lee Street, Box 800170, Charlottesville, VA (United States); Mallinckrodt Institute of Radiology, 510 S. Kingshighway, Campus Box 8131, St. Louis, MO (United States); Baker, Jonathan C. [Mallinckrodt Institute of Radiology, 510 S. Kingshighway, Campus Box 8131, St. Louis, MO (United States); Fox, Michael G. [University of Virginia, Department of Radiology and Medical Imaging, 1218 Lee Street, Box 800170, Charlottesville, VA (United States)

    2016-02-15

    The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries. (orig.)

  4. Inguinal hernia (image)

    Inguinal hernia is the result of an organ, usually bowel, protruding through a weak point or tear in the thin muscular abdominal wall. Inguinal hernias can restrict blood supply to the bowel herniated ...

  5. REPAIR OF ABDOMINAL WALL ASSOCIATED WITH BARIATRIC SURGERY FOR MORBID OBESITY. GASTRIC PLICATION AT THE GREATER CURVATURE – CASE PRESENT

    R.C. Tiutiuca; C. Ivașcu; Iuliana Tiutiuca; Carmen Vaida; C. Bîrleanu; C. Botez

    2011-01-01

    White line hernias are about 2% of all hernias and among them epigastric hernia are relatively rare (a rate of 8%). Surgery of anterolateral abdominal wall defects has been for long a therapeutic challenge because of the need to use effective methods aimed to reduce the risk of relapse. Its incidence depends on several factors including primarily obesity, than age, sex, type of surgery, type of suture, postoperative abdominal complications, wound healing power and metabolic diseases and cardi...

  6. Incisional hernia: new approaches and aspects

    2010-01-01

    textabstractThis thesis is about the anatomy, diagnosis, treatment and outcome of incisional hernia. New approaches and aspects are discussed in the following chapters. The following definitions were derived from Butterworth’s medical dictionary 1. A hernia is the protrusion of an internal organ through a defect in the wall of the anatomical cavity in which it lies. An abdominal hernia is the protrusion of abdominal content through the abdominal wall. A ventral hernia is any hernia protruding...

  7. Abdominal wall hernia repair with a composite ePTFE/polypropylene mesh: clinical outcome and quality of life in 152 patients

    Iversen, E; Lykke, Anna; Hensler, M

    2010-01-01

    No consensus has yet been reached regarding the optimal mesh for the repair of small ventral hernias. A composite polytetrafluoroethylene/polypropylene mesh (Ventralex(®)) is designed for this purpose, and this paper reports its use in a larger series of patients....

  8. Chronic contained rupture of an abdominal aortic aneurysm presenting as a Grynfeltt lumbar hernia. A case report.

    Dobbeleir, J; Fourneau, I; Maleux, G; Daenens, K; Vandekerkhof, J; Nevelsteen, A

    2007-06-01

    We report a unique case of chronic contained thoraco-abdominal aneurysm rupture presenting as a Grynfeltt lumbar hernia. A 79-year-old man presented with backpain and a bluish swelling in the left lumbar region in the presence of a non tender aortic aneurysm. CT scan confirmed contained rupture of a type IV thoraco-abdominal aortic aneurysm. The peri-aortic haematoma protruded through the lumbar wall causing a Grynfeltt lumbar hernia. The aneurysm was replaced through a thoraco-phreno-lumbotomy. The patient survived and is doing well six months postoperatively.

  9. Laparoscopic repair of an abdominal hernia using an expanded polytetrafluoroethylene patch secured by a four-corner tacking technique.

    Tagaya, N; Mikami, H; Kogure, H; Ohyama, O

    1995-01-01

    An improved technique for performing laparoscopic repair of an abdominal hernia is described herein. To ensure a successful repair, it is most important that adequate tension of the expanded-polytetrafluoroethylene (e-PTFE) patch be achieved, and that the defect be completely covered and securely stapled. Our technique involves tacking the four corners of the patch to the abdominal wall with a 2-0 nylon suture using a straight needle, then stapling it to the anterior abdominal wall over the defect with a laparoscopic stapler. We believe that this technique is a safe and reliable method which will prove useful for laparoscopic surgery.

  10. Abdominal muscle function and incisional hernia

    Jensen, K K; Kjaer, M; Jorgensen, L N

    2014-01-01

    of life depends largely on abdominal muscle function (AMF), and the present review thus evaluates to what extent AMF is influenced by VIH and surgical repair. METHODS: The PubMed and EMBASE databases were searched for articles following a systematic strategy for inclusion. RESULTS: A total of seven...

  11. Synthetic, biological and composite scaffolds for abdominal wall reconstruction.

    Meintjes, Jennifer; Yan, Sheng; Zhou, Lin; Zheng, Shusen; Zheng, Minghao

    2011-03-01

    The reconstruction of abdominal wall defects remains a huge surgical challenge. Tension-free repair is proven to be superior to suture repair in abdominal wall reconstruction. Scaffolds are essential for tension-free repair. They are used to bridge a defect or reinforce the abdominal wall. A huge variety of scaffolds are now commercially available. Most of the synthetic scaffolds are composed of polypropylene. They provide strong tissue reinforcement, but cause a foreign body reaction, which can result in serious complications. Absorbable synthetic scaffolds, such as Dexon™ (polyglycolic acid) and Vicryl™ (polyglactin 910), are not suitable for abdominal wall reconstruction as they usually require subsequent surgeries to repair recurrent hernias. Composite scaffolds combine the strength of nonabsorbable synthetic scaffolds with the antiadhesive properties of the absorbable scaffold, but require long-term follow-up. Biological scaffolds, such as Permacol™, Surgisis(®) and Alloderm(®), are derived from acellular mammalian tissues. Non-cross-linked biological scaffolds show excellent biocompatibility and degrade slowly over time. However, remnant DNA has been found in several products and the degradation leads to recurrence. Randomized controlled trials with long-term follow-up studies are lacking for all of the available scaffolds, particularly those derived from animal tissue. This article provides an overview of the different types of scaffolds available, and presents the key clinical studies of the commercially available synthetic, composite and biological scaffolds for abdominal wall reconstruction.

  12. Reconstruction of complex abdominal wall defects

    Slater, N.J.

    2014-01-01

    Incisional hernia is by far the most common complication after laparotomies, occurring in 10 – 20%. Its occurrence is secondary to insufficient healing of the postoperative scar, resulting in wound dehiscence and protrusion of abdominal contents through an opening in the musculo-fascial layer of the

  13. Extended mesh repair with external oblique muscle reinforcement for abdominal wall contour abnormalities following TRAM flap.

    Israeli, Ron; Hazani, Ron; Feingold, Randall S; DeNoto, George; Scheiner, Marc S

    2009-12-01

    Many patients undergoing reconstructive surgery after mastectomy opt for reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap. Among the morbidities related to TRAM flap reconstruction is the development of abdominal wall contour abnormalities, including bulges or hernias. Several repair techniques at the flap abdominal wall donor site have been described for use at the time of flap harvest in an attempt to reduce the risk of such abdominal wall complications. For patients that develop abdominal wall contour abnormalities, numerous reconstructive options have been reported, with mixed results. Ten patients were identified as having abdominal wall contour abnormalities after a TRAM flap and underwent an extended mesh repair with external oblique muscle reinforcement. The mesh was secured to the bony landmarks of the lower abdomen and the abdominal wall fascia. All patients achieved complete resolution of abdominal wall bulging. In the follow-up period, no recurrences, infections, or seromas were noted. One patient, who failed an earlier repair at the inferior abdominal wall, reported symptoms consistent with a scar neuroma. Symptoms were treated successfully with gabapentin and a nonsteroidal anti-inflammatory drug. We propose a novel and reliable method of lower abdominal wall reconstruction for patients with post-TRAM flap abdominal wall contour abnormalities. This technique incorporates the use of a large Marlex mesh reinforced with bilateral external oblique muscle flaps. We report a series of 10 patients who have achieved resolution of their symptoms and have regained a natural, flat-appearing abdominal wall contour.

  14. Laparoscopic Inguinal Hernia Repair

    ... hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. ... is a technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). ...

  15. Hernia sacs: is histological examination necessary?

    Wang, Tao; Vajpeyi, Rajkumar

    2013-12-01

    The hernia sac is a common surgical pathology specimen which can occasionally yield unexpected diagnoses. The College of American Pathologists recommends microscopic examination of abdominal hernias, but leaves submission of inguinal hernias for histology to the discretion of the pathologist. To validate this approach at a tertiary care centre, we retrospectively reviewed 1426 hernia sacs derived from inguinal, femoral and abdominal wall hernias. The majority of pathologies noted were known to the clinician, including herniated bowel, lipomas and omentum. A malignancy was noted in three of 800 inguinal hernias and seven of 576 abdominal wall hernias; five of these lesions were not seen on gross examination. Other interesting findings in hernia sacs included appendices, endometriosis, a perivascular epithelioid cell tumour, and pseudomyxoma peritoneii. All hernia sacs should be examined grossly as most pathologies are grossly visible. The decision to submit inguinal hernias for histology may be left to the discretion of the pathologist, but abdominal and femoral hernias should be submitted for histology.

  16. Direct and Recurrent Inguinal Hernias are Associated with Ventral Hernia Repair

    Henriksen, Nadia A; Sorensen, Lars T; Bay-Nielsen, Morten;

    2013-01-01

    A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim...... of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery....

  17. Use of biological meshes for abdominal wall reconstruction in highly contaminated fields

    Andrea; Cavallaro; Emanuele; Lo; Menzo; Maria; Di; Vita; Antonio; Zanghì; Vincenzo; Cavallaro; Pier; Francesco; Veroux; Alessandro; Cappellani

    2010-01-01

    Abdominal wall defects and incisional hernias represent a challenging problem. In particular, when a synthetic mesh is applied to contaminated wounds, its removal is required in 50%-90% of cases. Biosynthetic meshes are the newest tool available to surgeons and they could have a role in ventral hernia repair in a potential-ly contaminated field. We describe the use of a sheet of bovine pericardium graft in the reconstruction of abdominal wall defect in two patients. Bovine pericardium graft was placed in th...

  18. Teratogens inducing congenital abdominal wall defects in animal models.

    Van Dorp, Dennis R; Malleis, John M; Sullivan, Brian P; Klein, Michael D

    2010-02-01

    Congenital abdominal wall defects are common anomalies which include gastroschisis, omphalocele and umbilical cord hernia. Recent reports indicate that gastroschisis is increasing in prevalence, whereas omphalocele has remained steady, suggesting that environmental factors may play a part in their pathogenesis. The aim of this study is to review animal teratogen studies resulting in abdominal wall defects to investigate their possible causes. Each report was examined not only for the teratogens causing the defects, but also to carefully identify the defect occurring and its correlation with the known clinical anomalies. We found many discrepancies between the nomenclature used by animal teratology investigators and that used by clinicians. We were able to confirm the induction of gastroschisis by 22 teratogens, omphalocele by 9 teratogens and umbilical cord hernia by 8. There is no doubt that environmental factors may be responsible, at least in part, for all three of the clinical abdominal wall defects. Future studies should take care to appreciate the differences between these anomalies and describe them in detail, so that accurate and meaningful conclusions can be obtained.

  19. Abdominal wall repair with human acellular dermal autograft

    Roel E. Genders

    2011-12-01

    Full Text Available Repair of abdominal wall defects in the presence of contamination or infection is a significant problem. The loss of tissue warrants enforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive surgery. This paper presents a review of available literature of placement of an acellular human dermis to repair an abdominal fascia defect, in contaminated as well as in non-contaminated surgical fields. It is illustrated with a case report that describes the successful reconstruction of an infected abdominal wall defect with a human acellular dermis allograft. A systematic literature review was undertaken with searches performed in the Pubmed and Cochrane databases for the period up till March 2009, using the search terms Alloderm [Substance Name], Hernia [Mesh] and the key words acellular dermis, acellular dermal matrix, human acellular dermal allograft and abdominal wall defect. To assess methodological quality, each article was subjected to a modification of the methodological index for non-randomized studies (MINORS according to Slim et al. Two items from the original index were not included because none of the studies selected had an unbiased assessment of the study end points and in none of the studies was a prospective calculation of the study size performed. Seventeen studies were included in the review. Data were extracted regarding study design, number of patients, surgical technique, followup period, contaminated or non-contaminated area of the fascia defect, mortality and morbidity (hemorrhage, seroma, wound dehiscence, infection of the operative procedure, the longterm results (removal of the graft, reherniation and bulging and level of evidencey. A total of 169 short-term complications and 151 longterm complications occurred after 643 surgical procedures reconstructing both contaminated and clean abdominal wall defects by implantation of an HADA. Human acellular dermal allograft

  20. Quadratus lumborum block in chronic pain after abdominal hernia repair: case report

    Rita Carvalho

    Full Text Available Abstract Background and objectives: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II. The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. Case report: Male patient, 61 years old, 83 kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25 mL and depot (vial methylprednisolone (20 mg on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. Conclusions: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

  1. Pulmonary complications of abdominal wall defects.

    Panitch, Howard B

    2015-01-01

    The abdominal wall is an integral component of the chest wall. Defects in the ventral abdominal wall alter respiratory mechanics and can impair diaphragm function. Congenital abdominal wall defects also are associated with abnormalities in lung growth and development that lead to pulmonary hypoplasia, pulmonary hypertension, and alterations in thoracic cage formation. Although infants with ventral abdominal wall defects can experience life-threatening pulmonary complications, older children typically experience a more benign respiratory course. Studies of lung and chest wall function in older children and adolescents with congenital abdominal wall defects are few; such investigations could provide strategies for improved respiratory performance, avoidance of respiratory morbidity, and enhanced exercise ability for these children.

  2. [Spontaneous bilateral Petit hernia].

    Fontoura, Rodrigo Dias; Araújo, Emerson Silveira de; Oliveira, Gustavo Alves de; Sarmenghi Filho, Deolindo; Kalil, Mitre

    2011-01-01

    Petit's lumbar hernia is an uncommon defect of the posterior abdominal wall that represents less than 1% of all abdominal wall hernias. It is more often unilateral and founded in young females, rarely containing a real herniated sac. There are two different approaches to repair: laparoscopy and open surgery. The goal of this article is to report one case of spontaneous bilateral lumbar Petit's hernia treated with open surgery.

  3. Epigastric and Umbilical Hernia; Work Relatedness and Return to Work

    2013-01-01

    Abdominal wall hernia is common but reliable scientific data about its work relatedness is very limited and inconsistent. In this paper, a less common type of abdominal wall hernia in a 30 year old male worker is presented with recurrence after first surgery when he returned to work. In contrast with almost all kinds of hernia, a lifelong limitation for heavy lifting was recommended. It seems that contrary to popular belief, work relatedness of abdominal wall hernia is seriously doubtful, alt...

  4. Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia

    Vincent Delliere

    2014-01-01

    Full Text Available We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There are only 12 cases of bowel perforation in literature but this complication is probably underestimated. Prompt surgical debridement is absolutely mandatory in this life threatening scenario. Lumbar hernia is very rare and should be ruled out before every abdominal liposuction clinically or with imaging modalities.

  5. [Use of nickel-titanium alloys in plasty of the anterior abdominal wall].

    Veronskiĭ, G I; Zotov, V A

    2000-01-01

    The work presents results of the surgical treatment of postoperative hernias of the abdominal wall using explants of titanium nickelide in 48 patients. Data of biopsy of the anterior abdominal wall muscles in these patients are given. The anatomo-morphological and functional incompetence is shown. A method of preparing the patients with giant hernias to operation with the help of dynamic pneumocompression is described. The indications to using the explants in hernioplasty are determined by the methods of somatometry and intraoperative dynamometry. The data of three methods of combined hernioplasty are presented: with the use of a superelastic network from a nickelide-titanium alloy; explant with tractional properties, effect of the "shape memory"; method of extracorporeal extension of the abdominal wall at the postoperative period. The nearest and long-term results followed-up during 3 years are shown.

  6. Reconstruction of full thickness abdominal wall defect following tumor resection: A case report

    Kovačević Predrag

    2014-01-01

    Full Text Available Introduction. Reconstruction of a full thickness abdominal wall defect is a demanding procedure for general and also for plastic surgeons, requiring vigorous planning and reconstruction of three layers. Case Outline. We present a case of a 70-year-old patient with a huge abdominal wall tumor with 40 years evolution. Surgery was performed under general anesthesia. Full thickness abdominal defect appeared after the tumor resection. Reconstruction followed in the same act. The defect was reconstructed using a combination of techniques, including omental flap, fascia lata graft, local skin flaps and skin grafts. After surgery no major complications were noted, only a partial skin flap loss, which was repaired using partial thickness skin grafts. The final result was described by the patient as very good, without hernia formation. Conclusion. Omenthoplasty, abdominal wall reconstruction in combination with free fascia lata graft and skin grafts can be one of good options for the reconstruction of full thickness abdominal wall defects.

  7. A Large Intra-Abdominal Hiatal Hernia as a Rare Cause of Dyspnea

    Cem Sahin

    2015-01-01

    Full Text Available Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the left atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea.

  8. ABDOMINAL WALL DESMOID TUMOUR OVER APPENDICECTOMY SCAR

    Vijaya; Sarbeshwar; Gogoi

    2015-01-01

    BACKGROUND: Desmoid tumors are slow growing deep fibromatoses with aggressive infiltration of adjacent tissue but without any metastatic potential . (1,2,3) CASE PRESENTATION: We report a female patient with desmoid tumor of the abdominal wall over appendicectomy scar w ho underwent primary resection. Preoperative evaluation incl uded abdominal ultrasound, and computed tomography. The histology of this cases revealed a desmoid tumor. CONCLUSION: ...

  9. Treatment of Abdominal Segmental Hernia, Constipation, and Pain Following Herpes Zoster with Paravertebral Block.

    Kim, Saeyoung; Jeon, Younghoon

    2015-01-01

    Herpes zoster (HZ) most commonly occurs in elderly patients and involves sensory neurons resulting in pain and sensory changes. Clinically significant motor deficits and visceral neuropathies are thought to be relatively rare. A 72-year-old man presented with abdominal segmental hernia, constipation, and pain following HZ in the left T9-10 dermatome. Sixteen days before presentation, he had developed a painful herpetic rash in the left upper abdominal quadrant. Approximately 10 days after the onset of the rash, constipation occurred and was managed with daily oral medication with bisacodyl 5 mg. In addition, 14 days after the onset of HZ, the patient noticed a protrusion of the left upper abdominal wall. Abdominal x-ray, ultrasound of the abdomen, and electrolyte analysis showed no abnormalities. General physical examination revealed a reducible bulge in his left upper quadrant and superficial abdominal reflexes were diminished in the affected region. Electromyographic testing revealed denervational changes limited to the left thoracic paraspinal muscles and supraumbilical muscles, corresponding to the affected dermatomes. He was prescribed with 500 mg of famciclovir 3 times a day for 7 days, and pregabalin 75 mg twice a day and acetaminophen 650 mg 3 times a day for 14 days. However, his pain was rated at an intensity of 5 on the numerical analogue scale from 0 (no pain) to 10 (worst pain imaginable). A paravertebral block was performed at T9-10 with a mixture of 0.5% lidocaine 3 mL and triamcinolone 40 mg. One day after the procedure, the abdominal pain disappeared. In addition, 5 days after the intervention, the abdominal protrusion and constipation were resolved. He currently remains symptom free at a 6 month follow-up.

  10. Radiologic findings of abdominal wall endometriosis

    Seo, Jung Wook [Inje Univ. Ilsan Paik Hospital, Goyang (Korea, Republic of)

    2003-12-01

    To evaluate the imaging findings of abdominal wall endometriosis. In seven of 17 patients with surgically proven endometriosis of the abdominal wall, we retrospectively reviewed the findings of radiologic studies such as abdominal US (n=3), CT (n=4), and MRI (n=1). One patient under went more than one type of imaging, apparently. The surgical history of the seven, and their symptoms and preoperative diagnosis were reviewed, and the size, location, margin and nature of the mass, and the contrast enhancement patterns observed at radiologic studies, were assessed. The chief symptoms were palpable abdominal wall mass (n=5) and lower abdominal pain (n=2) around a surgical scar. Previous surgery included cesarean section (n=5), cesarean section with oophorectomy (n=1) and appendectomy (n=1). Masses were located in the subcutaneous fat layer (n=5) or rectus abdominis muscle (n=2), and their maximum diameter was 2.6 cm. Imaging findings, which correlated closely with the pathologic findings, included a well (n=5) or poorly marginated (n=2) solid mass, with a focal cystic area apparent in two cases. Although imaging findings of abdominal wall endometriosis may not be specific for diagnosis, the presence of a solid abdominal mass in female patients of reproductive age with a history of surgery is a diagnostic pointer.

  11. Texture analysis improves level set segmentation of the anterior abdominal wall

    Xu, Zhoubing [Electrical Engineering, Vanderbilt University, Nashville, Tennessee 37235 (United States); Allen, Wade M. [Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37235 (United States); Baucom, Rebeccah B.; Poulose, Benjamin K. [General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37235 (United States); Landman, Bennett A. [Electrical Engineering, Vanderbilt University, Nashville, Tennessee 37235 and Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37235 (United States)

    2013-12-15

    Purpose: The treatment of ventral hernias (VH) has been a challenging problem for medical care. Repair of these hernias is fraught with failure; recurrence rates ranging from 24% to 43% have been reported, even with the use of biocompatible mesh. Currently, computed tomography (CT) is used to guide intervention through expert, but qualitative, clinical judgments, notably, quantitative metrics based on image-processing are not used. The authors propose that image segmentation methods to capture the three-dimensional structure of the abdominal wall and its abnormalities will provide a foundation on which to measure geometric properties of hernias and surrounding tissues and, therefore, to optimize intervention.Methods: In this study with 20 clinically acquired CT scans on postoperative patients, the authors demonstrated a novel approach to geometric classification of the abdominal. The authors’ approach uses a texture analysis based on Gabor filters to extract feature vectors and follows a fuzzy c-means clustering method to estimate voxelwise probability memberships for eight clusters. The memberships estimated from the texture analysis are helpful to identify anatomical structures with inhomogeneous intensities. The membership was used to guide the level set evolution, as well as to derive an initial start close to the abdominal wall.Results: Segmentation results on abdominal walls were both quantitatively and qualitatively validated with surface errors based on manually labeled ground truth. Using texture, mean surface errors for the outer surface of the abdominal wall were less than 2 mm, with 91% of the outer surface less than 5 mm away from the manual tracings; errors were significantly greater (2–5 mm) for methods that did not use the texture.Conclusions: The authors’ approach establishes a baseline for characterizing the abdominal wall for improving VH care. Inherent texture patterns in CT scans are helpful to the tissue classification, and texture

  12. Fullterm pregnancy in umbilical hernia

    2011-01-01

    While umbilical hernias frequently occur during pregnancy, the few reported cases of uterine or fibroid incarceration in ventral hernias during pregnancy all involved incisional abdominal wall defects from prior laparotomies and Cesarean sections; none involved umbilical hernias. We discuss the case of a 42-year-old well-developed, well-nourished grand multiparous woman (G8P7) with a huge umbilical hernia containing a 38-week gravid uterus, as well as her management and the avoidance of known...

  13. Abdominal Wall Endometrioma. Report of Two Cases

    Tahiluma Santana Pedraza

    2014-08-01

    Full Text Available Abdominal wall endometrioma is a condition rarely seen by surgeons. It represents a diagnostic challenge due to its similarity with other tumors. This entity occurs in fertile women and often appears two to five years after gynecological and obstetric surgical procedures. It must be considered when dealing with a cyclically painful nodule located in a laparotomy scar. The diagnosis is established by histological examination; most imaging tests determine the characteristics of the lesion, concomitant lesions and the intra-abdominal origin or location in the abdominal wall. The cases of two patients treated at the General Surgery Department of the María Eugenia González Comprehensive Diagnostic Center in the Capital District, Venezuela, are presented. Wide excision of the tissue and histological examination were performed, confirming the diagnosis. The postoperative course was uneventful. This case is presented given the rarity of this condition.

  14. Abdominal Wall Desmoid during Pregnancy: Diagnostic Challenges

    Johnny Awwad

    2013-01-01

    Full Text Available Background. Desmoids are benign tumors, with local invasive features and no metastatic potential, which have rarely been described to be pregnancy associated. Case. We described the rapid growth of an anterior abdominal wall mass in a 40-year-old pregnant woman. Due to its close proximity to the enlarged uterus, it was misdiagnosed to be a uterine leiomyoma by ultrasound examination. Final tissue diagnosis and radical resection were done at the time of abdominal delivery. Conclusion. Due to the diagnostic limitations of imaging techniques, desmoids should always be considered when the following manifestations are observed in combination: progressive growth of a solitary abdominal wall mass during pregnancy and well-delineated smooth tumor margins demonstrated by imaging techniques. This case emphasizes the importance of entertaining uncommon medical conditions in the differential diagnosis of seemingly common clinical manifestations.

  15. Genetics Home Reference: abdominal wall defect

    ... Aug;6(4):232-6. Citation on PubMed Islam S. Clinical care outcomes in abdominal wall defects. Curr ... Site Map Customer Support Selection Criteria for Links USA.gov Copyright Privacy Accessibility FOIA Viewers & Players U.S. ...

  16. Value-based Clinical Quality Improvement (CQI) for Patients Undergoing Abdominal Wall Reconstruction.

    Stephan, Bradley; Ramshaw, Bruce; Forman, Brandie

    2015-05-01

    Patients with complex ventral/incisional hernias often undergo an abdominal wall reconstruction (AWR). These operations have a high cost of care and often result in a long hospital stay and high complication rates. Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a 3-year period. For consecutive cases of patients undergoing abdominal wall reconstruction, process improvement attempts included the use of a long-term resorbable synthetic mesh (TIGR® Resorbable Matrix, Novus Scientific, Uppsala, Sweden) in place of a biologic mesh, the use of the transversus abdominis release approach in place of an open or endoscopic component separation (external oblique release) technique, and the use of a preoperative transversus abdominis plane (TAP) block using a long-acting local anesthetic (Exparel®, Pacira Pharmaceutical, Parsippany, NJ) as a part of perioperative multi-modal pain management and an enhanced recovery program. After over 60 cases, improvement in materials costs and postoperative outcomes were documented. No mesh-related complications occurred and no mesh removal was required. In this real-world, value-based application of CQI, several attempts at process improvement led to decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral/incisional hernias. Value-based CQI could be a tool for improved health care value globally.

  17. Early results on the use of biomaterials as adjuvant to abdominal wall closure following cytoreduction and hyperthermic intraperitoneal chemotherapy

    Boutros Cherif

    2010-08-01

    Full Text Available Abstract Background Hyperthermic chemotherapy applies thermal energy to both abdominal wall as well as the intra-abdominal viscera. The combination of the hyperthemia, chemotherapy and cytoreductive surgery (CRS is associated with a defined risk of abdominal wall and intestinal morbidity reported to be as high as 15%, respectively to date, no studies have evaluated the use of biomaterial mesh as adjuvant to abdominal wall closure in this group of patients. In the present report, we hypothesized that post HIPEC closure with a biomaterial can reduce abdominal wall morbidity after CRS and hyperthermic intraperitoneal chemotherapy. Materials and methods All patients treated with HIPEC in a tertiary care center over 12 months (2008-2009 period were included. Eight patients received cytoreductive surgery followed by HIPEC for 90 minutes using Mitomycin C (15 mg q 45 minutes × 2. Abdominal wall closure was performed using Surgisis (Cook Biotech. mesh in an underlay position with 3 cm fascial overlap-closure. Operative time, hospital length of stay (LOS as well as postoperative outcome with special attention to abdominal wall and bowel morbidity were assessed. Results Eight patients, mean age 59.7 ys (36-80 were treated according to the above protocol. The primary pathology was appendiceal mucinous adenocarcinoma (n = 3 colorectal cancer (n = 3, and ovarian cancer (n = 2. Four patients (50% presented initially with abdominal wall morbidity including incisional ventral hernia (n = 3 and excessive abdominal wall metastatic implants (n = 1. The mean peritoneal cancer index (PCI was 8.75. Twenty eight CRS were performed (3.5 CRS/patient. The mean operating time was 6 hours. Seven patients had no abdominal wall or bowel morbidity, the mean LOS for these patients was 8 days. During the follow up period (mean 6.3 months, one patient required exploratory laparotomy 2 weeks after surgery and subsequently developed an incisional hernia and enterocutaneous

  18. Abdominal wall paresis as a complication of laparoscopic surgery

    G.H. van Ramshorst (Gabrielle); G.J. Kleinrensink (Gert Jan); J.J. Hermans (John); T. Terkivatan (Türkan); J.F. Lange (Johan)

    2009-01-01

    textabstractPurpose: Abdominal wall nerve injury as a result of trocar placement for laparoscopic surgery is rare. We intend to discuss causes of abdominal wall paresis as well as relevant anatomy. Methods: A review of the nerve supply of the abdominal wall is illustrated with a rare case of a patie

  19. 气腹与腹壁悬吊无气腹结合腹腔镜手术治疗滑动型食管裂孔疝17例疗效分析%Seventeen cases of analysis of efficacy for sliding esophageal hiatal hernia by laparoscopy via pneumoperitoneum and non-pneumoperitoneum through abdominal wall lifting

    张葆勋; 伍冀湘; 蒋俭; 于涛; 于磊; 李建业

    2014-01-01

    Objective To evaluate the clinical value of the method of surgical treatment in patients with sliding esophageal hiatal hernia by laparoscopy via pneumoperitoneum and non-pneumoperitoneum through abdominal wall lifting.Methods The clinical data of 17 cases of laparoscopic esophageal hiatal hernia repair combined with and gastric folding via pneumoperitoneum and non-pneumoperitoneum through abdominal wall lifting was collected between May 2012 and May 2014,including 15 cases of Nissen operation and,2 cases of Toupet operation.Results Surgeries in all patients were successfully completed,no transferring laparotomy,the average operation time was 45 to 220 minutes,intraoperative blood loss was less than 50 ml,there were no postoperative complications,all patients were cured and discharged,and the average hospitalization time was 10 days.Follow-up period was between 1 to 24 months.Clinical symptoms in 16 patients disappeared completely,and clinical symptoms in 1 case partly relieved,with no relapsed case.Conclusion Sliding esophageal hiatal hernia by laparoscopy via pneumoperitoneum and non-pneumoperitoneum through abdominal wall lifting is a safe and effective surgical treatment,and has wide value of popularization.%目的:评估气腹与腹壁悬吊无气腹结合腹腔镜食管裂孔疝修补和胃底折叠术治疗滑动型食管裂孔疝的临床价值。方法回顾性分析2012年5月至2014年5月,北京同仁医院胸外科进行的17例气腹与腹壁悬吊无气腹结合腹腔镜食管裂孔疝修补和胃底折叠术的临床资料,其中采用Nissen 术式15例,Toupet 术式2例。结果所有患者均顺利完成手术,无中转开腹,平均手术时间为45~220 min,术中出血量均小于50 ml,无术后并发症,全部治愈出院,术后平均住院时间10 d。随访时间1~24个月,16例患者临床症状完全消失,1例临床症状部分缓解,无明确复发病例。结论气腹与腹壁悬吊无气腹结合腹腔镜

  20. Laparoscopic tension-free hernioplasty for lumbar hernia.

    Maeda, K; Kanehira, E; Shinno, H; Yamamura, K

    2003-09-01

    Lumbar hernia, a defect of the posterior abdominal wall, is a very rare condition. The repair of a posterior abdominal wall hernia by simply closing the hernia port with sutures may not be adequate, especially when the herniation is due to a weakness in the abdominal wall. Recently, a simple, logical method of tension-free repair has become a popular means for the treatment of various abdominal wall hernias. Previous studies have advocated the use of tension-free repair for lumbar hernia; the technique uses a mesh replacement and requires an extensive incision. Herein we present a case of superior lumbar hernia. Our technique consisted of a laparoscopic tension-free hernioplasty with the application of a Prolene mesh. This technique, which provides an excellent operative view, is safe, feasible, and minimally invasive. We conclude that laparoscopic tension-free repair should be the preferred option for the treatment of lumbar hernia.

  1. Rare variant of inguinal hernia, interparietal hernia and ipsilateral abdominal ectopic testis, mimicking a spiegelian hernia. Case report.

    Hirabayashi, Takeshi; Ueno, Shigeru

    2013-07-20

    We report a case in which the combination of an interparietal inguinal hernia and ipsilateral ectopic testicle mimicked a spigelian hernia. The patient was a 22-day-old boy who presented with a reducible mass that extended from the right lumbar region to the iliac fossa region. The right testis was palpable in the right lumbar region. Ultrasonography and magnetic resonance imaging revealed that a small bowel had herniated through the inguinal region below the external oblique aponeurosis. Surgery was performed when the patient was 23 months old. Laparoscopic examination to identify the hernia orifice revealed that it was the deep inguinal ring, and the testicular vessels and the vas deferens passed beneath the hernia sac. An inguinal incision was made, and a hernia sac was observed passing through the deep inguinal ring and extending superiorly below the aponeurosis. The testis was found in the hernia sac. Traditional inguinal herniorrhaphy and traditional orchidopexy were performed, and the postoperative course was uneventful. It is difficult to understand the surgical anatomy of interparietal hernias, but once the surgical anatomy is understood, surgical repair is simple. We report the case with a review of the literature and also emphasize that laparoscopic exploration is helpful during surgery.

  2. Dystrophies of the abdominal wall in adults: Surgical treatment

    Jayme Fortunato Athias

    1997-03-01

    Full Text Available The authors present a retrospective study of 60 patients with abdominal dystrophies, both with and without hernias, operated on in the period between 01 June 1994 and 30 January 1996. Their average age was 47 years. The incision at hernia itself and the dystrophic abdomen were the principal objects of the study. The authors show the importance of abdominal dermolipectomy for the complete recovery of the patient as well as demonstrate how it facilitates the technical manipulation of hernias. The technique of bilateral, longitudinal peritonio-aponeurotic transposition {the technique of Alcíno Lázaro da Silva was used for large incisional hernias. A variation of this technique, for hernias with a hernial ring of up to 10 cm, is proposed by the authors, which consists in the closing of the ring and the reinforcement of the suture with the hernial sac. A revision is made of the results of these procedures realized in isolation and accompanied with abdominal dermolipectomy. Forty-nine recovered without complications (81.66%, three relapsed (5%, one necrosis of the midline with respiratory failure (1.67%, one little stitch gap (1,67%, two umbilical stenosis (3,33%, two wound abscess (3.33%, one cutaneous fistula (1,67% and one death from pulmonary embolism (1.66%.

  3. Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair

    Christoffersen, Mette; Olsen, B H; Rosenberg, J;

    2015-01-01

    -reducing effect of an abdominal binder in patients undergoing laparoscopic umbilical or epigastric hernia repair. METHODS: Based on power analysis, a minimum of 54 patients undergoing laparoscopic umbilical and epigastric hernia repair were to be included. Patients were randomized to abdominal binders vs......PURPOSE: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma...

  4. Management of Patients with Hernia or Incisional Hernia Undergoing Surgery for Morbid Obesity

    Ramon Vilallonga

    2011-01-01

    Full Text Available Morbidly obese patients (MOPs are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction and other morbidity. We report our experience in treating morbidly obese patients. Hernia prophylaxis has been attempted as a means of decreasing the incisional hernia risk associated with weight loss surgery. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing open or laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or splits of the omentum, and of leaving a plug in the hernia defect, to allow time to perform a delayed repair.

  5. [Neonatal occlusion due to a lumbar hernia].

    Hunald, F A; Ravololoniaina, T; Rajaonarivony, M F V; Rakotovao, M; Andriamanarivo, M L; Rakoto-Ratsimba, H

    2011-10-01

    A Petit lumbar hernia is an uncommon hernia. Congenital forms are seen in children. Incarceration may occur as an unreducible lumbar mass, associated with bilious vomiting and abdominal distention. Abdominal X-ray shows sided-wall bowel gas. In this case, reduction and primary closure must be performed as emergency repair.

  6. Radical cystectomy and pelvic lymphadenectomy with ileal conduit urinary diversion and abdominal wall reconstruction: an interesting case of multidisciplinary management

    Sofos SS

    2015-01-01

    Full Text Available Stratos S Sofos,1 Ciaran Walsh,2 Nigel J Parr,2 Kevin Hancock11Whiston Hospital, Prescot, 2Arrowe Park Hospital, Wirral, Merseyside, UKAbstract: The ileal conduit for urinary diversion after radical cystectomy is a well-described procedure. Furthermore, parastomal hernias, prolapse, stenosis, and retraction of the stoma have been reported as some of the more common complications of this procedure. The subsequent repair of parastomal hernias with a biological mesh and the potential of the conduit to “tunnel” through it has also been described. In this case report, we present a combined repair of a large incisional hernia with a cystectomy and a pelvic lymphadenectomy for invasive bladder cancer, with the use of a biological mesh for posterior component abdominal wall primary repair as well as for support to the ileal conduit used for urinary diversion.Keywords: incisional hernia, posterior component separation, biological mesh 

  7. the Clinical Value of Spiral CT Diagnosis of Abdominal Hernia Applied%螺旋CT诊断应用于腹部疝中的临床价值

    蒋宏华

    2013-01-01

    Objective Study and analysis of spiral CT diagnosis applied in abdominal hernia in the important clinical value. Methods The study object of study mainly for our 34 cases were treated abdominal hernia patients, and to all the research object of the clinical data were retrospectively analyzed. Results All patients with spiral CT diagnosis are more accurate. 34 cases of abdominal hernia patients, according to its hernia of the specific position, spiral CT diagnosed inguinal region hernia patients for 15 cases, umbilical hernia (3 cases), intraperitoneal hernia 4 cases, 2 cases of obturator hernia and traumatic abdominal wall hernia patients, 4 cases of abdominal incisional hernia patients 6 patients. Patients with abdominal hernia content of small intestine, Spiral CT performance under for intestinal obstruction of the patients in 34 cases, spiral CT diagnosis and surgical results of the coincidence rate is 100%. Conclusion For abdominal hernia patients is concerned, using spiral CT to carry on the diagnosis is very effective, it has the safe, convenient wait for a characteristic, can for clinical diagnosis and treatment to provide more substantial and reality basis.%  目的研究并分析螺旋CT诊断应用于腹部疝中的重要临床价值。方法本组研究的研究对象主要为我院收治的34例腹部疝患者,并对所有研究对象的临床资料进行回顾性分析。结果所有患者的螺旋CT诊断均较为准确。34例腹部疝患者中,根据其疝的具体位置,螺旋CT诊断出腹股沟区疝患者为15例、脐疝3例、腹腔内疝4例、闭孔疝2例和外伤性腹壁疝患者4例、腹壁切口疝患者6例。患者的腹部疝内容物为小肠;螺旋CT下表现为肠梗阻的患者为34例,螺旋CT的诊断与手术结果的符合率为100%。结论对于腹部疝的患者而言,运用螺旋CT来对其进行诊断是十分有效的,其具有安全、方便等特点,可以为临床的诊断与治疗提供较为可观与真实的依据。

  8. Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort

    Henriksen, N A; Sorensen, L T; Jørgensen, Lars Nannestad

    2013-01-01

    Previous studies have reported a higher prevalence of inguinal hernia in patients with abdominal aortic aneurysm (AAA). The aim of this study was to explore the association between inguinal hernia and AAA in a large population-based cohort of men who had screening for AAA....

  9. Full-term pregnancy in umbilical hernia

    2011-01-01

    While umbilical hernias frequently occur during pregnancy, the few reported cases of uterine or fibroid incarceration in ventral hernias during pregnancy all involved incisional abdominal wall defects from prior laparotomies and Cesarean sections; none involved umbilical hernias. We discuss the case of a 42-year-old well-developed, well-nourished grand multiparous woman (G8P7) with a huge umbilical hernia containing a 38-week gravid uterus, as well as her management and the avoidance of known...

  10. Adhesions to Mesh after Ventral Hernia Mesh Repair Are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain

    Odd Langbach

    2016-01-01

    Full Text Available Aim. The aim of the present study was to perform MRI in patients after ventral hernia mesh repair, in order to evaluate MRI’s ability to detect intra-abdominal adhesions. Materials and Methods. Single-center long term follow-up study of 155 patients operated for ventral hernia with laparoscopic (LVHR or open mesh repair (OVHR, including analyzing medical records, clinical investigation with patient-reported pain (VAS-scale, and MRI. MRI was performed in 124 patients: 114 patients (74% after follow-up, and 10 patients referred for late complaints after ventral mesh repair. To verify the MRI-diagnosis of adhesions, laparoscopy was performed after MRI in a cohort of 20 patients. Results. MRI detected adhesions between bowel and abdominal wall/mesh in 60% of the patients and mesh shrinkage in 20–50%. Adhesions were demonstrated to all types of meshes after both LVHR and OVHR with a sensitivity of 70%, specificity of 75%, positive predictive value of 78%, and negative predictive value of 67%. Independent predictors for formation of adhesions were mesh area as determined by MRI and Charlson index. The presence of adhesions was not associated with more pain. Conclusion. MRI can detect adhesions between bowel and abdominal wall in a fair reliable way. Adhesions are formed both after open and laparoscopic hernia mesh repair and are not associated with chronic pain.

  11. Incarcerated inferior lumbar (Petit's) hernia.

    Astarcioğlu, H; Sökmen, S; Atila, K; Karademir, S

    2003-09-01

    Petit's hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh reinforcement repair.

  12. A preclinical evaluation of alternative synthetic biomaterials for fascial defect repair using a rat abdominal hernia model.

    Daniela Ulrich

    Full Text Available INTRODUCTION: Fascial defects are a common problem in the abdominal wall and in the vagina leading to hernia or pelvic organ prolapse that requires mesh enhancement to reduce operation failure. However, the long-term outcome of synthetic mesh surgery may be unsatisfactory due to post-surgical complications. We hypothesized that mesh fabricated from alternative synthetic polymers may evoke a different tissue response, and provide more appropriate mechanical properties for hernia repair. Our aim was to compare the in vivo biocompatibility of new synthetic meshes with a commercial mesh. METHODS: We have fabricated 3 new warp-knitted synthetic meshes from different polymers with different tensile properties polyetheretherketone (PEEK, polyamide (PA and a composite, gelatin coated PA (PA+G. The rat abdominal hernia model was used to implant the meshes (25 × 35 mm, n = 24/ group. After 7, 30, 60, 90 days tissues were explanted for immunohistochemical assessment of foreign body reaction and tissue integration, using CD31, CD45, CD68, alpha-SMA antibodies. The images were analysed using an image analysis software program. Biomechanical properties were uniaxially evaluated using an Instron Tensile® Tester. RESULTS: This study showed that the new meshes induced complex differences in the type of foreign body reaction over the time course of implantation. The PA, and particularly the composite PA+G meshes, evoked a milder early inflammatory response, and macrophages were apparent throughout the time course. Our meshes led to better tissue integration and new collagen deposition, particularly with the PA+G meshes, as well as greater and sustained neovascularisation compared with the PP meshes. CONCLUSION: PA, PA+G and PEEK appear to be well tolerated and are biocompatible, evoking an overlapping and different host tissue response with time that might convey mechanical variations in the healing tissue. These new meshes comprising different polymers may

  13. Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report

    Hipkins Gabrielle

    2010-06-01

    Full Text Available Abstract We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers. To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.

  14. Abdominal wall muscle elasticity and abdomen local stiffness on healthy volunteers during various physiological activities.

    Tran, D; Podwojewski, F; Beillas, P; Ottenio, M; Voirin, D; Turquier, F; Mitton, D

    2016-07-01

    The performance of hernia treatment could benefit from more extensive knowledge of the mechanical behavior of the abdominal wall in a healthy state. To supply this knowledge, the antero-lateral abdominal wall was characterized in vivo on 11 healthy volunteers during 4 activities: rest, pullback loading, abdominal breathing and the "Valsalva maneuver". The elasticity of the abdominal muscles (rectus abdominis, obliquus externus, obliquus internus and transversus abdominis) was assessed using ultrasound shear wave elastography. In addition, the abdomen was subjected to a low external load at three locations: on the midline (linea alba), on the rectus abdominis region and on lateral muscles region in order to evaluate the local stiffness of the abdomen, at rest and during "Valsalva maneuver". The results showed that the "Valsalva maneuver" leads to a statistically significant increase of the muscle shear modulus compared to the other activities. This study also showed that the local stiffness of the abdomen was related to the activity. At rest, a significant difference has been observed between the anterior (0.5N/mm) and the lateral abdomen locations (1N/mm). Then, during the Valsalva maneuver, the local stiffness values were similar for all locations (ranging from 1.6 to 2.2N/mm). This work focuses on the in vivo characterization of the mechanical response of the human abdominal wall and abdomen during several activities. In the future, this protocol could be helpful for investigation on herniated patients.

  15. Mini-abdominoplasty combined with mesh used for abdominal wall endometriosis

    ZHAO Ru; WANG Xiao-jun; SONG Ke-xin; ZHU Lan; LI Bin

    2012-01-01

    Background Wide excision is considered the treatment of endometriosis.It is difficult to surgeon for reconstruction of a large full-thickness defect through the abdominal-wall.We introduce a method of mini-abdominoplasty combined with mesh that can be used for reconstruction of a large full-thickness defect through the abdominal-wall after wide excision of abdominal wall endometriosis.Methods This retrospective study includes a series of patients who underwent wide excision of abdominal wall endometriosis and reconstruction of a large full-thickness defect through the abdominal-wall over a 5-year period.Information obtained from chart reviews includes age,size of lesion and defect,complications and revisions.Results The method was used for 8 patients including 2 patients with recurrence.The mean size of the masses was (3.5±2.0) cm.The mean size of the fascia defects was 7.1 cm x 8.6 cm.The mean length of follow-up was (24±12)months.There was no recurrence,no hernia,and no other complications.The technique generated only a horizontal scar.The scar and contour of the lower abdomen provided a more pleasant appearance than the traditional procedure.Conclusions Mini-abdominoplasty combined with mesh is a useful and acceptable reconstruction method for large full-thickness defects through the abdominal wall after endometriosis resection.It is feasible for wide excision with 1 cm normal tissues around the margin.It provides an aesthetically pleasing result.

  16. Spontaneous abdominal wall endometriosis: a case report.

    Papavramidis, Th S; Sapalidis, K; Michalopoulos, N; Karayanopoulou, G; Raptou, G; Tzioufa, V; Kesisoglou, I; Papavramidis, S T

    2009-01-01

    Endometriosis is the presence of endometrial glands and stroma outside the uterus. Spontaneous abdominal wall endometriosis (AWE) is any ectopic endometrium found superficial to the peritoneum without the presence of any previous scar. Rarely, endometriosis represents a disease of specific interest to the general surgeon, on account of its extrapelvic localisations. We describe a case with spontaneous AWE presenting as a painful mass with cyclic symptoms. A 28-year-old woman presented to the day-surgery division of our department, suffering from a painful mass in the left lower abdominal quadrant. A mobile mass of 5 x 4 cm was identified. The initial diagnosis was lipoma and excision was planned. During the operation two masses were spotted, very close to one another, and were excised within healthy limits. Pathology revealed endometrial glands surrounded by a disintegrating mantle of endometrial stroma and fibrous scar tissue in which there was a scattering of leucocytes. The woman had no scars. She was discharged from hospital after 2 hours. Two years after the excision she is free of disease and no recurrence has been observed. Spontaneous AWE is rare, accounting for 20% of all AWEs. The triad ; mass, pain and cyclic symptomatology helps in the diagnosis, but unfortunately it is not present in all cases. Spontaneous endometriomas are usually diagnosed by pathology and the treatment of choice is surgical excision.

  17. [Pain originating from the abdominal wall: a forgotten diagnostic option].

    Rivero Fernández, Miguel; Moreira Vicente, Víctor; Riesco López, José María; Rodríguez Gandía, Miguel Angel; Garrido Gómez, Elena; Milicua Salamero, José María

    2007-04-01

    Chronic abdominal pain is a common clinical problem in primary care, and is usually referred to gastroenterologists or general surgeons. Although up to 20% of cases of idiopathic abdominal pain arise in structures of the abdominal wall, this is frequently overlooked as a possible cause. It includes pain arising from structures of the abdominal wall including skin, parietal peritoneum, cellular subcutaneous tissue, aponeuroses, abdominal muscles and somatosensorial innervation from lower dorsal roots. The diagnosis is based on anamnesis and physical examination. Carnett's sign is a simple maneuver that discriminates between parietal and visceral pain. Management with topical anesthesia is effective in a majority of patients and can help to confirm the diagnosis.

  18. Animal model of chronic abdominal hernia in rabbit Modelo animal de hérnia abdominal crônica em coelhos

    Walter da Silva

    2009-08-01

    Full Text Available PURPOSE: To create a feasible animal model of hernia that should be reliable to test the different types of mesh and/or surgical technique. METHODS: Thirty six male New Zealand albino rabbits were submitted to surgical procedure to provoke a standard hole in the abdominal wall. A metallic frame measuring 3 cm length and 1 cm width was allocated longitudinally on the umbilicus scar and the comprehensive three squared centimeters area was resected. A continuous 4.0 polyamide was performed to closure the subcutaneous and skin. RESULTS: During three weeks a score of signals/symptoms was performed to evaluate the wound and clinical conditions. No death or severe complications occurred. In the 3rd week the hernia ring and visceral adhesions were evaluated. Soft omental adherences were present in the hernial sac in all animals. The area of hernia ring ranged from 32.1±5.5 to 35.6±3.1 squared centimeter and the maximum was 39 cm² and the minimum was 30 cm². The model results in protrusion which was similar to a human incisional hernia with hernia sac, visceral adhesions and fibrous healing ring. CONCLUSION: The model was more reliable to test further techniques or mesh on hernia repair.OBJETIVO: Criação de um modelo animal de hérnia que seja confiável para testar as diferentes técnicas e tipos de telas. MÉTODOS: Trinta e seis coelhos foram submetidos a procedimento operatório que provocou uma falha na parede abdominal. Uma moldura metálica com 3 cm de comprimento e 1 cm de largura foi colocada longitudinalmente sobre a cicatriz umbilical e ressecada uma área de 3cm². Uma sutura contínua de poliamida 4.0 fechou a tela subcutânea e pele. RESULTADOS: durante três semanas o escore de sinais e sintomas foi coletado para avaliar as condições clínicas e da ferida operatória. Não ocorreram óbitos ou complicações graves. Na terceira semana o anel herniário e aderências peritoneais foram avaliadas. Aderências frouxas estavam presentes

  19. Z-plasty for uterus-to-abdominal-wall fistula

    Lou Xiaoli; Zhang Mingli; Cui Ying; Song Jianxing

    2009-01-01

    Objective: Uterus-to-abdominal-wall fistula is a very rare complication after uterine-incision delivery over the last decades. It can even lead to death. Mainly, the fistula occurs when big tension and critical infection exist within the incision of uterus and abdominal wall. Methods: The authors described the clinical presentation, pathology of uterus-to-abdominal-wall fistula, and reported their experience in 6 cases who underwent Z-plasty operation for this rare complication from January 1998 to January 2008. Results: All flaps survived completely and all the wounds in abdominal walls healed very well. The six cases were followed up for 1 to 5 years, and no fistula recurrence occurred. Conclusion: Z-plasty technique is a very simple and efficient approach to repair uterus to abdominal fistula after uterine-incision delivery.

  20. Therapy of umbilical hernia during laparoscopic cholecystectomy.

    Zoricić, Ivan; Vukusić, Darko; Rasić, Zarko; Schwarz, Dragan; Sever, Marko

    2013-09-01

    The aim of this study is to show our experience with umbilical hernia herniorrhaphy and laparoscopic cholecystectomy, both in the same act. During last 10 years we operated 89 patients with cholecystitis and pre-existing umbilical hernia. In 61 of them we performed standard laparoscopic cholecystectomy and additional sutures of abdominal wall, and in 28 patients we performed in the same act laparoscopic cholecystectomy and herniorrhaphy of umbilical hernia. We observed incidence of postoperative herniation, and compared patients recovery after herniorrhaphy combined with laparoscopic cholecystectomy in the same act, and patients after standard laparoscopic cholecystectomy and additional sutures of abdominal wall. Patients, who had in the same time umbilical hernia herniorrhaphy and laparoscopic cholecystectomy, shown better postoperative recovery and lower incidence of postoperative umbilical hernias then patients with standard laparoscopic cholecystectomy and additional abdominal wall sutures.

  1. Laparoscopic management of inferior lumbar hernia (Petit triangle hernia).

    Ipek, T; Eyuboglu, E; Aydingoz, O

    2005-05-01

    Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8 x 10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.

  2. Laparoscopic umbilical hernia repair in the presence of extensive paraumbilical collateral veins: A case report

    S.S. Lases (Seilenna); H.H. Eker (Hasan); E.G.J.M. Pierik; P. Klitsie (Pieter); B. de Goede (Barry); M.P.F.V. Peeters; G. Kazemier (Geert); J.F. Lange (Johan)

    2011-01-01

    textabstractA patient with an umbilical hernia presenting with collateral veins in the abdominal wall and umbilicus is a case that every hernia surgeon has to deal with occasionally. Several underlying diseases have been described to provoke collateral veins in the abdominal wall. However, the treat

  3. Experimental models of longitudinal abdominal incisional hernia in rats Modelos experimentais de hérnias incisionais abdominais longitudinais, em ratos

    Danilo N. S. Paulo

    1997-12-01

    Full Text Available Abdominal incisional hernias in rats has been produced after resection of a segment of abdominal muscle. In a attempt to create a model of incisional hernia in rats, without resection of abdominal muscle, the following surgical procedures were performed: (a Rats anesthetized with ether were submitted to a 4 cm long median incision, supra and infraumbilical, followed by dissection of the subcutaneous tissue 1.5 cm laterally to the median line in each side; after, one incision was performed in the linea alba and peritoneum, with the same extension of the skin incision; the skin incision was sutured. (b Rats were submited to a suprapubic transversal incision and a scissors introduced through this incision and used to dissect the subcutaneous tissue at least 1.5 cm for each side of median line; after, the linea alba and peritoneoum were incised and the transversal skin incision sutured. (c For control, rats were submitted to a resection of a 2.5 x 4 cm of the abdominal muscles, creating a large defect in the abdominal wall. All the animal, submitted to the three different procedures, developed similar well constituted hernias. We concluded that abdominal incisonal hernias are easily induced in rats after an incision of the abdominal wall, without partial resection of abdominal muscle, since the subcutaneous have been dissected at least 1.5 cm laterally to the median line.Hérnias incisionais abdominais no rato têm sido produzidas pela ressecção de fragmento dos músculos de parede abdominal. Na tentativa de criar um modelo de hérnia incisional abdominal no rato, sem ressecção de fragmentos de músculo de parede abdominal, os seguintes procedimentos cirúrgicos foram realizados: (a Ratos anestesiados com vapores de éter foram submetidos à uma incisão longitudinal mediana supra e infra umbilical, de 4 cm de comprimento, seguida do descolamento do tecido celular subcutaneo em uma extensão de 1,5 cm lateralmente à linha mediana; de cada lado

  4. Incidence of abdominal hernias in service members, active component, U.S. Armed Forces, 2005-2014.

    O'Donnell, Francis L; Taubman, Stephen B

    2016-08-01

    From 1 January 2005 through 31 December 2014, a total of 87,480 incident diagnoses of the five types of abdominal hernia (incidence rate 63.3 cases per 10,000 person-years) were documented in the health records of 72,404 active component service members. The overall incidence rate of inguinal hernias among males was six times the rate among females. However, incidence rates of femoral, ventral/incisional, and umbilical hernias were higher among females than males. During the 10-year interval, annual incidence rates for most of the five types of hernia trended downward, but rates increased for umbilical hernias in both males and females and for ventral/ incisional hernias among females. For most types of hernia, the incidence rates tended to be higher among the older age groups. Health records documented 35,624 surgical procedures whose descriptions corresponded to the types of hernia diagnoses in the service members. Most repair procedures were performed in outpatient settings. The proportion of surgical procedures performed via laparoscopy increased during the period, but the majority of operations were open procedures. The limitations to the generalizability of the findings in this study are discussed.

  5. Enterotomy risk in abdominal wall repair: a prospective study.

    Broek, R.P. Ten; Schreinemacher, M.H.; Jilesen, A.P.; Bouvy, N.; Bleichrodt, R.P.; Goor, H. van

    2012-01-01

    OBJECTIVES: To establish the incidence and predictive factors of enterotomy made during adhesiolysis in abdominal wall repair and to assess the impact of enterotomies and long-lasting adhesiolysis on postoperative morbidity such as sepsis, wound infection, abdominal complications and pneumonia, and

  6. Incarcerated Amyand hernia with simultaneous rupture of an adenocarcinoma in an inguinal hernia sac: a case report

    Karanikas, Ioannis; Ioannidis, Argyrios; Siaperas, Petros; Efstathiou, Georgios; Drikos, Ioannis; Economou, Nicolaos

    2015-01-01

    Introduction An Amyand’s hernia is a rare occurrence of an inguinal hernia, with an estimated prevalence of 1%. The major complications of an Amyand’s hernia include necrotizing fasciitis of the anterior abdominal wall and secondary intestinal perforation. Though the incidence of this type of hernia is low, the appendix may easily become initially incarcerated, possibly leading to strangulation and perforation. Case presentation A 92-year-old female patient presented to our emergency departme...

  7. Epigastric and Umbilical Hernia; Work Relatedness and Return to Work

    Ramin Mehrdad

    2013-03-01

    Full Text Available Abdominal wall hernia is common but reliable scientific data about its work relatedness is very limited and inconsistent. In this paper, a less common type of abdominal wall hernia in a 30 year old male worker is presented with recurrence after first surgery when he returned to work. In contrast with almost all kinds of hernia, a lifelong limitation for heavy lifting was recommended. It seems that contrary to popular belief, work relatedness of abdominal wall hernia is seriously doubtful, although conclusive evidences are not enough. It is preferable to make decisions cautiously for return to heavy duties of work after surgery of large umbilical, umbilical & epigastric or incisional hernia, while avoiding recommendations for long days off work after surgery of any hernia.

  8. Epigastric and umbilical hernia; work relatedness and return to work.

    Mehrdad, Ramin; Sadeghniiat Haghighi, Khosro; Naseri Esfahani, Amir Hossein

    2013-01-01

    Abdominal wall hernia is common but reliable scientific data about its work relatedness is very limited and inconsistent. In this paper, a less common type of abdominal wall hernia in a 30 year old male worker is presented with recurrence after first surgery when he returned to work. In contrast with almost all kinds of hernia, a lifelong limitation for heavy lifting was recommended. It seems that contrary to popular belief, work relatedness of abdominal wall hernia is seriously doubtful, although conclusive evidences are not enough. It is preferable to make decisions cautiously for return to heavy duties of work after surgery of large umbilical, umbilical & epigastric or incisional hernia, while avoiding recommendations for long days off work after surgery of any hernia.

  9. Current practice of abdominal wall closure in elective surgery – Is there any consensus?

    Ridwelski Karsten

    2009-05-01

    Full Text Available Abstract Background Development of incisional hernia after open abdominal surgery remains a major cause of post-operative morbidity. The aim of this study was to determine the current practice of surgeons in terms of access to and closure of the abdominal cavity in elective open surgery. Methods Twelve surgical departments of the INSECT-Trial group documented the following variables for 50 consecutive patients undergoing abdominal surgery: fascial closure techniques, applied suture materials, application of subcutaneous sutures, subcutaneous drains, methods for skin closure. Descriptive analysis was performed and consensus of treatment variables was categorized into four levels: Strong consensus >95%, consensus 75–95%, overall agreement 50–75%, no consensus Results 157 out of 599 patients were eligible for analysis (85 (54% midline, 54 (35% transverse incisions. After midline incisions the fascia was closed continuously in 55 patients (65%, using slowly absorbable (n = 47, 55%, braided (n = 32, 38% sutures with a strength of 1 (n = 48, 57%. In the transverse setting the fascia was closed continuously in 39 patients (72% with slowly absorbable (n = 22, 41% braided sutures (n = 27, 50% with a strength of 1 (n = 30, 56%. Conclusion In the present evaluation midline incision was the most frequently applied access in elective open abdominal surgery. None of the treatments for abdominal wall closure (except skin closure in the midline group is performed on a consensus level.

  10. Abdominal Wall Endometrioma after Laparoscopic Operation of Uterine Endometriosis

    Tihomir Vukšić

    2016-01-01

    Full Text Available Endometriosis is presence of functional endometrium outside of uterine cavum. As a pluripotent tissue, endometrium has the possibility of implanting itself almost everywhere; even implantation in abdominal wall was described, but it is not common site. This case report presents implantation of functional endometrium in abdominal wall, inside scar tissue, and after insertion of a laparoscopic trocar port. Final diagnosis was confirmed by pathohistological examination.

  11. Peritoneography for diagnosis of non-palpable hernias. Peritoneographie zum Nachweis nicht tastbarer Hernien

    Schumacher, K.H.

    1981-01-01

    The detection of non-palpable hernia by means of peritoneography is almost unknown in the German-speaking areas. By injection of an iodine-containing contrast medium into the abdominal cavity, and with the corresponding positioning of the patient, a hernia can certainly be diagnosed or excluded. This method is indicated in cases of inguinal pain with undetected genesis, particularly in adipose patients, for detecting recidivous hernias with postoperative complaints, for the diagnosis of traumatic hernias or abdominal wall hernias. Between July 1, 1979 and December 31, 1980 peritoneography was performed in 154 patients in Bruchsal Hospital in order to detect herniae.

  12. Synovial sarcoma of the abdominal wall: An unusual presentation

    Parag J Karkera

    2013-01-01

    Full Text Available Synovial sarcoma (SS is a malignant mesenchymal neoplasm which commonly occurs in the extremities in close association with tendon sheaths, bursae, joint capsules, and fascial structures. Rarely, SS may be present in unexpected location such as the abdominal wall. Surgical resection with wide margins is the initial standard treatment; however, a multimodal approach including radiotherapy and chemotherapy is often favored. Here, we present a case of SS of the anterior abdominal wall in a 14-year-old patient with a right upper abdominal lump. He underwent wide surgical excision and has received adjuvant chemotherapy. He is doing well on follow-up of six months.

  13. Chronic abdominal pain after ventral hernia due to mesh migration and erosion into the sigmoid colon from a distant site: a case report and review of literature.

    Millas, S G; Mesar, T; Patel, R J

    2015-10-01

    Hernia repair is one of the most commonly performed procedures in general surgery. Use of mesh has been shown to decrease the overall recurrence rate. Mesh implantation, however, carries its own risks and complications. We report a case of a 41-year-old female who presented with nonspecific, chronic lower abdominal pain after ventral hernia repair with mesh implantation. The chronic pain was found to be the consequence of mesh migration and erosion into the sigmoid colon from a previous supraumbilical hernia repair. Hernia repair, use of mesh, and chronic abdominal pain are discussed.

  14. Asymptomatic congenital intrapericardial diaphragmatic hernia and epigastric hernia in the adult.

    La Greca, Gaetano; Sofia, Maria; Randazzo, Valentina; Barbagallo, Francesco; Lombardo, Rosario; Soma, Pierfranco; Russello, Domenico

    2007-08-01

    The congenital intrapericardial hernia is a rare kind of diaphragmatic hernia. It is due to an embryologic defect of the central tendon of the diaphragm, often accompanied by other congenital malformations. This work presents a unique case report in the literature of the congenital association between intrapericardial diaphragmatic hernia and epigastric hernia in an adult woman. In spite of herniation of the colon and omentum the patient was completely asymptomatic, requesting surgery for an epigastric hernia for aesthetic reasons. The defect of the diaphragm was sutured and the abdominal wall was repaired with a prosthetic mesh.

  15. Reduction en masse of inguinal hernia: MDCT findings of two cases.

    Hoshiai, S; Mori, K; Shiigai, M; Uchikawa, Y; Watanebe, A; Shiotani, S; Atake, S; Minami, M

    2015-12-01

    Reduction en masse of inguinal hernia is an extremely rare complication arising from manual reduction of a hernia. The hernial content remaining in the hernia sac returns above the inguinal canal but remains in the abdominal wall. Accurate preoperative diagnosis of reduction en masse of inguinal hernia is challenging because the hernia appears to be reduced upon physical examination. We experienced two cases of reduction en masse. In both cases, multidetector row computed tomography revealed a closed loop obstruction near the inguinal fossa. In addition, we observed a continuous tract of the hernia sac to the inguinal canal and prominent peritoneal thickening suggestive of the hernia sac.

  16. Rejection of Permacol(R) mesh used in abdominal wall repair: A case report

    Franchesca T Wotton; Jacob A Akoh

    2009-01-01

    Permacol(R) mesh has shown promise when used in abdominal wall repair, especially in the presence of a contaminated surgical field. This biomaterial, derived from porcine dermis collagen, has proposed advantages over synthetic materials due to increased biocompatibility and reduced foreign body reaction within human tissues. However, we present a case report describing a patient who displayed rejection to a Permacol(R) mesh when used in the repair of abdominal wound dehiscence following an emergency laparotomy. Review of the English language literature using PubMed and Medline, showed only two previously published cases of explantation of Permacol(R) due to sepsis or wound breakdown. The authors believe this is the first case of severe foreign body reaction leading to rejection of Permacol(R). Both animal and human studies show conflicting evidence of biocompatibility. There are several reports of successful use of Permacol(R) to repair complex incisional herniae or abdominal walls in the presence of significant contamination. It appears from the literature that Permacol(R) is a promising material, but as we have demonstrated, it has the potential to evoke a foreign body reaction and rejection in certain subjects.

  17. Modified sliding myofascial flap of the rectus abdominus muscles for the closure of huge planned abdominal hernia%改良双侧腹直肌推徙术治疗巨大计划性腹疝

    孙士锦; 张连阳

    2013-01-01

    Abdominal increment is applied to patients with abdominal compartment syndrome (ACS) after severe trauma,while for some patients,intra-abdominal volume increment could not close the fascia within the primary stage.For theses patients,abdominal wound skin grafting was conducted,and the planned hernia was formed.Planned abdominal hernia developed over time,and finally huge incisional hernia was formed.This article described a modified sliding myofascial flap of the rectus abdominus muscles for definitive abdominal wall reconstruction for a patient with huge planned abdominal hernia,and a good curative effect was obtained.%严重创伤后腹腔间隙综合征患者,需行腹腔扩容术.腹腔扩容术后部分患者不能行一期确定性关闭腹壁筋膜层,只能施行腹壁创面植皮术,从而形成计划性腹疝.随着时问延长,计划性腹疝的疝环进行性扩大,成为巨大腹壁切口疝.第三军医大学大坪医院野战外科研究所对1例巨大计划性腹疝患者施行改良双侧腹直肌推徙术,成功进行了确定性腹壁重建.实践证明该术式是一种安全、可靠的方法.

  18. Relación entre la presión intrabdominal en diálisis peritoneal con las hernias y fugas The link between intra-abdominal pressure in peritoneal dialysis and hernias and fugues

    Concepción Blasco Cabañas

    2012-06-01

    ±253 ml/m². Un 23.5 % tenían una presión intrabdominal mayor a 20 cm. de H2O. En sedestación la media fue de 28±5.5 cm. de H2O y en bipedestación de 43.7±5.3 cm. de H2O. Los enfermos con presión intrabdominal > 20 cm. H2O tenían más porcentaje de hernias (50% vs 12 % y fugas pericatéter (37 % vs. 12 %. Como principales conclusiones, podemos destacar que los niveles de presión intrabdominal de nuestros pacientes son algo más elevados que en otras series. A mayor edad, mayor comorbilidad y mayor índice de masa corporal, la presión intrabdominal es más elevada. Los enfermos con presión intrabdominal elevada presentaron más episodios de hernias y fugas.Normal intra-abdominal pressure is equal to atmospheric pressure (zero. In peritoneal dialysis the introduction of intra-peritoneal liquid increases intra-abdominal pressure. In various studies it is recommended that this does not exceed 16-20cm H2O. In addition to possible abdominal discomfort, high intra-abdominal pressure can be linked to problems with the abdominal wall, such as hernias and fugues, and have implications for peritoneal transport and ultrafiltration deficit. The aims of this study were the following: to find out the intra-abdominal pressure levels in the prevalent type of patients in peritoneal dialysis, to assess the factors influencing the values for this pressure and to study the relationship between intra-abdominal pressure and the development of hernias and fugues, retrospectively. A transversal, observational and retrospective study was conducted to measure intra-abdominal pressure in the prevalent, stable patients who had been on peritoneal dialysis for more than three months. Intra-abdominal pressure was measured using the method described by Durand: patient in a supine position, with diurnal peritoneal volume. The final intra-abdominal pressure is the average of the measurements taken during inspiration and expiration, is expressed in cm H2O and the volume drained is

  19. Improving the efficiency of abdominal aortic aneurysm wall stress computations.

    Zelaya, Jaime E; Goenezen, Sevan; Dargon, Phong T; Azarbal, Amir-Farzin; Rugonyi, Sandra

    2014-01-01

    An abdominal aortic aneurysm is a pathological dilation of the abdominal aorta, which carries a high mortality rate if ruptured. The most commonly used surrogate marker of rupture risk is the maximal transverse diameter of the aneurysm. More recent studies suggest that wall stress from models of patient-specific aneurysm geometries extracted, for instance, from computed tomography images may be a more accurate predictor of rupture risk and an important factor in AAA size progression. However, quantification of wall stress is typically computationally intensive and time-consuming, mainly due to the nonlinear mechanical behavior of the abdominal aortic aneurysm walls. These difficulties have limited the potential of computational models in clinical practice. To facilitate computation of wall stresses, we propose to use a linear approach that ensures equilibrium of wall stresses in the aneurysms. This proposed linear model approach is easy to implement and eliminates the burden of nonlinear computations. To assess the accuracy of our proposed approach to compute wall stresses, results from idealized and patient-specific model simulations were compared to those obtained using conventional approaches and to those of a hypothetical, reference abdominal aortic aneurysm model. For the reference model, wall mechanical properties and the initial unloaded and unstressed configuration were assumed to be known, and the resulting wall stresses were used as reference for comparison. Our proposed linear approach accurately approximates wall stresses for varying model geometries and wall material properties. Our findings suggest that the proposed linear approach could be used as an effective, efficient, easy-to-use clinical tool to estimate patient-specific wall stresses.

  20. Desmoid tumors of the abdominal wall: A case report

    Textor Hans Jochen

    2003-07-01

    Full Text Available Abstract Background Desmoid tumors are slow growing deep fibromatoses with aggressive infiltration of adjacent tissue but without any metastatic potential. Case Presentation We report on two female patients with desmoid tumor of the abdominal wall who underwent primary resection. Both patients had a history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, magnetic resonance imaging and computed tomography. The histology in both cases revealed a desmoid tumor. Conclusion Complete surgical resection is the first line management of this tumor entity.

  1. Combined epigastric hernia repair and mini-abdominoplasty. Case report.

    Grella, Roberto; Razzano, Sergio; Lamberti, Rossella; Trojaniello, Biagio; D'Andrea, Francesco; Nicoletti, Giovanni Francesco

    2015-01-01

    The objectives of abdominal hernia repair are to restore the structural integrity of the abdominal wall. Current techniques include primary closure, staged repair and the use of prosthetic materials. Techniques for mini-abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. We report a case of epigastric hernia repair through a transverse lower abdominal incision with the resection of excess of skin. Our purpose is to evaluate the results of the procedure by incorporating these aspects into an epigastric hernia repair, we found out that the procedures are made safer and the results are improved. Proper indication and details of the technique are described.

  2. Mycobacterium fortuitum abdominal wall abscesses following liposuction

    Al Soub Hussam

    2008-01-01

    Full Text Available We describe here a case of abdominal abscesses due to Mycobacterium fortuitum following liposuction. The abscesses developed three months after the procedure and diagnosis was delayed for five months. The clues for diagnosis were persistent pus discharge in spite of broad spectrum antibiotics and failure to grow any organisms on routine culture. This condition has been rarely reported; however, the increasing number of liposuction procedures done and awareness among physicians will probably result in the identification of more cases. Combination antibiotic therapy with surgical drainage in more extensive diseases is essential for cure.

  3. Bilateral prevascular herniae – A rare complication of aorto-uniiliac endovascular abdominal aortic aneurysm repair and femoro-femoral bypass

    Obinna Obinwa

    2015-01-01

    Full Text Available A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication.

  4. Evaluation of a Porcine Dermal Collagen (Permacol Implant for Abdominal Wall Reconstruction in a Pediatric Multitrauma Patient

    Idit Melnik

    2014-01-01

    Full Text Available The presence of a contaminated surgical field in abdominal wall defects caused by trauma presents a challenge for surgeons. Both primary suture and synthetic meshes are strongly discouraged as surgical treatments in such cases. We describe the use of a porcine dermal collagen (Permacol implant in an eight-year-old patient with multiple injuries. Three months after discharge, the child remains well with good cosmetic results. He is free of pain and has returned to full activity levels with complete wound closure and without any evidence of residual hernia. In conclusion, our experience indicates that the use of Permacol can be considered an efficient technique for reconstructing an infected abdominal wall defect of a pediatric multitrauma patient.

  5. 无张力疝片修补中老年腹外疝的护理%Nursing of Tension Free Hernia Patch in Elderly Abdominal External Hernia

    田玉波

    2015-01-01

    Objective To explore the nursing measures of tension free hernia patch in elderly abdominal external hernia. Methods selected in our hospital in 2013 February to 2014 February, 60 patients admitted during in the elderly patients with abdominal external hernia, inguinal hernia underwent tension-free hernioplasty patch in treatment and nursing, observe the operation time, and the recurrence of postoperative wound healing. Results the operation was successful in all patients, the average operation time was 55.5min, 60 patients the wound healed well, no infection, 24 months follow-up showed no recurrence. Conclusion Tension free hernia patch in elderly abdominal external hernia with small wound pain, rapid recovery, cure rate higher characteristic. Nursing measures for patients with good quality, can improve the success rate of operation, reduce complications and recurrence rate.%目的:探究无张力疝片修补中老年腹外疝的护理措施。方法选取我院2013年2月~2014年2月期间收治的60例中老年腹外疝患者,进行无张力疝片修补治疗护理,注意观察手术时间,术后伤口愈合情况及复发情况。结果所有患者均顺利完成手术,平均手术时间为55.5 min,60例患者伤口愈合良好,无感染,进行24个月随访均未出现复发情况。结论无张力疝片修补中老年腹外疝具有创伤疼痛小,恢复快,治愈率高等特点。为患者提供优质良好的护理措施,可以提高手术成功率,减少并发症和复发率。

  6. Congenital Lumbar Hernia

    Sanjay Sharma

    2008-01-01

    Full Text Available Lumbar hernia is a rare hernia. It constitutes less than one percent of all abdominal hernias. It can becongenital or acquired. Acquired can occur either spontaneously or after surgery or trauma. Only 300cases of lumbar hernia are reported till date. We report a case of congenital lumbar hernia in one month oldmale baby

  7. Defective anterior wall of inguinal canal and its role in the pathophysiology of direct inguinal hernias

    Abdolvahabi SA

    2002-06-01

    Full Text Available Regrding pathophysiology of direct inguinal hernias the following are pointed our:1-Absence of contribution of fascia of transverses abdominis muscle along with fascia transversalis in making posterior wall of the inguinal canal causing defect point in Hesselbachs triangle.2- Defects in protectin mechanisms of the inguinal canal such as: I shutter like effect of the arch of internal oblique and transverses abdominis muscles. ii Sphincter like effect of fascia of oblique muscle (anterior wall of canl.During several years of observation and practice in the field of surgical repair of hernias, a new phenomenon was observed regarding the etiology of direct hernias.Evaluation of superficial ring and Ant. Wall of inguinal canal in 25 patients showed that the ant. Wall was not perfect and the defect was seen as a spectrum of moderate defect to complete absence of the wall. This phenomenon may be a newly observed mechanism in pathology of direct inguinal hernia that might help the operative repair. Taking this into account, i.e. repair of this defect, might help the classic herniorrhaphy techniques

  8. Abdominal wall lipoma--CT and MRI appearance.

    Bloom, R A; Gomori, J M; Fields, S I; Katz, E

    1991-01-01

    Although soft tissue lipomata are common tumours, a large lipoma arising from the deep layers of the abdominal wall would appear to be excessively rare and the site of origin may be difficult to determine. The CT and MRI appearances of such a tumour are described.

  9. A New Rat Model for Orthotopic Abdominal Wall Allotransplantation

    William W. Lao, MD

    2014-04-01

    Conclusions: Technical, histological, and immunological aspects of a new rat model are described. These results give clues to what occurs in human abdominal wall transplantation. In addition, Th1, a proinflammatory cell, was found to be a potential biomarker for allograft rejection.

  10. Which mesh or graft? Prosthetic devices for abdominal wall reconstruction.

    Abid, Shazia; El-Hayek, Kevin

    2016-03-01

    This article reviews the ever-increasing number of prosthetic devices--both synthetic mesh and biologic grafts--now in use for abdominal wall reconstruction. It also introduces a novel hybrid synthetic/biologic graft (Zenapro) and suture passer device (Novapass).

  11. Autologous tissue repair of large abdominal wall defects.

    Vries Reilingh, T.S. de; Bodegom, M.E.; Goor, H. van; Hartman, E.H.M.; Wilt, G.J. van der; Bleichrodt, R.P.

    2007-01-01

    BACKGROUND AND METHOD: Techniques for autologous repair of abdominal wall defects that could not be closed primarily are reviewed. Medline and PubMed were searched for English or German publications using the following keywords: components separation technique (CST), Ramirez, da Silva, fascia lata,

  12. A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

    Jeffrey CY Chan

    2016-12-01

    Full Text Available An animal model that allows for assessment of the degree of stretching or contraction of the implant area and the in vivo degradation properties of biological meshes is required to evaluate their performance in vivo. Adult New Zealand rabbits underwent full thickness subtotal unilateral rectus abdominis muscle excision and were reconstructed with the non-biodegradable Peri-Guard®, Prolene® or biodegradable Surgisis® meshes. Following 8 weeks of recovery, the anterior abdominal wall tissue samples were collected for measurement of the implant dimensions. The Peri-Guard and Prolene meshes showed a slight and obvious shrinkage, respectively, whereas the Surgisis mesh showed stretching, resulting in hernia formation. Surgisis meshes showed in vivo biodegradation and increased collagen formation. This surgical rabbit model for abdominal wall defects is advantageous for evaluating the in vivo behaviour of surgical meshes. Implant area stretching and shrinkage were detected corresponding to mesh properties, and histological analysis and stereological methods supported these findings.

  13. ACUTE TRAUMATIC VENTRAL HERNIA

    Dinesh

    2013-10-01

    Full Text Available ABSTRACT : A traumatic abdominal wall hernia is a rare type of hernia, which follows blunt trauma to the abdomen, where disruption of the musculature and fascia occu rs, with the overlying skin remaining intact. Associated abdominal injuries are infrequent. An elderly male patient was seen in emergency within 6 hrs of alleged history of bull gore injury, while working in the fields; he presented with complaints of pain abdomen and swelling in the right side of lower abdomen. On Examination, soft, tender swelling is noted in RIF with overlying contusion, which increased in size over the next two days, with expansile cough impulse. Swelling was completely reducible and vi sible peristalsis seen.USG Abdomen showed defect in right iliac fossa abdominal wall with bowel loops in subcutaneous plane. A local exploration was performed incorporating the site of injury. A defect in all layers of abdominal wall muscles in right iliac fossa with intact skin and subcutaneous tissue was found. Primary tension free repair of the defect in layers done with inlay placement of prolene mesh due to poor abdominal muscle tone. A high index of clinical suspicion is essential, as an accompanying hematoma often confounds the diagnosis. Mesh repair is desirable in the elderly with weak anterior abdominal wall so as to prevent the long - term complications of recurrences

  14. Muscle Patterning in Mouse and Human Abdominal Wall Development and Omphalocele Specimens of Humans

    Nichol, Peter F.; Corliss, Robert F.; Yamada, Shigehito; SHIOTA, KOHEI; Saijoh, Yukio

    2012-01-01

    Human omphalocele is a congenital defect of the abdominal wall in which the secondary abdominal wall structures (muscle and connective tissue) in an area centered around the umbilicus are replaced by a translucent membranous layer of tissue. Histological examination of omphalocele development and moreover the staging of normal human abdominal wall development has never been described. We hypothesized that omphalocele is the result of an arrest in the secondary abdominal wall development and p...

  15. Systemic and local collagen turnover in hernia patients

    Henriksen, Nadia A

    2016-01-01

    . METHODS AND RESULTS: In a systematic literature review, a total of 55 original articles were reviewed evaluating connective tissue alterations in patients with abdominal wall hernias. Patients with inguinal and incisional hernias exhibit a decreased type I to III collagen ratio in fascia and skin biopsies...... to controls. Pro-MMP-2 and pro-MMP-9 levels in the PTFE tubes did not differ between hernia patients and controls. A fascia transversalis biopsy was excised perioperatively in all four patient groups. There were no significant differences between hernia patients and controls in total collagen concentration...... or morphology of the fascia transversalis. 
 CONCLUSIONS: Direct and recurrent inguinal hernia repair are associated with ventral hernia repair, suggesting a systemic predisposition to the hernia disease. MMPs are not suitable as serum biomarkers for inguinal or incisional hernia disease. Serum biomarkers...

  16. Fetal Abdominal Wall Repair with a Collagen Biomatrix in an Experimental Sheep Model for Gastroschisis

    Roelofs, Luc A. J.; Eggink, Alex J.; Hulsbergen-van de Kaa, Christina A.; van den Berg, Paul P.; van Kuppevelt, Toin H.; van Moerkerk, Herman T. B.; Crevels, A. Jane; Lotgering, Fred K.; Feitz, Wout F. J.; Wijnen, Rene M. H.

    2008-01-01

    We evaluated the regeneration of the abdominal wall using a dual- layer collagen biomatrix, and the protective effect on the bowel of fetal abdominal wall repair in a fetal sheep model for gastroschisis. In 14 fetal lambs, the abdominal wall was opened at 79 days' gestation, creating a gastroschisis

  17. Traumatic lumbar hernia: report of a case.

    Torer, Nurkan; Yildirim, Sedat; Tarim, Akin; Colakoglu, Tamer; Moray, Gokhan

    2008-12-01

    Traumatic lumbar hernias are very rare. Here, we present a case of secondary lumbar hernia. A 44-year-old man sustained a crushing injury. On admission, ecchymotic, fluctuating swelling was present on his left flank with normal vital signs. Subcutaneous intestinal segments were revealed at his left flank on abdominal CT. Emergency laparotomy revealed a 10-cm defect on the left postero-lateral abdominal wall. The splenic flexure was herniated through the defect. Herniated segments was reduced, the defect was repaired with a polypropylene mesh graft. There was also a serosal tear and an ischemic area 3mm wide on the splenic flexure and was repaired primarily. The patient had an uneventful recovery. Most traumatic lumbar hernias are caused by blunt trauma. Trauma that causes abdominal wall disruption also may cause intraabdominal organ injury. Abdominal CT is useful in the diagnosis and allows for diagnosis of coexisting organ injury. Emergency laparotomy should be performed to repair possible coexisting injuries.

  18. Abdominal wall endometrioma: Our experience in Vladimir, Russia

    Mahir Gachabayov

    2016-01-01

    Full Text Available Background: Endometriosis is defined as an estrogen-dependent, benign inflammatory disease characterized by the presence of ectopic endometrial implants. Abdominal wall endometrioma (AWE being a rare entity is a benign tumor defined as ectopic functional, endometrial tissue located in the abdominal wall. Subjects and Methods: A retrospective study of 23 female patients treated with AWE in four departments of three centers in Vladimir city, Russia, from January 2010 to December 2014 was performed. Results: In twenty patients (87%, AWE was symptomatic, and in three patients (13%, AWE was asymptomatic. Esquivel triad presented in 17 patients (74%, and modified Esquivel triad existed in 20 patients (87%. All 23 patients were operated, and AWE excision was performed. Recurrence occurred in 4 cases (17.4% and was associated with postoperative pain and seroma. Conclusion: Postoperative pain for more than 7 days and seroma (on ultrasonography seem to be associated with recurrence of AWE.

  19. Clear Cell Adenocarcinoma Arising from Abdominal Wall Endometriosis

    Thouraya Achach

    2008-01-01

    Full Text Available Endometriosis is a frequent benign disorder. Malignancy arising in extraovarian endometriosis is a rare event. A 49-year-old woman is presented with a large painful abdominal wall mass. She underwent a myomectomy, 20 years before, for uterus leiomyoma. Computed tomography suggested that this was a desmoid tumor and she underwent surgery. Histological examination showed a clear cell adenocarcinoma associated with endometriosis foci. Pelvic ultrasound, computed tomography, and endometrial curettage did not show any malignancy or endometriosis in the uterus and ovaries. Adjuvant chemotherapy was recommended, but the patient was lost to follow up. Six months later, she returned with a recurrence of the abdominal wall mass. She was given chemotherapy and then she was reoperated.

  20. Abdominal wall actinomycosis associated with an IUD. A case report.

    Adachi, A; Kleiner, G J; Bezahler, G H; Greston, W M; Friedland, G H

    1985-02-01

    Abdominal wall actinomycosis without pelvic organ involvement in users of intrauterine contraceptive devices (IUDs) has not been reported on previously. We encountered one such patient, whose uterine cervix was colonized superficially with Actinomyces. We suggest that systemic actinomycosis be included in the differential diagnosis of pain in IUD users when Actinomyces is found on Papanicolaou smears or in endocervical curettings. Such patients should be treated with appropriate antibiotic therapy, especially prior to any surgical intervention.

  1. Embolotherapy using N-butyl cyanoacrylate for abdominal wall bleeding

    Choi, Young Ho; Koh, Young Hwan; Han, Dae Hee; Kim, Ji Hoon; Cha, Joo Hee; Lee, Eun Hye; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2008-05-15

    We describe our experience with the use of N-butyl cyanoacrylate (NBCA) embolization of abdominal wall bleeding and we evaluate the clinical effectiveness of the procedure. Embolization was performed in nine patients with abdominal wall bleeding. The sites of embolization were the left first lumbar (n = 1), left second lumbar (n = 1), right inferior epigastric (n 2), left inferior epigastric (n = 3), right circumflex iliac (n = 1), and left circumflex iliac artery (n = 1). A coil was used with NBCA in one patient due to difficulty in selecting only a bleeding focus and anticipated reflux. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:4. Blood pressure and heart rate were measured before and after the embolization procedure, and the serial hemoglobin and hematocrit levels and transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Hemostasis was obtained in six out of the nine patients and technical success was achieved in all patients. There were no procedure-related complications. Four out of the nine patients died due to rebleeding of a subarachnoid hemorrhage (n = 1), multiorgan failure (n = 1), and hepatic failure (n =2) that occurred two to nine days after the embolization procedure. One patient had rebleeding. The five surviving patients had no rebleeding, and the patients continue to visit the clinical on an outpatient basis. NBCA embolization is a clinically safe procedure and is effective for abdominal wall bleeding.

  2. Developing a new methodology to characterize in vivo the passive mechanical behavior of abdominal wall on an animal model.

    Simón-Allué, R; Montiel, J M M; Bellón, J M; Calvo, B

    2015-11-01

    The most common surgical repair of abdominal wall hernia goes through implanting a mesh that substitutes the abdominal muscle/fascia while it is healing. To reduce the risk of relapse or possible complications, this mesh needs to mimic the mechanical behavior of the muscle/fascia, which nowadays is not fully determined. The aim of this work is to develop a methodology to characterize in vivo the passive mechanical behavior of the abdominal wall. For that, New Zealand rabbits were subjected to pneumoperitoneum tests, taking the inner pressure from 0 mmHg to 12 mmHg, values similar to those used in human laparoscopies. Animals treated were divided into two groups: healthy and herniated animals with a surgical mesh (polypropylene Surgipro(TM) Covidien) previously implanted. All experiments were recorded by a stereo rig composed of two synchronized cameras. During the postprocessing of the images, several points over the abdominal surface were tracked and their coordinates extracted for different levels of internal pressure. Starting from that, a three dimensional model of the abdominal wall was reconstructed. Pressure-displacement curves, radii of curvature and strain fields were also analysed. During the experiments, animals tissue mostly deformed during the first levels of pressure, showing the noticeable hyperelastic passive behavior of abdominal muscles. Comparison between healthy and herniated specimen displayed a strong stiffening for herniated animals in the zone where the high density mesh was situated. Cameras were able to discern this change, so this method can be used to measure the possible effect of other meshes.

  3. Full-term pregnancy in umbilical hernia

    Damien Punguyire

    2011-01-01

    Full Text Available While umbilical hernias frequently occur during pregnancy, the few reported cases of uterine or fibroid incarceration in ventral hernias during pregnancy all involved incisional abdominal wall defects from prior laparotomies and Cesarean sections; none involved umbilical hernias. We discuss the case of a 42-year-old well-developed, well-nourished grand multiparous woman (G8P7 with a huge umbilical hernia containing a 38-week gravid uterus, as well as her management and the avoidance of known complications that have occurred in similar incisional hernia cases. Successful pregnancy outcomes can occur in cases of pregnancies in ventral hernias, even in resource-poor settings that have Cesarean section capabilities

  4. Effects of the flexibility of the arterial wall on the wall shear stresses and wall tension in Abdominal Aortic Aneurysms.

    Salsac, Anne-Virginie; Fernandez, Miguel; Chomaz, Jean-Marc

    2005-11-01

    As an abdominal aortic aneurysm develops, large changes occur in the composition and structure of the arterial wall, which result in its stiffening. So far, most studies, whether experimental or numerical, have been conducted assuming the walls to be rigid. A numerical simulation of the fluid structure interactions is performed in different models of aneurysms in order to analyze the effects that the wall compliance might have on the flow topology. Both symmetric and non-symmetric models of aneurysms are considered, all idealistic in shape. The wall mechanical properties are varied in order to simulate the progressive stiffening of the walls. The spatial and temporal distributions of wall tension are calculated for the different values of the wall elasticity and compared to the results for the rigid walls. In the case of rigid walls, the calculation of the wall shear stresses and pressure compare very well with experimental results.

  5. Damage control apronectomy for necrotising fasciitis and strangulated umbilical hernia.

    Coyle, P

    2012-01-31

    We present a case of a 50-year-old morbidly obese woman who presented with a case of necrotizing fasciitis of the anterior abdominal wall due to a strangulated umbilical hernia. The case was managed through damage control surgery (DCS) with an initial surgery to stabilise the patient and a subsequent definitive operation and biological graft hernia repair. We emphasise the relevance of DCS principles in the management of severe abdominal sepsis.

  6. Quantitative evaluation of tissue reconfigurations after the plastic reconstruction of experimental defect of the anterior abdominal wall in rats.

    Malkov I.I.

    2007-01-01

    Full Text Available The active retrieval of methods for the increase of the efficiency of ventral hernia alloplasty is performed now; however the structural-functional changes of scar and muscle tissues during their reorganization are still little studied. The analysis of relationship of connective tissue with the hemomicrocirculation elements plays the important role for the understanding of the structural-functional condition of the anterior abdominal wall and also concrete mechanisms of reorganization of microvessels taking into account the dynamics of muscle-aponeurotic structures reconfiguration. The purpose of the current study was to determine the dynamics of structural-functional reconfiguration of microcircular and muscle-aponeurotic components, as well as connective tissue in the anterior abdominal wall after alloplasty of experimental ventral defect with the polypropylene monofilament net "Prolene". The quantitative morphological analysis was carried out during 1 year. The analysis of scar tissue formation and muscles reconfiguration in the anterior abdominal wall after plastic reconstruction of experimental defect allowed to reveal that the presence of polypropylene prosthetic device increases the duration of early inflammatory processes in a moderate degree, providing, however, adequate and full structural reconfiguration of scar and muscle tissue in the future, including microcirculation components.

  7. Reparación de una eventración abdominal mediante técnica SILS Abdominal hernia repair with SILS technique

    M. Gascón Hove

    2011-03-01

    Full Text Available La cirugía laparoscópica se dirige hacia técnicas menos invasivas con mejores resultados cosméticos, como el abordaje SILS (Single incision laparoscopic surgery. Con los nuevos avances tecnológicos, es posible introducir en la cavidad abdominal múltiples instrumentos a través de un solo puerto. Una opción es el Tri-Port™. Presentamos un paciente con una eventración abdominal previamente reparada en otro hospital, a quien se realizó una eventroplastia tipo SILS, utilizando una única incisión. No se requirieron suturas abdominales adicionales en todo el proceso. No hubo complicaciones durante la intervención ni en el postoperatorio y el paciente se fue del hospital 48 horas después sin presentar dolor postoperatorio. La cirugía tipo SILS es factible y segura, y representa una alternativa válida a la laparoscopia convencional, aunque es técnicamente más compleja. Se necesitan más estudios para que pueda instaurarse como procedimiento estándar.Abdominal surgery is leading to less invasive and cosmetically superior approaches, such as SILS. Due to new surgical advances, it is possible to insert into the abdomen multiple instruments through a single device. One option is Tri-Port™. We report a patient with ventral hernia previously repaired in other hospital, who underwent a laparoscopic abdminal hernia repair through a single umbilical incision. No additional transabdominal sutures were utilized in this procedure. No perioperative or postoperative complications were recorded and the patient was discharged 48 hours after surgery with no postoperative pain. Single incision laparoscopic surgery (SILS hernia repair is feasable and safe, and represents a valuable alternative to a laparoscopic approach, although it is technically more complicated. Further studies are necessary to recommend it as a standard procedure.

  8. Mesocolic hernia: An unusual internal hernia

    Tauro L

    2007-01-01

    Full Text Available Internal hernia may be either congenital or acquired. Its incidence has been reported to be 1-2%. Herniation may be persistent or intermittent. Internal hernia is a rare cause of small bowel obstruction with a reported incidence of 0.2-0.9%. The most common type is paraduodenal. Less common types include mesocolic hernia, which occurs following abdominal surgery. We report mesocolic hernias in two young patients, which presented as small bowel obstruction without any prior abdominal surgery.

  9. Abdominal wall abscess containing gallstones as a late complication to laparoscopic cholecystectomy performed 17 years earlier

    Christensen, Anders Mark; Christensen, Mads Mark

    2013-01-01

    of a 53-year-old woman who developed two abscesses--one intra-abdominally and one in the abdominal wall-17 years after an LC. Three gallstones were found during surgical excision of the abdominal wall abscess. Surgeons should strive to avoid perforation of the gall bladder during LC. If spillage...

  10. Hérnias abdominais e inguinais em pacientes cirróticos: qual é a melhor conduta? Abdominal and inguinal hernia in cirrhotic patients: what's the best approach?

    Felipe Duarte Silva

    2012-03-01

    Full Text Available INTRODUÇÃO: Tradicionalmente os procedimentos abdominais eletivos em pacientes cirróticos têm sido amplamente desencorajados graças à elevada morbi-mortalidade consequente às complicações da cirrose, descritas por diversos autores. Outros serviços, em contrapartida, obtiveram resultados distintos, advogando a favor de cirurgia eletiva. MÉTODOS: Uma revisão de artigos utilizando-se a palavras "abdominal wall hernia" e "cirrhotic patients" foi realizada na base de dados PubMed. Dos resultados obtidos, 28 artigos foram considerados para elaboração desta revisão. RESULTADOS: Pôde-se observar que a incidência de hérnias em parede abdominal é relativamente elevada em pacientes cirróticos, sendo que muitas delas têm evolução desfavorável e requerem tratamento cirúrgico específico. Com o advento do sistema de alocação de órgãos baseados no escore de MELD, muitos centros estão repensando suas condutas em situações como esta, dado que muitos dos pacientes em questão encontram-se em lista de espera para transplante hepático. Dessa forma a cirurgia eletiva tem conquistado maior papel no manejo desta condição com intuito de diminuir morbi-mortalidade nesses pacientes. Além disso, a qualidade de vida mostrou-se um importante fator a ser considerado, estando muito prejudicada nesta condição. CONCLUSÃO: Poucos estudos com grandes amostragens foram conduzidos até o momento e não há consenso sobre qual conduta é a mais indicada levando em consideração taxas de morbi-mortalidade.BACKGROUND: Traditionally, elective abdominal procedures in cirrhotic patients have been largely discouraged due to high morbidity and mortality consequent to complications of cirrhosis, described by several authors. Other services, however, obtained different results, advocating in favor of elective surgery. METHODS: A literature review using as key-words "abdominal wall hernia" and "cirrhotic patients" was performed using PubMed database

  11. Mechanical and histological characterization of the abdominal muscle. A previous step to modelling hernia surgery.

    Hernández, B; Peña, E; Pascual, G; Rodríguez, M; Calvo, B; Doblaré, M; Bellón, J M

    2011-04-01

    The aims of this study are to experimentally characterize the passive elastic behaviour of the rabbit abdominal wall and to develop a mechanical constitutive law which accurately reproduces the obtained experimental results. For this purpose, tissue samples from New Zealand White rabbits 2150±50 (g) were mechanically tested in vitro. Mechanical tests, consisting of uniaxial loading on tissue samples oriented along the craneo-caudal and the perpendicular directions, respectively, revealed the anisotropic non-linear mechanical behaviour of the abdominal tissues. Experiments were performed considering the composite muscle (including external oblique-EO, internal oblique-IO and transverse abdominis-TA muscle layers), as well as separated muscle layers (i.e., external oblique, and the bilayer formed by internal oblique and transverse abdominis). Both the EO muscle layer and the IO-TA bilayer demonstrated a stiffer behaviour along the transversal direction to muscle fibres than along the longitudinal one. The fibre arrangement was measured by means of a histological study which confirmed that collagen fibres are mainly responsible for the passive mechanical strength and stiffness. Furthermore, the degree of anisotropy of the abdominal composite muscle turned out to be less pronounced than those obtained while studying the EO and IO-TA separately. Moreover, a phenomenological constitutive law was used to capture the measured experimental curves. A Levenberg-Marquardt optimization algorithm was used to fit the model constants to reproduce the experimental curves.

  12. A comparative study between Total Extra-Peritoneal (TEP repair and Trans Abdominal Pre-Peritoneal (TAPP repair in management of inguinal hernia

    Nimesh Verma

    2015-03-01

    Full Text Available Background: Groin hernias are the most common conditions referred to surgeons all over the world and over five lakh hernia repairs are performed annually. Our purpose in this study is to compare the results of laparoscopic hernioplasty by Total Extra-Peritoneal (TEP technique and laparoscopic Trans Abdominal Pre-Peritoneal (TAPP technique. Methodology: This was the prospective study conducted on cases of inguinal hernia in which half cases were operated by Laparoscopic Trans Abdominal Pre-Peritoneal (TAPP mesh repair while other half were treated by Total Extra-Peritoneal (TEP mesh repair of inguinal hernia in New Civil Hospital, Surat. All the patients were admitted and a detailed history and clinical examination were carried out as per written proforma. Results: This comparative study consisted of 60 patients. The most common diagnosis was right indirect inguinal hernia followed by left direct inguinal hernia in the both the groups. Overall the TEP was far better procedure compared to TAPP. The indicators like mean operative, Post-op pain, post-op hospital stay (in days and return to normal work (in days were far better than TAPP. Conclusion: Our study supports the view that laparoscopic TEP and TAPP mesh repair of inguinal hernia is safe and efficacious, but long term Randomized Control Trials with enhanced sample size and reduced confounding factors are still required to establish the absolute superiority of TEP over TAPP. [Natl J Med Res 2015; 5(1.000: 64-66

  13. Deletion of mesenchymal glucocorticoid receptor attenuates embryonic lung development and abdominal wall closure.

    Aiqing Li

    Full Text Available As a member of the nuclear hormone receptor superfamily of ligand-activated transcription factors, the glucocorticoid receptor (GR is essential for normal embryonic development. To date, the role of mesenchymal glucocorticoid signaling during development has not been fully elucidated. In the present study, we investigated the role of the GR during embryogenesis specifically in mesenchymal tissues. To this aim, we crossed GRflox mice with Dermo1-Cre mice to generate GR(Dermo1 mice, where the GR gene was deleted within mesenchymal cells. Compared to their wild type littermates, GR(Dermo1 mice displayed severe pulmonary atelectasis, defects in abdominal wall formation resulting in intestinal herniation, abnormal extracellular matrix synthesis in connective tissues and high postnatal lethality. Lungs of GR(Dermo1 mice failed to progress from the canalicular to saccular stage, as evidenced by the presence of immature air sacs, thickened interstitial mesenchyme and an underdeveloped vascular network between E17.5 and E18.5. Furthermore, myofibroblasts and vascular smooth muscle cells, although present in normal numbers in GR(Dermo1 animals, were characterized by significantly reduced elastin synthesis, whilst epithelial lining cells of the immature saccules were poorly differentiated. A marked reduction in normal elastin and collagen deposits were also observed in connective tissues adjacent to the umbilical hernia. This study demonstrates that eliminating the GR in cells of the mesenchymal lineage results in marked effects on interstitial fibroblast function, including a significant decrease in elastin synthesis. This results in lung atelectasis and postnatal lethality, as well as additional and hitherto unrecognized developmental defects in abdominal wall formation. In addition, altered glucocorticoid signaling in the mesenchyme attenuates normal lung epithelial differentiation.

  14. Incisional hernia after upper abdominal surgery: A randomised controlled trial of midline versus transverse incision

    J.A. Halm (Jens); H. Lip (Harm); P.I.M. Schmitz (Paul); J. Jeekel (Hans)

    2009-01-01

    textabstractObjectives: To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Summary background data: Incisional hernias after midline i

  15. Electrical muscle stimulation for deep stabilizing muscles in abdominal wall.

    Coghlan, Simon; Crowe, Louis; McCarthyPersson, Ulrik; Minogue, Conor; Caulfield, Brian

    2008-01-01

    Low back pain is associated with dysfunction in recruitment of muscles in the lumbopelvic region. Effective rehabilitation requires preferential activation of deep stabilizing muscle groups. This study was carried out in order to quantify the response of deep stabilizing muscles (transverses abdominis) and superficial muscle in the abdominal wall (external oblique) to electrical muscle stimulation (EMS). Results demonstrate that EMS can preferentially stimulate contractions in the deep stabilizers and may have significant potential as a therapeutic intervention in this area, pending further refinements to the technology.

  16. Assessment of the abdominal wall function after pedicled TRAM flap surgery for breast reconstruction: Use of modified mesh repair for the donor defect

    Cyriac Chacko

    2010-01-01

    Full Text Available Background: The pedicled TRAM flap has been a workhorse of autologous breast reconstruction for decades. However, there has been a rising concern about the abdominal wall donor site morbidity with the use of conventional TRAM flap. This has generally been cited as one of the main reasons for resorting to "abdominal wall friendly" techniques. This study has been undertaken to assess the abdominal wall function in patients with pedicled TRAM flap breast reconstruction. The entire width of the muscle and the overlying wide disk of anterior rectus sheath were harvested with the TRAM flap in all our patients and the anterior rectus sheath defect was repaired by a Proline mesh. Materials and Methods: Abdominal wall function was studied in 21 patients who underwent simultaneous primary unipedicled TRAM flap reconstruction after mastectomy for cancer. In all the patients, the abdominal wall defect was repaired using wide sheet of Proline mesh both as inlay and onlay. The assessment tools included straight and rotational curl ups and a subjective questionnaire. The abdominal wall was also examined for any asymmetry, bulge, or hernia. The minimal follow-up was 6 months postoperative. The objective results were compared with normal unoperated volunteers. Results and Conclusions: The harvesting the TRAM flap certainly results in changes to the anterior abdominal wall that can express themselves to a variable degree. A relatively high incidence of asymptomatic asymmetry of the abdomen was seen. There was total absence of hernia in our series even after a mean follow-up period of 15.5 months. A few patients were only able to partially initiate the sit up movement and suffered an important loss of strength. In most patients, synergists took over the functional movement but as the load increased, flexion and rotation performances decreased. The lack of correlation between exercise tests and the results of the questionnaire suggests that this statistically

  17. Richter hernia: surgical anatomy and technique of repair.

    Skandalakis, Panagiotis N; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

    2006-02-01

    Richter hernia (partial enterocele) is the protrusion and/or strangulation of only part of the circumference of the intestine's antimesenteric border through a rigid small defect of the abdominal wall. The first case was reported in 1606 by Fabricius Hildanus. The first definition of partial enterocele was given by August Gottlieb Richter in 1785. Sir Frederick Treves discriminated it from Littre hernia (hernia of the Meckel diverticulum). More often these hernias are diagnosed in the sixth and seventh decades of life. They comprise 10 per cent of strangulated hernias. Their common sites are the femoral ring, inguinal ring, and at incisional trauma. The most-often entrapped part of the bowel is the distal ileum, but any part of the intestinal tube may be incarcerated. These hernias progress more rapidly to gangrene than other strangulated hernias, and obstruction is less frequent. The gold standard technique for repair is the preperitoneal approach, followed by laparotomy and resection if perforation is suspected.

  18. Cadaver as an experimental model to study abdominal wall tension

    Nahas Fábio Xerfan

    2003-01-01

    Full Text Available The use of cadaver as an experimental model to evaluate tension of the abdominal wall after aponeurotic incisions and muscular undermining is described on this article. The tension required to pull the anterior and the posterior rectus sheaths towards the midline was studied in fresh cadavers at two levels: 3 cm above and 2 cm below the umbilicus. Traction measurement was assessed with a dynamometer attached to suture loops on the anterior and posterior recti sheaths, close to the midline, above and below the umbilicus. The quotient of the force used to mobilize the aponeurotic site to the midline and its resulting displacement was called the traction index. These indices were compared in three situations: 1 prior to any aponeurotic undermining; 2 after the incision of the anterior rectus sheath and the undermining of the rectus muscle from its posterior sheath; and 3 after additionally releasing and undermining of the external oblique muscle. The experimental model described showed to be feasible to demonstrate the effects on tension of the abdominal wall after incisions and undermining of its muscles and aponeurosis.

  19. Segmentalliverincarcerationthrougha recurrent incisional lumbar hernia

    Nikolaos S. Salemis; Konstantinos Nisotakis; Stavros Gourgiotis; Efstathios Tsohataridis

    2007-01-01

    BACKGROUND: Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after lfank surgery. Incarceration or strangulation of hernia contents is uncommon. METHOD: Segmental liver incarceration through a recurrent incisional lumbar defect was diagnosed in a 58 years old woman by magnetic resonance imaging. RESULTS: The patient underwent an open repair of the com-plicated hernia. An expanded polytetralfouoroethylene (e-PTFE) mesh was fashioned as a sublay prosthesis. She had an uncomplicated postoperative course. Follow-up examinations revealed no evidence of recurrence. CONCLUSIONS: Although lumbar hernia rarely results in incarceration or strangulation, early repair is necessary because of the risks of complications and the increasing dififculty in repairment as it enlarges. Surgical repair is often dififcult and challenging.

  20. Effect Observation and Comparison of Different Tension Free Hernia Repair in the Treatment of Abdominal External Hernia%观察对比不同无张力疝修补手术治疗腹外疝的效果

    叶静凯

    2015-01-01

    目的:对比分析传统修补术与改进无张力疝修补手术在腹外疝的治疗中的应用价值。方法选取80例腹外疝患者,依据治疗方法的不同将其列入观察组与对照组,每组各为40例。对照组和观察组分别应用传统疝修补术与改进无张力疝修补术。结果两组手术及预后相关指标和并发症的发生率比较,差异均有统计学意义(P <0.05)。结论在腹外疝的治疗中,与传统修补术相比,改良后无张力疝修补术的效果更佳。%Objective To analyze and compare application value in the treatment of abdominal external hernia between traditional repair and improved without tension hernia repair surgery. Methods Chose 80 patients with abdominal external hernia,according to the different treatment methods,they were divided into observation group and control group,each group with 40 cases. The control group and observation group were applied traditional hernia repair and improved without tension hernia repair. Results Compared related index of prognosis and the incidence of complications in two groups of surgery,the difference had statistical significance(P < 0.05). Conclusion In the treatment of abdominal external hernia,compared with the traditional repair,modified without tension hernia repair’effect is better.

  1. Umbilical hernia (image)

    An umbilical hernia is a protrusion of the peritoneum and fluid, omentum, or a portion of abdominal organ(s) through the ... spontaneously without treatment by age 1 or 2. Umbilical hernias are usually painless and are common in infants.

  2. Arterial embolization for traumatic lethal lateral abdomi-nal wall hemorrhage in a liver cirrhosis patient

    Seiji Morita; Tomoatsu Tsuji; Takeshi Yamagiwa; Hiroyuki Otsuka; Sadaki Inokuchi

    2009-01-01

    @@ B lood loss due to abdominal wall hemorrhage is generally managed conservatively. Further, abdominal wall hemorrhage rarely develops into a life-threatening condition. However, it is difficult to sur-gically achieve hemostasis. We report the case of a liver cirrhosis patient with life-threatening abdominal wall hemorrhage that developed as a result of a minor trauma and was successfully treated with arterial embolization (AE).

  3. Simplified technique of mesh fixation during laparoscopic repair of abdominal ventral hernia.

    Piskun, G; Shaftan, G; Fogler, R

    1999-04-01

    The current techniques for intraperitoneal mesh fixation are complex and time-consuming. We present here a simple technique for the fixation of the mesh during laparoscopic intraperitoneal ventral hernia repair.

  4. Are fibrinogen and complete blood count parameters predictive in incarcerated abdominal hernia repair?

    Kahramanca, Sahin; Kaya, Oskay; Ozgehan, Gulay; Guzel, Hakan; Azili, Cem; Gokce, Emre; Kucukpinar, Tevfik; Kulacoglu, Hakan

    2014-01-01

    Therapeutic delays in cases of external incarcerated hernias typically result in increasing morbidity, mortality, and health expenditures. We investigated the diagnostic role of blood fibrinogen level, white blood count (WBC), mean platelet volume (MPV), and platelet distribution width (PDW) in patients with incarcerated hernia. Two groups, each containing 100 patients, were studied. Group A underwent elective, and group B underwent incarcerated and urgent external hernia repair. We observed high fibrinogen and WBC levels but low MPV and PDW values for patients in group B. Contrary to our expectations, we found lower MPV and PDW values in the complicated group than in the elective group. The morbidity rate and cost burden were higher in group B, and the results were statistically significant. Early operation should be recommended for patients with incarcerated external hernias if their fibrinogen and WBC levels are high.

  5. Long-term anisotropic mechanical response of surgical meshes used to repair abdominal wall defects.

    Hernández-Gascón, B; Peña, E; Pascual, G; Rodríguez, M; Bellón, J M; Calvo, B

    2012-01-01

    Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue.

  6. Spontaneous epigastric hernia causing gastric outlet obstruction: a case report.

    Arowolo, O A; Ogundiran, T O; Adebamowo, C A

    2006-09-01

    Epigastric hernia, a rare form of ventral abdominal hernia, accounts for 0.4 - 1.5% of all abdominal wall hernias. It usually occurs in middle - aged individuals and is rarely large enough to admit more than a small amount of extra-peritoneal fat. In this case report, we present a 64 years old woman with 6 days history of sudden onset of painful epigastric swelling associated with acute gastric outlet obstruction. We did not find a previous report of a similar case in the medical literature.

  7. CLINICAL STUDY AND MANAGEMENT OF INCISIONAL HERNIA

    Jyothirmayi

    2016-05-01

    Full Text Available Incisional hernia follows operations on the anterolateral abdominal wall. It is a diffuse extrusion of peritoneum and abdominal contents through a weak scar due to the failure of the lines of closure of the abdominal wall following laparotomy. The incidence of incisional hernia varies widely in different series published and is at least 10% as shown in longterm follow-up studies. Clarification regarding the type of mesh and its positioning and operative methods of open surgery and laparoscopic repair needs to be addressed. In addition to surgical closure techniques, patient's risk factors also influence surgical outcome following wound closure. RESULTS Age, gender and risk factors such as diabetes, Hypertension, Anaemia, Obesity, COPD and Type of previous incision contribute to the development of primary and recurrent incisional hernia. Although complete prevention of development of incisional hernia is not possible, repair of hernia by replacement of simple suture technique with that of mesh reinforcement has shown better longterm results and patient satisfaction. CONCLUSION For management of incisional hernia, the available evidence has been favourable for good quality long term results with mesh repair techniques.

  8. 改进无张力疝修补术对腹外疝的临床疗效探析%The clinical efficacy of improvement of tension-free hernia repair in the abdominal external hernia

    陆海涛

    2014-01-01

    目的:分析研究改进无张力疝修补术治疗腹外疝的临床效果。方法选调我院收治的132例腹外疝患者,分析比较不同手术方法的治疗情况。结果观察组与对照组患者的手术时间、住院时间、术后并发症以及术后12个月复发率差异有统计学意义(P<0.05)。结论采用改进无张力疝修补术方法治疗腹外疝疾病,可显著提高患者生命质量。%Objective To analyze and research the clinical efficacy of the improvement of tension-free hernia repair in abdominal external hernia. Methods 132 patients of hernia in our hospital were selected, the treatment conditions of different surgical treatment methods were analyzed and compared. Results The differences of operative time, hospital stay, postoperative complications, and recurrence rates postoperative 12 months between the study group and the control group of patients were significant, with statistically significant P<0.05. Conclusion The treatment of abdominal external hernia disease with improved tension-free hernia repair method, can significantly improve the quality of life in patients.

  9. The collagen turnover profile is altered in patients with inguinal and incisional hernia

    Henriksen, Nadia A; Mortensen, Joachim H; Sorensen, Lars T;

    2015-01-01

    BACKGROUND: Disturbed metabolism in the extracellular matrix (ECM) contributes to formation of abdominal wall hernias. The aim of this study was to gain deeper insight into the ECM turnover in hernia patients by analyzing serum biomarkers specifically reflecting collagen synthesis and breakdown...... in the interstitial matrix (types I, III, and V collagens) and in the basement membrane (type IV collagen). MATERIAL AND METHODS: Patients with 3 different types of hernias were included: Primary unilateral inguinal hernia (n = 17), multiple hernias defined as ≥3 hernias (n = 21), and incisional hernia (n = 25......). Patients without hernias scheduled to undergo elective operation for gallstones (n = 18) served as controls. Whole venous blood was collected preoperatively. Biomarkers for synthesis of interstitial matrix (PINP, Pro-C3, P5CP) and basement membrane (P4NP) as well as corresponding degradation (C1M, C3M, C5M...

  10. Abdominal compliance, parasternal activation, and chest wall motion.

    Cala, S J; Edyvean, J; Engel, L A

    1993-03-01

    We measured abdominal compliance (Cab) and rib cage displacement (delta Vrc) relative to abdominal displacement (delta Vab) during relaxation and tidal breathing in upright (U) and supine (S) postures in five normal subjects. In S, an abdominal binder was used to decrease Cab in two to five increments. We also measured the electrical activity of the parasternal muscle (EMGps) with the use of fine-wire intramuscular electrodes during CO2 rebreathing in U and in supine unbound (SU) and supine bound (SB) postures. During maximum binding (SB2), Cab decreased to 39 +/- 7% of the SU value (P = 0.01), matching Cab in U (P = 0.16). In the SB condition, the ratio of tidal delta Vrc/delta Vab to relaxation delta Vrc/delta Vab increased as Cab decreased, matching the data in U. For the group, this ratio decreased during SU to 47 +/- 10% (P = 0.02) but increased during SB2 to 86 +/- 7% (P = 0.18) of the value in U. During CO2 rebreathing, EMGps increased linearly with tidal volume (r > 0.727, P < 0.01). However, at any given tidal volume, the SU and SB2 EMGps were not significantly different (P = 0.12), and both were less than that in U (P < 0.02). The results suggest that the differences in chest wall motion between U and S may be due to the difference in Cab and not to different patterns of respiratory muscle recruitment. The mechanism may relate to changes in mechanical coupling between the diaphragm and the rib cage.

  11. Primary abdominal wall clear cell carcinoma arising from incisional endometriosis

    Burcu Gundogdu; Isin Ureyen; Gunsu Kimyon; Hakan Turan; Nurettin Boran; Gokhan Tulunay; Dilek Bulbul; Taner Turan; M Faruk Kose

    2013-01-01

    A 49 year-old patient with the complaint of a mass located in the caesarean scar was admitted. There was a fixed mass 30í30 mm in diameter with regular contour located at the right corner of the pfannenstiel incision. Computed tomography revealed a (40í50í50) mm solid mass lesion with margins that cannot be distinguished from the uterus, bladder and small intestines and a heterogeneous mass lesion (50í45í55) mm in diameter, located in the right side of the anterior abdominal wall. Cytoreductive surgery including total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Final pathology was clear cell carcinoma. Clear cell carcinoma arising from an extraovarian endometriotic focus was diagnosed and the patient received 6 cycles paclitaxel-carboplatin chemotherapy as adjuvant treatment. The patient who was lost to follow-up applied to our clinic 2 years after surgery with a recurrent mass in the left inguinal region. After 3 cycles of chemotherapy, the patient's tumoral mass in the left inguinal region was excised. The result of the pathology was carcinoma metastasis. It is decided that the following treatment of the patient should be palliative radiation therapy. The patient who underwent palliative radiation therapy died of disease after 4 months of the second operation.

  12. Seatbelt triad: severe abdominal wall disruption, hollow viscus injury, and major vascular injury.

    Kulvatunyou, Narong; Albrecht, Roxie M; Bender, Jeffrey S; Friese, Randy S; Joseph, Bellal; Latifi, Rifat; O'Keefe, Terrance; Wynn, Julie L; Rhee, Peter M

    2011-05-01

    The triad of seatbelt-related severe abdominal wall disruption, hollow viscus injury, and distal abdominal aortic injury after a motor vehicle collision is uncommon. We present a small case series involving those three clinical features with the goal of preventing a future missed diagnosis of the distal abdominal aortic injury in particular.

  13. Abdominal wound closure: current perspectives

    Williams ZF

    2015-12-01

    Full Text Available Zachary F Williams, William W Hope Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC, USA Abstract: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh. Keywords: incisional, abdominal, hernia, prevention, wound closure techniques 

  14. Comparison between general and spinal anesthesia in inguinal hernia repair in Clinical University Hospital "St. Naum Ohridski" - Skopje

    2015-01-01

    Most often recommended treatment for inguinal hernia diagnosed patients is surgery. Generally, the surgical treatment includes several components: opening the subcutaneous fat by incision of the abdominal wall, mobilization of cord structures, dissection of weakened tissue and closure of inguinal canal with application of sterile synthetic mesh patch used to repair and decrease the tension in the weakened area of the abdominal wall after mobilization of hernia. Usually, the patient is given g...

  15. Clinical analysis of abdominal wall endometriosis in 101 cases

    Cheng Ning-hai; Zhu Lan; Lang Jing-he; Liu Zhu-feng; Sun Da-wei; Leng Jin-hua

    2006-01-01

    Objective: To review the clinical characteristics, treatment and prognoses of abdominal wall endometriosis(AWE).Methods: A retrospective study of 101 cases of AWE from 1992 to 2005 at Obstetric and Gynecologic Department of Peking Union Medical College Hospital was performed. Ninety-eight patients had a history of caesarean section. The mean age of the patients was (33.3±4.8) years and the average size of the mass was 1.5 cm. Abdominal wall mass associated pain during the menstrual cycle was noticed in 89.8% of the patients. The occurrence of AWE after caesarean section was 0.05% at our hospital. In patients without pelvic endometriosis or adenomyosis, 20.5% were presented with high CA125 >35 U/ml and the highest one was 93.4 U/ml. 92.1% of patients were diagnosed before surgery. 4 patients were administrated first in General Surgical Department with painless abdominal mass. Medication was adopted in 16 cases pre-operatively and 14 cases post-operatively.Results: The mean size of the resected mass was 4.2 cm, significantly larger than the estimation with palpation or ultrasonography, which was 0.8-1.2 cm (P=0.006, P<0.001). Pelvic endometriosis or adenomyosis was detected during the operation in 13 patients. One patient was diagnosed as atypical endometriosis by pathological examination in the beginning but transformed to be sarcoma finally. Ten patients recurred after surgery. 2 of them received medication and 5 of them received second operation.Conclusions: Ultrasonography can be used to evaluate the size of the mass and the infiltrative scope pre-operation. The serum CA125 is not specific for diagnosis of AWE. Complete eradication of the lesion with at least 1 cm beyond the edge of the mass is recommended as the primary treatment. Eradication should be considered also in recurrent cases. It may transform to malignant lesions after multiple recurrence.

  16. Primary synovial sarcoma of the abdominal wall: A case report and review of the literature

    Alsaif H Saif

    2008-01-01

    Full Text Available Synovial sarcoma is a malignant mesenchymal neoplasm which commonly occurs in the extremities of adults, in close association with joint capsules, tendon sheaths, bursae and fascial structures. Only a few cases of synovial sarcoma occurring in the abdominal wall have been reported. A case of a primary synovial sarcoma arising from the anterior abdominal wall fascial aponeurosis is presented.

  17. Muscle patterning in mouse and human abdominal wall development and omphalocele specimens of humans.

    Nichol, Peter F; Corliss, Robert F; Yamada, Shigehito; Shiota, Kohei; Saijoh, Yukio

    2012-12-01

    Human omphalocele is a congenital defect of the abdominal wall in which the secondary abdominal wall structures (muscle and connective tissue) in an area centered around the umbilicus are replaced by a translucent membranous layer of tissue. Histological examination of omphalocele development and moreover the staging of normal human abdominal wall development has never been described. We hypothesized that omphalocele is the result of an arrest in the secondary abdominal wall development and predicted that we would observe delays in myoblast maturation and an arrest in secondary abdominal wall development. To look for evidence in support of our hypothesis, we performed a histological analysis of normal human abdominal wall development and compared this to mouse. We also conducted the first histological analysis of two human specimens with omphalocele. In these two omphalocele specimens, secondary abdominal wall development appears to have undergone an arrest around Carnegie Stage 19. In both specimens disruptions in the unidirectional orientation of myofibers were observed in the external and internal obliques, and rectus abdominis but not in the transversus abdominis. These latter findings support a model of normal abdominal wall development in which positional information instructs the orientation of myoblasts as they organize into individual muscle groups.

  18. [Large abdominal wall reconstruction by free flap after recurrence of a dermatofibrosarcoma protuberans].

    Le Fourn, B; Lejeune, F; Sartre, J Y; Loirat, Y; Pannier, M

    1996-12-01

    Based on a case of recurrence of a dermatofibrosarcoma protuberans of the abdominal wall, the authors discuss the need for initial wide resection of this type of skin tumour and the possibilities of repair of extensive full thickness defects of the abdominal wall by means of a latissimus dorsi myocutaneous free flap.

  19. Abdominal wall necrotizing fasciitis from dislodged percutaneous endoscopic gastrostomy tubes: a case series.

    MacLean, Alexandra A; Miller, George; Bamboat, Zubin M; Hiotis, Karen

    2004-09-01

    We report three cases of abdominal wall necrotizing fasciitis that occurred as a result of leakage from displaced percutaneous endoscopic gastrostomy tubes. This is the first report of such a series. Patients underwent extensive operative excisions of their abdominal walls down to their posterior fascia. All patients tolerated their initial surgery, however, two patients ultimately expired from respiratory complications. The surviving patient underwent multiple repeat debridements and reconstructive abdominal wall surgery. We review the epidemiology of patients at risk for this complication and discuss its presentation, as well as the appropriate workup and management. We also address the issues of closure of large abdominal wall defects and future alimentation in this patient group. Finally, abdominal wall necrotizing faciitis from gastrostomy tube leakage is a devastating complication, and the development of preventative strategies for patients at risk is of paramount importance.

  20. Lumbar hernia misdiagnosed as a subcutaneous lipoma: a case report

    Amelio Gianfranco

    2009-12-01

    Full Text Available Abstract Introduction Lumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis. Case presentation We report the case of a 40-year-old Caucasian woman with a superior lumbar hernia (Grynfeltt hernia initially misdiagnosed as a recurrent lipoma. The correct diagnosis was made intra-operatively and the hernia was repaired using synthetic mesh. The patient was free of recurrence at 4 months after the operation. Conclusion A lumbar or flank mass should always raise suspicion of a lumbar hernia. Ultrasound and computed tomography may confirm the diagnosis. Adequate surgical treatment should be planned on the basis of etiology and hernia size. Both open and laparoscopic techniques can be used with good results.

  1. Ultrasonic diagnosis of strangulated Richter's hernia. Ultralydundersoekelse av strangulert Richters hernie

    Aakhus, S.; Roeysland, P.; Husby, O.S. (University and Regional Hospital, Trondheim (Norway))

    1990-10-01

    Ultrasonography may show early pathological changes in an obstructed intestine and also identify abnormal structures in the abdominal wall and inguinal region. A patient with intestinal obstruction due to a femoral hernia of Richter's type, is described. The hernia was well shown by ultrasonography. Ultrasonic examination of the abdomen, including the inguinal regions, may facilitate earlier diagnosis in patients with acute abdominal disease. 9 refs., 2 figs.

  2. Traumatic lumbar hernias: do patient or hernia characteristics predict bowel or mesenteric injury?

    Mellnick, Vincent M; Raptis, Constantine; Lonsford, Chad; Lin, Michael; Schuerer, Douglas

    2014-06-01

    Traumatic lumbar hernias are rare but important injuries to diagnose in blunt abdominal trauma, both because of delayed complications of the hernia itself and because of well-documented association with bowel and mesenteric injuries. No study to our knowledge has determined whether specific features of the hernia-size of the wall defect, inferior or superior location, or the side of the hernia-bear any predictive value on the presence of underlying bowel and mesenteric injury. A retrospective query of the radiology information system yielded 21 patients with lumbar hernias which were diagnosed on CT. These were reviewed by three radiologists to confirm the presence of an acute lumbar hernia and to determine the size and location of the hernia. The patients' medical records were reviewed to determine the presence of operatively confirmed bowel and/or mesenteric injuries, which occurred in 52 % of patients. A significant (p hernia defects greater than 4.0 cm (100 %) and those less than 4.0 cm (17 %). Larger hernias also resulted in more procedures (p = 0.042) and a trend towards longer ICU stay, but no difference in injury severity score (ISS) or overall hospital stay. No significant difference was seen in the frequency of bowel and/or mesenteric injuries based on side or location of the hernia, though distal colonic injuries were more commonly seen with left-sided hernias (50 %) compared to right-sided hernias (18 %). Although based on a small patient population, these results suggest that larger traumatic lumbar hernias warrant particularly close evaluation for an underlying bowel and/or mesenteric injury.

  3. Effects of aging on abdominal wall healing in rats

    Biondo-Simões Maria de Lourdes Pessole

    2005-01-01

    Full Text Available PURPOSE: The aim of this study was to assess abdominal wall healing in old and young adult rats. METHODS: On average, young animals were 110 days old and old animals were 762 days old. A 4.0 cm median laparotomy was performed under anesthesia, followed by laparorrhaphy on two synthesis planes, i.e. peritoneum-muscle-aponeurosis and skin, using continuous 5.0 nylon sutures. The animals were evaluated on the 3rd, 7th, 14th and 21st postoperative days. The resistance of the two planes was studied separately and a histopathologic analysis was performed on sections stained with hematoxylin-eosin and Sirius Red. Immunohistochemical analysis was also carried out using PCNA, LCA and CD34. RESULTS: The skin scars gained resistance in a similar manner at the initial time points, but those of young rats were more resistant on the 21st day (p=0.0029. Total and type III collagen content was similar in the two groups and type I collagen content was higher in young animals on the 14th day. Inflammatory cell infiltration was more marked in the skin wounds of young animals on the 3rd day (p=0.0190. Reepithelialization was similar and angiogenesis was more intense in the skin wounds of young animals on the 14th day (p=0.0062. The peritoneum-muscle-aponeurosis wounds gained similar resistance during the early phases, but were more resistant on the 14th day (p=0.0005 and on the 21st day (p=0.0023 in old rats Collagen concentration was higher in the wounds of old animals on the 3rd day (p=0.0112 and in the wounds of young animals on the 21st day (p=0.0348. The inflammatory reaction was more intense in the wounds of old animals on the 3rd day (p=0.0060 and angiogenesis was more intense on the 14th day (0.0432. CONCLUSION: Although there are some differences in the healing course between young and old animals, age, of itself, does not impair the healing of abdominal wall wounds in rats.

  4. Acquired umbilical hernias in four captive polar bears (Ursus maritimus).

    Velguth, Karen E; Rochat, Mark C; Langan, Jennifer N; Backues, Kay

    2009-12-01

    Umbilical hernias are a common occurrence in domestic animals and humans but have not been well documented in polar bears. Surgical reduction and herniorrhaphies were performed to correct acquired hernias in the region of the umbilicus in four adult captive polar bears (Ursus maritimus) housed in North American zoos. Two of the four bears were clinically unaffected by their hernias prior to surgery. One bear showed signs of severe discomfort following acute enlargement of the hernia. In another bear, re-herniation led to acute abdominal pain due to gastric entrapment and strangulation. The hernias in three bears were surgically repaired by debridement of the hernia ring and direct apposition of the abdominal wall, while the large defect in the most severely affected bear was closed using polypropylene mesh to prevent excessive tension. The cases in this series demonstrate that while small hernias may remain clinically inconsequential for long periods of time, enlargement or recurrence of the defect can lead to incarceration and acute abdominal crisis. Umbilical herniation has not been reported in free-ranging polar bears, and it is suspected that factors such as body condition, limited exercise, or enclosure design potentially contribute to the development of umbilical hernias in captive polar bears.

  5. Lumbar hernia: surgical anatomy, embryology, and technique of repair.

    Stamatiou, Dimitrios; Skandalakis, John E; Skandalakis, Lee J; Mirilas, Petros

    2009-03-01

    Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the posterolateral abdominal wall. Barbette was the first, in 1672, to suggest the existence of lumbar hernias. The first case was reported by Garangeot in 1731. Petit and Grynfeltt delineated the boundaries of the inferior and superior lumbar triangles in 1783 and 1866, respectively. These two anatomical sites account for about 95 per cent of lumbar hernias. Approximately 20 per cent of lumbar hernias are congenital. The rest are either primarily or secondarily acquired. The most common cause of primarily acquired lumbar hernias is increased intra-abdominal pressure. Secondarily acquired lumbar hernias are associated with prior surgical incisions, trauma, and abscess formation. During embryologic development, weakening of the area of the aponeuroses of the layered abdominal muscles that derive from somitic mesoderm, which invades the somatopleure, may potentially lead to lumbar hernias. Repair of lumbar hernias should be performed as early as possible to avoid incarceration and strangulation. The classic repair technique uses the open approach, where closure of the defect is performed either directly or using prosthetic mesh. The laparoscopic approach, either transabdominal or extraperitoneal, is an alternative.

  6. Retrosternal (Morgagni) diaphragmatic hernia.

    Lojszczyk-Szczepaniak, Anna; Komsta, Renata; Debiak, Piotr

    2011-08-01

    This study presents the case of a shih tzu puppy, in which a rare congenital Morgagni diaphragmatic hernia was diagnosed. The diagnosis was based on abdominal and thoracic radiographs, including a contrast study of the gastrointestinal tract, which revealed a co-existing umbilical hernia. Both hernias were repaired by surgery.

  7. Sports Hernia (Athletic Pubalgia)

    ... a traditional, abdominal hernia, it is a different injury. A sports hernia is a strain or tear of any ... to you about your symptoms and how the injury occurred. If you have a sports hernia, when your doctor does a physical examination, ...

  8. Epigastric Hernia

    2015-01-01

    Epigastric hernia is a common condition, mostly asymptomatic although sometimes their unusual clinical presentation still represents a diagnostic dilemma for clinician. The theory of extra tension in the epigastric region by the diaphragm is the most likely theory of epigastric hernia formation. A detailed history and clinical examination in our thin, elderly male patient who presented with abdominal pain and constipation of 5 days of evolution was crucial in establishing a diagnosis. Noninva...

  9. Anterior abdominal wall leiomyoma arising de novo in a fertile women: A case report

    Cho, Je Young; Woo, Ji Young; Hong, Hye Suk; Yang, Ik; Lee, Yul; Hwang, Ji Young; Kim, Han Myun; Shin, Mi Kyung [Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of)

    2016-01-15

    Abdominal wall leiomyoma arising de novo is very rare, hence the reported imaging findings of this disease are also rare. We reported the case of a 33-year-old woman who presented with an abdominal wall mass without antecedent gynecological surgeries. The initial abdominal computed tomography (CT) showed thickening of the left rectus abdominis and the loss of intervening fat between the rectus abdominis and the lateral abdominal muscles. After 8 months, the follow-up contrast-enhanced CT and ultrasonography (US) showed a lentiform-shaped mass with isodensity to the adjacent muscles. The US-guided biopsy was consistent with leiomyoma.

  10. Blunt Abdominal Wall Disruption by Seatbelt Injury; A Case Report and Review of the Literature

    Maarten Philip Cornelissen

    2016-04-01

    Full Text Available With the introduction of the use of seatbelts in cars, mortality following motor vehicle crashes has decreased significantly. However, two patterns of injuries, the ‘seatbelt sign’ and ‘seatbelt syndrome’ have emerged. Injuries may consist of traumatic abdominal wall disruption. We present two cases of severe abdominal wall disruption caused by a seatbelt injury and treated with primary repair. A review of the literature is provided. Two patients were brought in after a high velocity Motor Vehicle Collision. Both presented with an acute abdomen and a seatbelt sign upon which the decision was made to perform emergency laparotomies. Both patients had an abdominal wall disruption along the seatbelt sign. These disruptions were primarily closed and during six months of follow-up no complications occurred. A disruption of the abdominal wall is a rare complication. However, it is a diagnosis that may not be missed as patients have a higher risk of morbidity and mortality. CT-scanning is an accurate method to detect disruptions. Closure of blunt traumatic abdominal wall disruption can be done primarily with sutures or addition of a mesh. In both cases of the severe abdominal wall disruption, primary repair without mesh in the acute phase was successful. When a laparotomy is not indicated, the abdominal wall must be assessed for disruption. If there is a disruption primary repair is a good option.

  11. Appearance of abdominal wall endometriosis on MR imaging

    Busard, Milou P.H.; Kuijk, Cees van; Waesberghe, Jan Hein T.M. van [VU Medical Center, Department of Radiology, Endometriosis Center VUMC, Amsterdam (Netherlands); Mijatovic, Velja; Hompes, Peter G.A. [VU Medical Center, Department of Gynecology, Endometriosis Center, Amsterdam (Netherlands)

    2010-05-15

    Abdominal wall endometriosis (AWE) is defined as endometrial tissue that is superficial to the peritoneum. AWE is often difficult to diagnose, mimicking a broad spectrum of diseases. The aim of this study was to describe the appearance of AWE on magnetic resonance (MR) imaging. We present ten patients with AWE (12 lesions) in which MR imaging was used for diagnosis. MR imaging included T2-weighted imaging and T1-weighted imaging with fat suppression. To assess the value of diffusion-weighted imaging (DWI) in endometriosis, four patients underwent additional DWI. The apparent diffusion coefficient (ADC) was calculated using b values of 50, 400, 800 and 1,200 s/mm{sup 2}. In most cases, the lesion was located ventral or dorsal to the aponeurosis of the rectus oblique muscle (n=6) or in the rectus abdominis (n = 5). MR of AWE lesions showed isointense or slightly hyperintense signal compared with muscle on T2-weighted images and showed isointense or slightly hyperintense signal compared with muscle on T1-weighted images with foci of high signal intensity, indicative of haemorrhage. The mean ADC value of AWE was 0.93 x 10{sup -3}/mm{sup 2}/s. MR imaging seems to be useful in determining the location and depth of infiltration in surrounding tissue preoperatively. (orig.)

  12. Epigastric Hernia.

    Suarez Acosta, Carlos Enrique; Romero Fernandez, Esperanza; Calvo Manuel, Elpidio

    2015-08-01

    Epigastric hernia is a common condition, mostly asymptomatic although sometimes their unusual clinical presentation still represents a diagnostic dilemma for clinician. The theory of extra tension in the epigastric region by the diaphragm is the most likely theory of epigastric hernia formation. A detailed history and clinical examination in our thin, elderly male patient who presented with abdominal pain and constipation of 5 days of evolution was crucial in establishing a diagnosis. Noninvasive radiologic modalities such as ultrasonographic studies in the case of our patient can reliably confirm the diagnosis of epigastric hernia.

  13. Catamenial Pain in Umbilical Hernia with Spontaneous Reduction: An Unusual Presentation of a Rare Entity.

    Pandey, Divya; Sharma, Ritu; Salhan, Sudha

    2015-08-01

    Spontaneous umbilical endometriosis occurring in absence of any previous abdominal or uterine surgery is extremely atypical. Its association with umbilical hernia is very rare and hernia getting spontaneously resolved has not been reported in literature so far. Here we report a case of a patient with spontaneous umbilical endometriosis associated with umbilical hernia which led to spontaneous hernia reduction. This was also associated with multiple uterine fibromyoma and bilateral ovarian endometrioma which were simultaneously treated by total abdominal hysterectomy with bilateral salpingo-oopherectomy along with surgical excision of the endometriotic tissue and repair of the abdominal wall defect. To the best of our knowledge, this is the first described case of spontaneous umbilical hernia reduction due to development of endometriosis.

  14. Grynfelt hernia: case report and literature review.

    Cesar, D; Valadão, M; Murrahe, R J

    2012-02-01

    Back lumbar hernia is a rare abdominal wall defect that usually presents spontaneously after trauma or lumbar surgery or, less frequently, during infancy (congenital). Few reports have been published in the literature describing primary lumbar hernia. A general surgeon will have the opportunity to repair only one or a few lumbar hernia cases in his/her lifetime. We report a case of a healthy 50-year-old man, with no previous surgeries or history of trauma, who presented to the outpatient department with abdominal discomfort, pain, and a sensation of a growing mass on his lower left back for 4 years. CT scan of the abdomen showed a mass in the left posterolateral abdominal wall. Specifically, a herniation of retroperitoneal fat between the erector spinae muscle group and internal oblique muscles through aponeurosis of the transversalis muscle (Grynfeltt hernia). The patient underwent a small lumbotomy, polypropylene mesh was placed and he recovered well. Although many techniques have been described for the surgical management of such hernias, none of them can be recommended as the preferred method. Our impression, however, is that the open approach, with a small lumbotomy, seems to be easy, safe and presents good postoperative recovery.

  15. Retropsoas hernia as a cause of chronic abdominal pain: CT diagnosis

    Benson, J.E. [Div. of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD (United States); Strauch, E.D. [Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, Maryland (United States)

    1998-05-01

    Congenital retropsoas small bowel herniation is reported as the cause of long-standing recurrent abdominal pain in a teenage girl. Knowledge of this entity is important for differential diagnosis of abdominal pain, mass, or retroperitoneal gas and fluid, and for avoiding complications of percutaneous renal interventions. (orig.) With 2 figs., 6 refs.

  16. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair

    Kokotovic, Dunja; Bisgaard, Thue; Helgstrand, Frederik

    2016-01-01

    Importance: Prosthetic mesh is frequently used to reinforce the repair of abdominal wall incisional hernias. The benefits of mesh for reducing the risk of hernia recurrence or the long-term risks of mesh-related complications are not known. Objective: To investigate the risks of long......-term recurrence and mesh-related complications following elective abdominal wall hernia repair in a population with complete follow-up. Design, Setting, and Participants: Registry-based nationwide cohort study including all elective incisional hernia repairs in Denmark from January 1, 2007, to December 31, 2010....... Exposures: Hernia repair using mesh performed by either open or laparoscopic techniques vs open repair without use of mesh. Main Outcomes and Measures: Five-year risk of reoperation for recurrence and 5-year risk of all mesh-related complications requiring subsequent surgery. Results: Among the 3242...

  17. [The history of treatment of groin hernia].

    Legutko, Janusz; Pach, Radosław; Solecki, Rafał; Matyja, Andrzej; Kulig, Jan

    2008-01-01

    muscles. These modifications decreased recurrence rate to 3%. The next epoch in the history of hernia surgery lasting to present days is referred to as era of tensionless hernia repair. The tension of sutured layers was reduced by incisions of the rectal abdominal muscle sheath or using of foreign materials. The turning point in hernia surgery was discovery of synthetic polymers by Carothers in 1935. The first tensionless technique described by Lichtenstein was based on strengthening of the posterior wall of inguinal canal with prosthetic material. Lichtenstein published the data on 1,000 operations with Marlex mesh without any recurrence in 5 years after surgery. Thus fifth rule of groin hernia repair was introduced--tensionless repair. Another treatment method was popularized by Rene Stoppa, who used Dacron mesh situated in preperitoneal space without fixing sutures. First such operation was performed in 1975, and reported recurrence rates were quite low (1.4%). The next type of repair procedure was sticking of a synthetic plug into inguinal canal. Lichtenstein in 1968 used Marlex mesh plug (in shape of a cigarette) in the treatment of inguinal and femoral hernias. The mesh was fixated with single sutures. The next step was introduction of a Prolene Hernia System which enabled repair of the tissue defect in three spaces: preperitoneal, above transverse fascia and inside inguinal canal. Laproscopic treatment of groin hernias began in 20th century. The first laparoscopic procedure was performed by P. Fletcher in 1979. In 1990 Schultz plugged inguinal canal with polypropylene mesh. Later such methods like TAPP and TEP were introduced. The disadvantages of laparoscopic approach were: high cost and risk connected with general anesthesia. In conclusion it may be stated that history of groin hernia repair evolved from life-saving procedures in case of incarcerated hernias to elective operations performed within the limits of 1 day surgery.

  18. Abdominal adiposity is the main determinant of the C-reactive response to injury in subjects undergoing inguinal hernia repair

    Irkulla Sashidhar

    2013-02-01

    Full Text Available Abstract Background Obesity and serum C-reactive protein (CRP (a sensitive marker of inflammatory activity are associated with most chronic diseases. Abdominal adiposity along with age is the strongest determinant of baseline CRP levels in healthy subjects. The mechanism of the association of serum CRP with disease is uncertain. We hypothesized that baseline serum CRP is a marker of inflammatory responsiveness to injury and that abdominal adiposity is the main determinant of this responsiveness. We studied the effect of abdominal adiposity, age and other environmental risk factors for chronic disease on the CRP response to a standardised surgical insult, unilateral hernia repair to not only test this hypothesis but to inform the factors which must be taken into account when assessing systemic inflammatory responses to surgery. Methods 102 male subjects aged 24-94 underwent unilateral hernia repair by a single operator. CRP was measured at 0, 6, 24 and 48 hrs. Response was defined as the peak CRP adjusted for baseline CRP. Results Age and waist:hip ratio (WHR were associated both with basal CRP and CRP response with similar effect sizes after adjustment for a wide-range of covariates. The adjusted proportional difference in CRP response per 10% increase in WHR was 1.50 (1.17-1.91 p = 0.0014 and 1.15(1.00-1.31 p = 0.05 per decade increase in age. There was no evidence of important effects of other environmental cardiovascular risk factors on CRP response. Conclusion Waist:hip ratio and age need to be considered when studying the inflammatory response to surgery. The finding that age and waist:hip ratio influence baseline and post-operative CRP levels to a similar extent suggests that baseline CRP is a measure of inflammatory responsiveness to casual stimuli and that higher age and obesity modulate the generic excitability of the inflammatory system leading to both higher baseline CRP and higher CRP response to surgery. The mechanism for

  19. Fibrolipoma of the Anterior Abdominal Wall: an Atypical Presentation; Fibrolipoma de la pared abdominal anterior de presentacion atipica

    Lorente, R.M.; Diaz, J. M.; Valle, Y. del; Gallego, I. [Hospital Universitario Santa Cristina. Madrid (Spain)

    2004-07-01

    Fibrolipoma is a type of lipoma that contains fibrous tissue. We present the case of an unusually large anterior abdominal wall fibrolipoma presenting rarely seem radiological characteristics which hinder its radiological diagnosis. We present the findings in ultrasound scan CT, surgery and pathological anatomy, as well as the lesion's differential diagnosis. (Author) 12 refs.

  20. Umbilical endometriosis associated with large umbilical hernia. Case report.

    Stojanovic, M; Radojkovic, M; Jeremic, L; Zlatic, A; Stanojevic, G; Janjic, D; Mihajlovic, S; Dimov, I; Kostov, M; Zdravkovic, M; Stojanovic, M

    2014-01-01

    Umbilical endometriosis is a rare condition, usually following laparoscopic and surgical procedures involving the umbilicus.Spontaneous umbilical endometriosis occurring without any previous abdominal or uterine surgery is extremely rare. The maximal depth of penetration of the umbilical endometriosis described is up to fascial level. There have been only two cases of endometriosis reported arising within umbilical hernia. The authors report a case of a patient with spontaneous umbilical endometriosis associated with a large umbilical hernia, treated by surgical excision and mesh repair of the abdominal wall. To the best of our knowledge, this is the first described case of the association of umbilical endometriosis with a large umbilical hernia that requires prosthetic mesh repair of the abdominal wall defect.

  1. Combined epigastric hernia repair and mini-abdominoplasty. Case report

    Grella Roberto

    2015-01-01

    Full Text Available The objectives of abdominal hernia repair are to restore the structural integrity of the abdominal wall. Current techniques include primary closure, staged repair and the use of prosthetic materials. Techniques for mini-abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. We report a case of epigastric hernia repair through a transverse lower abdominal incision with the resection of excess of skin. Our purpose is to evaluate the results of the procedure by incorporating these aspects into an epigastric hernia repair, we found out that the procedures are made safer and the results are improved. Proper indication and details of the technique are described.

  2. Architectural and morphological assessment of rat abdominal wall muscles: comparison for use as a human model.

    Brown, Stephen H M; Banuelos, Karina; Ward, Samuel R; Lieber, Richard L

    2010-09-01

    The abdominal wall is a composite of muscles that are important for the mechanical stability of the spine and pelvis. Tremendous clinical attention is given to these muscles, yet little is known about how they function in isolation or how they interact with one another. Given the morphological, vascular, and innervation complexities associated with these muscles and their proximity to the internal organs, an appropriate animal model is important for understanding their physiological and mechanical significance during function. To determine the extent to which the rat abdominal wall resembles that of human, 10 adult male Sprague-Dawley rats were killed and formalin-fixed for architectural and morphological analyses of the four abdominal wall muscles (rectus abdominis, external oblique, internal oblique, and transversus abdominis). Physiological cross-sectional areas and optimal fascicle lengths demonstrated a pattern that was similar to human abdominal wall muscles. In addition, sarcomere lengths measured in the neutral spine posture were similar to human in their relation to optimal sarcomere length. These data indicate that the force-generating and length change capabilities of these muscles, relative to one another, are similar in rat and human. Finally, the fiber lines of action of each abdominal muscle were similar to human over most of the abdominal wall. The main exception was in the lower abdominal region (inferior to the pelvic crest), where the external oblique becomes aponeurotic in human but continues as muscle fibers into its pelvic insertion in the rat. We conclude that, based on the morphology and architecture of the abdominal wall muscles, the adult male Sprague-Dawley rat is a good candidate for a model representation of human, particularly in the middle and upper abdominal wall regions.

  3. Intraperitoneal granulomatous foreign body reaction after accidental perforation of the abdominal wall. Case report

    Lanng, C; Winther-Nielsen, H; Hougen, H P

    2013-01-01

    After an accidental perforation by a wooden stake of the abdominal wall and distal ileum a 28-year-old man developed an aggressive granulomatous foreign body reaction of the greater omentum with high fever and abdominal pain. The patient was cured by omental resection and prednisone treatment....

  4. Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report

    Kosuke Kobayashi

    2016-01-01

    Discussion and conclusion: Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures.

  5. Influence of the abdominal wall on the nonlinear propagation of focused therapeutic ultrasound

    Liu Zhen-Bo; Fan Ting-Bo; Zhang Dong; Gong Xiu-Fen

    2009-01-01

    y This article theoretically studies the influence of inhomogeneous abdominal walls on focused therapeutic ultrasound based on the phase screen model. An inhomogeneous tissue is considered as a combination of a homogeneous medium and a phase aberration screen. Variations of acoustic parameters such as peak positive pressure, peak negative pressure, and acoustic intensity are discussed with respect to the phase screen statistics of human abdominal walls. Results indicate that the abdominal wall can result in energy loss of the sound in the focal plane. For a typical human abdominal wall with correlation length of 7.9 mm and variance of 0.36, the peak acoustic intensity radiated from a 1 MHz transmitter with a radius of 30 mm can be reduced by about 14% at the focal plane.

  6. [MORPHOLOGICAL PECULIARITIES OF MUSCULO-APONEUROTIC TISSUES OF ANTERIOR ABDOMINAL WALL IN PATIENTS, SUFFERING MORBID OBESITY].

    Usenko, O Yu; Gomolyako, I V; Kondratenko, B M; Moskalenko, V V

    2015-11-01

    Results of morphological investigation of musculo-aponeurotic structures of anterior abdominal wall were presented in the morbid obesity patients. The role of obesity as a primary cause for morphofunctional insufficience of musculo-aponeurotic structures was established.

  7. Ureteral reconstruction with abdominal wall muscle flap: experimental study in rabbits

    Nelson Alfred Smith

    2014-12-01

    Full Text Available The authors detail the experimental development of a technique for the reconstruction of the ureter using a tubular shape, muscle flap of the abdominal wall. the preliminary results indicate the feasibility of this surgical technique.

  8. Ureteral reconstruction with abdominal wall muscle flap: experimental study in rabbits

    Nelson Alfred Smith; Paulo Cesar Silva; Manoel Luiz Ferreira; Alberto Schanaider

    2014-01-01

    The authors detail the experimental development of a technique for the reconstruction of the ureter using a tubular shape, muscle flap of the abdominal wall. the preliminary results indicate the feasibility of this surgical technique.

  9. Excision of a large abdominal wall lipoma improved bowel passage in a Proteus syndrome patient

    2009-01-01

    Proteus syndrome is an extremely rare congenital disorder that produces multifocal overgrowth of tissue. This report presents a surgical case of a large lipoma in the abdominal wall of a patient with Proteus syndrome. She was diagnosed with Proteus syndrome based on certain diagnostic criteria. The neoplasm increased in size gradually, producing hemihypertrophy of her left lower extremity and trunk, and spread to her retroperitoneum and her left abdominal wall. She experienced gradually progr...

  10. Instant Abdominal Wall Reconstruction with Biologic Mesh following Resection of Locally Advanced Colonic Cancer

    Oskay Kaya

    2012-01-01

    Full Text Available We present a case of immediate abdominal wall reconstruction with biologic mesh following the resection of locally advanced colonic cancer. The tumor in the right colon did not respond to neoadjuvant chemotherapy. Surgical enbloc excision, including excision of the invasion in the abdominal wall, was achieved, and the defect was reconstructed with porcine dermal collagen mesh. The patient was discharged with no complication, and adaptation of the mesh was excellent at the six-month followup.

  11. Umbilical hernia repair in conjunction with abdominoplasty: a surgical technique to maintain umbilical blood supply.

    Bruner, Terrence W; Salazar-Reyes, Hector; Friedman, Jeffrey D

    2009-01-01

    Abdominal wall hernias are often diagnosed on clinical examination or encountered intraoperatively during an abdominoplasty. Traditional surgical techniques for abdominoplasty and umbilical hernia repair, when performed simultaneously, can potentially compromise the vascular supply to the umbilicus. The authors describe a simplified surgical technique for the correction of umbilical hernias in conjunction with abdominoplasty. This procedure avoids any fascial incisions immediately adjacent to the umbilicus, thereby maintaining a maximal blood supply to the umbilical stalk. Over a six-year period, 17 patients underwent the described procedure. None have had a recurrence of their hernia or umbilical necrosis, and the aesthetics of the umbilicus have been improved.

  12. Management of Complex Abdominal Wall Defects Associated with Penetrating Abdominal Trauma

    2014-05-09

    acinetobacter Resistant E coli (ESBL) Acinetobacter Klebsiella Coliform ITU LOS 14 days 12 days 4 days 13 days 13 days Hospital LOS 25 days 18 days 20...dressing to his abdomen. On second look in theatre, these small wounds on the abdomen were found to be still grossly contaminated and infected and...implanting foreign materials because of the risk of infection and the need to repair a ventral hernia, however, where this was not possible (ie, cases 2 and

  13. Traumatic lumbar hernia: can't afford to miss.

    Saboo, Sachin S; Khurana, Bharti; Desai, Naman; Juan, Yu-Hsiang; Landman, Wendy; Sodickson, Aaron; Gates, Jonathan

    2014-06-01

    We describe the radiological and surgical correlation of an uncommon case of a traumatic lumbar hernia in a 22-year-old man presenting to the emergency department following a motor vehicle accident. Computed tomography (CT) of the abdomen revealed a right-sided traumatic inferior lumbar hernia containing a small amount of fat through the posterior lateral internal oblique muscle with hematoma in the subcutaneous fat and adjacent abdominal wall musculature, which was repaired surgically via primary closure on emergent basis. The purpose of this article is to emphasize the importance of diagnosing traumatic lumbar hernia on CT and need for urgent repair to avoid potential complications of bowel incarceration and strangulation.

  14. Incarcerated small bowel within a spontaneous lumbar hernia.

    Teo, K A T; Burns, E; Garcea, G; Abela, J E; McKay, C J

    2010-10-01

    Lumbar hernias are rare, resulting from protrusion through the posterior abdominal wall that may be congenital, acquired or spontaneous. They very rarely present with acute bowel obstruction. We present a case of incarcerated small bowel within a spontaneous inferior (Petit's) lumbar hernia, treated by early open repair with mesh insertion. This case highlights the importance of thorough clinical examination and a high index of suspicion, even in the absence of previous surgery around the anatomical site of the suspected hernia, in order to effect an early repair before the onset of ischaemia in incarcerated contents.

  15. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

    Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang [Gachon University of Medicine and Science, Incheon (Korea, Republic of)

    2009-12-15

    Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

  16. Congenital Spigelian Hernia and Cryptorchidism: Another Case of New Syndrome

    Dhiraj Parihar

    2013-09-01

    Full Text Available Spigelian hernia (SH is rarely seen in pediatric age group and is usually associated with cryptorchidism on the same side; termed as a syndromic association of the defect in the Spigelian fascia and absence of gubernaculum and inguinal canal. The absence of the inguinal canal has surgical implication as to placement of the undescended testis into the scrotum. A 3-month-old baby presented with spigelian hernia and ipsilateral impalpable testis. The spigelian hernia was repaired and undescended testis which was present in abdominal wall layers was brought to scrotum with cord structures anterior to external oblique muscle.

  17. Congenital spigelian hernia and cryptorchidism: another case of new syndrome.

    Parihar, Dhiraj; Kadian, Yogender Singh; Raikwar, Preeti; Rattan, Kamal Nain

    2013-01-01

    Spigelian hernia (SH) is rarely seen in pediatric age group and is usually associated with cryptorchidism on the same side; termed as a syndromic association of the defect in the Spigelian fascia and absence of gubernaculum and inguinal canal. The absence of the inguinal canal has surgical implication as to placement of the undescended testis into the scrotum. A 3-month-old baby presented with spigelian hernia and ipsilateral impalpable testis. The spigelian hernia was repaired and undescended testis which was present in abdominal wall layers was brought to scrotum with cord structures anterior to external oblique muscle.

  18. Emergent Laparoscopic Repair of a Spigelian Hernia: Case Report and Review of the Literature

    Reid Barker

    2013-01-01

    Full Text Available A spigelian hernia is a protrusion through an anterior abdominal wall defect along the linea semilunaris. The traditional method of repair consists of an open surgical technique requiring a lengthy abdominal incision to allow visualization of the defect. However, with the emergence and availability of laparoscopic techniques, a minimally invasive approach is feasible. Only eight prior case reports have documented emergent laparoscopic repair of a spigelian hernia. We describe the first successful laparoscopic repair of a spigelian hernia in an emergent setting at our institution.

  19. Laparoscopic umbilical hernia repair in the presence of extensive paraumbilical collateral veins: a case report.

    Lases, Seilenna S; Eker, Hasan H; Pierik, Engelbertus G J M; Klitsie, Pieter J; de Goede, Barry; Peeters, Mark P F M Vrancken; Kazemier, Geert; Lange, Johan F

    2011-12-01

    A patient with an umbilical hernia presenting with collateral veins in the abdominal wall and umbilicus is a case that every hernia surgeon has to deal with occasionally. Several underlying diseases have been described to provoke collateral veins in the abdominal wall. However, the treatment strategy should be uniform. We herein report a case of a successful laparoscopic umbilical hernia repair in a patient with collateral veins in the abdominal wall and umbilicus. A 63-year-old man was referred to the surgical outpatient clinic with a large symptomatic umbilical hernia and collateral veins in the abdominal wall, secondary to an occlusion of both common iliac veins. Because of collateral veins in the umbilicus and the size of the hernial defect, he was offered laparoscopic hernia repair without compromising these veins. Because of the extensive abdominal wall collaterals, duplex sonography vein mapping was performed preoperatively to mark a safe collateral-free area for trocar introduction. The defect was repaired by mesh prosthesis.

  20. Comparison of two surgical techniques in large incisional hernias

    Mustafa Sit

    2014-03-01

    Full Text Available Objectives: Incisional hernias occur from incisions of previous abdominal operations. It is an often complication of abdominal interventions. Prevalence of incisional hernias is approximately 2.9% and 3.6% in vertical midline incisions and transverse incisions, respectively. Incisional hernias cause morbidity and loss of manpower. The only treatment option is surgery. We aimed to compare surgical methods of incisional hernias and discuss the postoperative data in this retrospective report. Methods: We retrospectively analyzed the data of 54 patients with large incisional hernias operated between 2007 and 2011. Results: We compared age, chronic diseases (e.g. Chronic obstructive pulmonary disease, diabetes mellitus,which may cause postoperative recurrence, gender, personal factors, such as patients undergoing incisional hernia repair mesh over solid fascia less or over than 5 cm with the placement of decolation; recurrence, the development of postoperative seroma, receiving postoperative drainage and postoperative length of hospital stay were compared. While the recurrence rate of less than 5 cm above the decolation; seroma development, no significant difference in length of hospital stay and drain times to get. Conclusion: In conclusion, we think that recurrence rate should be reduced by dissection of 5 cm intact fascia and grafting in incisional hernias of anterior abdominal wall. J Clin Exp Invest 2014; 5 (1: 36-39

  1. [Surgical treatment of the defects of the lumbar-lateral region of the abdominal wall in elderly and senile patients].

    Vorovs'kyĭ, O O

    2012-12-01

    The results of surgical treatment of 44 patients with defects in the lumbar-lateral abdomen. Age of patients ranged from 60 to 78 years. Causes defects in 32 (72.7%) patients were hernia after surgical interventions on the urinary system using lumbotomic accesses; in 4 (9.1%)--hernias, in 2 (4.5%)--eventration after applying troakar lateral openings during laparoscopic surgery; in 2 (4.5%)--hernias, in 2 (4.5%)--eventration, and in 2 (4.5%)--evisceration through aperture after removing drains for drainage of the abdominal cavity. To prevent the development of the proposed method of drainage of the abdominal cavity during laparoscopic operations (patent for useful model No 51170 from 12.07.10). Autotransplantation own tissues justified by the size of the defect W1. If there is a defect larger aloplastyc shown by the method of sub lay in the proposed original method.

  2. Tratamento cirúrgico das distrofias da parede abdominal no adulto Dystrophies of the abdominal wall in adults

    Fortunato Jayme Athias

    1998-04-01

    operações sem dermolipectomia (2,5%; uma necrose de linha média+embolia pulmonar (1,26%; e um óbito por embolia pulmonar (1,26%.The authors present a retrospective study of 79 patients with abdominal dystrophies, both with and without hernias, operated on from June 1st, 1994 to December,31,1996. Their average age was 47 years. The incisional hernia it self and the dystrophic abdomen were principal objects of the study. The authors show the importance of abdominal dermolipectomy for the complete recovery of the patient as well as demonstrate how it facilitates the technical manipulation of hernias. The technique of bilateral, longitudinal peritonio-aponeurotic transposition (the technique of Alcino Lázaro da Silva was used for large incisional hernias. This technique has been approved by its good results (5% of relapses in five years of follow up according the author. In this technique we use three levels of suture without superposing each other. The great advantage of the technique is that we use the herniary sac itself to close the ring and to strengthen. It avoids the use of meshes and the its complications (rejections, fistulas, etc.. A variation of this technique, for hernias with a hernial ring up to 10cm, is proposed by the authors, which consists in the closure of the ring and the reinforcement of the suture with the hernial sac overlapping its edge. The advantage is the facility of performing, reductions in the operative time and to avoid large dissections of the aponeurotic layer. When the herniary ring is 10cm or bigger it is possible to slack the tension by making a relaxing incision over on the anterior rectum abdominal aponeurosis and covering the wide area with the hernial sac. A review is made of the results of these procedures done associated with abdominal dermolipectomy isolated. The results are: 63 patients recovered without complications (81.66%, three relapsed (3.8%, one of extensive hematoma (1.26%, one necrosis of the midline with respiratory

  3. Carbon nanotubes as VEGF carriers to improve the early vascularization of porcine small intestinal submucosa in abdominal wall defect repair

    Liu Z

    2014-03-01

    Full Text Available Zhengni Liu,1,* Xueyi Feng,2,* Huichun Wang,1 Jun Ma,1 Wei Liu,3 Daxiang Cui,4 Yan Gu,1 Rui Tang,11Department of General Surgery, Shanghai Ninth People’s Hospital, Hernia and Abdominal Wall Disease Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of General Surgery, Lu’an People’s Hospital, Lu’an Affiliated Hospital of Anhui Medical University, Lu’an, Province Anhui, People’s Republic of China; 3Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, People’s Republic of China; 4Institute of Nano Biomedicine and Engineering, Key Laboratory for Thin Film and Microfabrication Technology of the Ministry of Education, Research Institute of Micro/Nano Science and Technology, Bio-X Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China *These authors contributed equally to this work Abstract: Insufficient early vascularization in biological meshes, resulting in limited host tissue incorporation, is thought to be the primary cause for the failure of abdominal wall defect repair after implantation. The sustained release of exogenous angiogenic factors from a biocompatible nanomaterial might be a way to overcome this limitation. In the study reported here, multiwalled carbon nanotubes (MWNT were functionalized by plasma polymerization to deliver vascular endothelial growth factor165 (VEGF165. The novel VEGF165-controlled released system was incorporated into porcine small intestinal submucosa (PSIS to construct a composite scaffold. Scaffolds incorporating varying amounts of VEGF165-loaded functionalized MWNT were characterized in vitro. At 5 weight percent MWNT, the scaffolds exhibited optimal properties and were implanted in rats to repair abdominal wall defects. PSIS scaffolds incorporating VEGF165-loaded MWNT (VEGF

  4. Excision of a large abdominal wall lipoma improved bowel passage in a Proteus syndrome patient.

    Nakayama, Yoshifumi; Kusuda, Shinichi; Nagata, Naoki; Yamaguchi, Koji

    2009-07-14

    Proteus syndrome is an extremely rare congenital disorder that produces multifocal overgrowth of tissue. This report presents a surgical case of a large lipoma in the abdominal wall of a patient with Proteus syndrome. She was diagnosed with Proteus syndrome based on certain diagnostic criteria. The neoplasm increased in size gradually, producing hemihypertrophy of her left lower extremity and trunk, and spread to her retroperitoneum and her left abdominal wall. She experienced gradually progressive constipation, nausea, vomiting, and abdominal pain. Computed tomography (CT) of the abdomen demonstrated a large mass in the subcutaneous adipose tissue of the left lower abdominal wall which measured 12 cm x 8 cm x 6 cm in diameter and encased the left colon. This mass in the abdominal wall was excised. The weight of the excised mass was 1550 g. The histopathological diagnosis of this mass was lipoma. After surgery, the encasement of the left colon was improved, and the patient was able to move her bowels twice per day. The excision of the large lipoma in the abdominal wall contributed to the improved bowel passage in this patient with Proteus syndrome.

  5. Resection and repair of large abdominal wall lesions in gynecologic patients

    LIU Zhu-feng; WANG Jin-hui; CUI Bing-qian; FAN Qing-bo; WANG Xiao-jun; ZHAO Ru; SONG Ke-xin

    2013-01-01

    Background The techniques of resection and repair of large lesions in the abdominal wall are very challenging in the area of gynecology.We explored the techniques of resection and plastic surgical repair of large abdominal wall lesions in gynecologic patients.Methods Twenty-six patients with large lesions in the abdominal wall underwent resection by the gynecologists and repair through abdominal plasty and V-Y plasty with or without fascia patch grafting by the gynecologists or plastic surgeons from March 2003 to October 2010.Results All patients had a history of cesarean section.One patient had an infected sinus tract after cesarean section,one patient had an inflammatory nodule,and the others had lesions of endometriosis,including one cancer.The average largest lesion diameter was (4.79 ± 4.18) cm according to the ultrasonography results.The lesions of all patients were completely resected with pretty abdominal contour.A polypropylene biological mesh was added to the fascia in 20 patients.One patient underwent groin flap repair,and one underwent V-Y advanced skin flap repair on the left of the incision to relieve the suture tension.Conclusions Multi-department cooperation involving the gynecology and plastic surgery departments,and even the general surgery department,is essential for patients with large lesions in the abdominal wall.This cooperative effort enabled surgeons to completely resect large lesions.Abdominal wall plastic surgical repair can ameliorate large wounds of the abdominal wall.

  6. Extensive Abdominal Wall Incisional Heterotopic Ossification Reconstructed with Component Separation and Strattice Inlay

    Suleiman, Nergis Nina

    2016-01-01

    Summary: Symptomatic heterotopic ossification of abdominal surgical incisions is a rare occurrence. We present a 67-year-old man with severe discomfort caused by heterotopic ossification extending from the xiphoid to the umbilicus. The patient underwent an abdominal aortic aneurysm repair 3 years before our treatment. A 13 × 3.5 cm ossified lesion was excised. The resulting midline defect was closed using component separation and inlay Strattice. Tension-free midline adaptation of the recti muscles was achieved. A computed tomography scan of the abdomen 6 months after the surgery showed no recurrence or hernias. Heterotopic ossification in symptomatic patients has previously been treated with excision and primary closure. We believe that tension-free repair is important to prevent recurrence. Acellular dermal matrix may add to this effect and also compartmentalize the process. PMID:27536495

  7. Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments

    Ding-Hui Dong; Wen-Yan Liu; Hai-Bo Feng; Yi-Li Fu; Shi Huang; Jun-Xi Xiang; Yi Lyu

    2015-01-01

    Background:Magnetic anchored surgical instruments (MASI),relying on magnetic force,can break through the limitations of the single port approach in dexterity.Individual characteristic abdominal wall thickness (ICAWT) deeply influences magnetic force that determines the safety of MASI.The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT,and then construct an artful method to predict ICAWT,resulting in better safety and feasibility for MASI.Methods:For MASI,ICAWT is referred to the thickness of thickest point in the applied environment.We determined ICAWT through finding the thickest point in computed tomography scans.We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT.Results:Abdominal wall at C point in the middle third lumbar vertebra plane (L3) is the thickest during chosen points.Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness."BMI-ICAWT" curve was obtained based on abdominal wall thickness of C point in L3 plane,and the expression was as follow:f(x) =P1 × x2 + P2 x x + P3,where P1 =0.03916 (0.01776,0.06056),P2 =1.098 (0.03197,2.164),P3 =-18.52 (-31.64,-5.412),R-square:0.99.Conclusions:Abdominal wall thickness of C point at L3 could be regarded as ICAWT.BMI could be a reliable predictor of ICAWT.In the light of "BMI-ICAWT" curve,we may conveniently predict ICAWT by BMI,resulting a better safety and feasibility for MASI.

  8. Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments

    Ding-Hui Dong

    2015-01-01

    Full Text Available Background: Magnetic anchored surgical instruments (MASI, relying on magnetic force, can break through the limitations of the single port approach in dexterity. Individual characteristic abdominal wall thickness (ICAWT deeply influences magnetic force that determines the safety of MASI. The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT, and then construct an artful method to predict ICAWT, resulting in better safety and feasibility for MASI. Methods: For MASI, ICAWT is referred to the thickness of thickest point in the applied environment. We determined ICAWT through finding the thickest point in computed tomography scans. We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT. Results: Abdominal wall at C point in the middle third lumbar vertebra plane (L3 is the thickest during chosen points. Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness. "BMI-ICAWT" curve was obtained based on abdominal wall thickness of C point in L3 plane, and the expression was as follow: f(x = P1 × x 2 + P2 × x + P3, where P1 = 0.03916 (0.01776, 0.06056, P2 = 1.098 (0.03197, 2.164, P3 = −18.52 (−31.64, −5.412, R-square: 0.99. Conclusions: Abdominal wall thickness of C point at L3 could be regarded as ICAWT. BMI could be a reliable predictor of ICAWT. In the light of "BMI-ICAWT" curve, we may conveniently predict ICAWT by BMI, resulting a better safety and feasibility for MASI.

  9. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

    Roje Zdravko

    2011-12-01

    Full Text Available Abstract Necrotizing fasciitis (NF is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS, he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia. On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was

  10. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs.

    Roje, Zdravko; Roje, Zeljka; Matić, Dario; Librenjak, Davor; Dokuzović, Stjepan; Varvodić, Josip

    2011-12-23

    Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other

  11. Abdominal and scrotal wall emphysema in a patient with severe ulcerative colitis.

    Sharma, Manik; Thandassery, Ragesh Babu; Hilli, Shatha Al; Kaabi, Saad Al

    2014-07-01

    Severe ulcerative colitis can be associated with bowel perforation. Bowel perforation rarely leads on to abdominal wall and scrotal wall emphysema. Bowel perforation in such cases can be spontaneous or iatrogenic (colonoscopy-related). We report a rare scenario where a patient presented with abdominal wall and scrotal emphysema after topical corticosteroid enema-induced traumatic rectal perforation. Topical corticosteroids were stopped immediately after identification of rectal perforation. The patient was managed conservatively with intravenous antibiotics. With this report we intend to sensitise clinicians and topical enema manufacturers regarding this rare complication.

  12. 腹腔内疝囊充填关闭术治疗小儿斜疝%Intra-abdominal sac filling closer plugging for pediatric inguinal hernia: a report of 37 cases

    雷泽华; 高峰畏; 包平倩; 王志旭; 张英毅; 王志刚; 俞慎林; 彭忠; 蒋鸿元

    2014-01-01

    Objective To explore the feasibility of treating pediatric inguinal hernia with self-developed plugging pediatric hernia sac closer.Methods Under general anesthesia intubation,through a 10 mm puckering in umbilical region,lens and pediatric hernia sac closer were inserted.And a special puncture needle was guided from the corresponding places of outer and inner rings of inguinal canal surface into abdominal cavity.Then the positioning lines were pulled out from inguinal canal and knotted for closing abdominal wall defects.Results From December 2011 to March 2013,37 cases (38 sides) of inguinal hernia were treated surgically.At discharge,neither redness nor hardness was found in all groin areas.Thirty-five cases had no scrotal edema and only 1 case showed umbilical incision redness at Day 9 post-operation.During a follow-up period of 14.6 ± 5.89 months,neither recurrence of hernia nor obvious scarring or hardness occurred in groin area.Conclusions The pediatric hernia sac closer is both feasible and safe in the treatment of pediatric inguinal hernia.%目的 采用一种自制“小儿疝囊闭合器”的封堵技术来治疗小儿腹股沟疝.方法 插管全身麻醉下,通过脐部10mm单孔置入镜头和“小儿疝囊闭合器”,从腹股沟管外环和内环体表对应处,用特制针从这两处分别穿刺入腹腔将闭合器上的定位线从腹股沟管内拉出,2根固定线也从腹腔拉出,牵拉定位线使闭合器由内向外充填腹壁缺损后,在体外将两根固定线打结皮下固定闭合器完成疝囊的关闭.结果 从2011年12月至2013年09月对37例38侧小儿疝实施了手术.37例术后出院时,腹股沟区域均无红肿和硬节存在,35例男性阴囊无水肿;仅1例术后9d回访时见脐部切口出现红肿.全部随访,随访最长时间为21个月,最短3个月,平均随访为(14.6±5.89)个月,无术后疝复发,腹股沟区无明显瘢痕和硬节存在.结论 此手术是一种创伤小、操作快捷方便、

  13. Functional outcome after laparoscopic and open incisional hernia repair

    H.H. Eker (Hasan); D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); G.J. Kleinrensink (Gert Jan); H.J. Stam (Henk); J.F. Lange (Johan)

    2010-01-01

    textabstractAbstract: Background: The debate about the advantages of laparoscopic versus open incisional hernia repair is still ongoing. The primary outcomes of already published studies are mainly recurrence, pain and quality of life. Data on postoperative abdominal wall function after these corre

  14. Incisional, epigastric and umbilical hernia repair using the Prolene Hernia System: describing a novel technique.

    Khera, Goldie; Berstock, David A

    2006-08-01

    The Prolene Hernia System (PHS) is already widely in use in the United Kingdom for inguinal hernias. We describe the novel technique of using the three-in-one design of the PHS (Ethicon Endo-Surgery, Bracknell, UK) for repairing incisional, epigastric and umbilical herniae. This is a three-dimensional device and consists of an onlay patch, a tubular connector and an underlay patch. We recommend a four 'corner' suturing of the underlay patch under vision (and then) through the full thickness of abdominal wall layers to ensure a flat underlay mesh. These four sutures flatten out the underlay patch and can be tied or removed with equal effect. The sutures are placed at 3, 6, 9 and 12 o'clock, which simplifies the procedure and ensures that the underlay lays correctly and is corrugation-free and tension-free, thereby providing a two-layer repair for those herniae with a high rate of recurrence.

  15. [Spieghel's hernia and its treatment].

    Kienzle, H F; Staemmler, S

    1978-04-27

    It is reported about 12 patients with hernias through the spigelian fascia, among them one case with a rare bilateral hernia. The cause of these hernias are congenital or acquired gaps in the fascia transversalis medial to the linea semilunaris. Mostly they are discovered below the umbilicus in the height of the linea semicircularis, lateral to the rectussheath and medial to the spigelian line. All clinical details are shown in a table (Tab. 1). There is referred about localisation, sex, age, complications before operation (e.g. incarceration), complaints of the patients and operative findings. The results correspond to those of other authors. Seldom a spigelian hernia is noticed in children. To diagnose a spigelian hernia it is very important to think of it, for the symptoms are often not very characteristically and the clinical findings misleading. At times only operation reveals the real diagnosis. The operation is often simple and remaining complaints are very seldom; we didnt see any. Sometimes the operative finding requires an extensive laparotomia and bowel resection. If one finds the abdominal wall intact, one should open the abdomen in every case.

  16. Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

    Satomi Jyunichiro

    2009-11-01

    Full Text Available Abstract Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS, but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.

  17. [Morphology of tissue reactions around implants after combined surgical repair of the abdominal wall].

    Vostrikov, O V; Zotov, V A; Nikitenko, E V

    2004-01-01

    Tissue reactions to titanium-nickelide and polypropylen and caprone implants used in surgical treatment of anterior aldomen wall hernias were studied in experiment. Digital density of leukocytes, fibroblasts, vessels, thickness of the capsule were studied. Pronounced inflammatory reaction was observed on day 3 which attenuated on day 14 in case of titanium nickelide and on day 30-60 in case of polypropylene and caprone. Fibroplastic processes start in the first group after 7 days while in the second group only after 30 days of the experiment. Thickness of the capsule around titanium-nickelide was 2-3 times less than around polypropylene and caprone. Thus, titanium-nickelide material is biologically more inert than caprone and polypropylen which are widely used in surgery of hernias.

  18. A case report on management of synergistic gangrene following an incisional abdominal hernia repair in an immunocompromised obese patient

    N. Merali

    2015-01-01

    Conclusion: This case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair.

  19. Hérnias incisionais no pós-operatório de correção de aneurisma de aorta abdominal Postoperative incisional hernias after open abdominal aortic aneurysm repair

    Fábio Hüsemann Menezes

    2012-09-01

    Full Text Available CONTEXTO: A incidência de hérnia incisional no pós-operatório da correção aberta de aneurisma de aorta abdominal é alta, variando de 10 a 37% e mais de três vezes mais comum do que em pacientes submetidos à correção para doença obstrutiva aorto-ilíaca. OBJETIVO: Apresentar a incidência de hérnia incisional em um grupo de pacientes acompanhados no pós-operatório da correção aberta de aneurisma de aorta abdominal. MÉTODOS: Série de casos em uma população de 144 pacientes operados por aneurisma de aorta abdominal, entre junho de 1989 e junho de 2010, e que estão em acompanhamento regular no Ambulatório de Moléstias Vasculares. RESULTADOS: O seguimento médio dos pacientes foi de 63 meses (1 a 238. A idade média foi de 67 anos (45 a 91 e o tamanho médio dos aneurismas foi de 6,54 cm. Foram realizadas 130 laparotomias medianas xifo-púbicas e 13 acessos extraperitoniais pelo flanco esquerdo. Nestes pacientes, a incidência de hérnia incisional foi de 18,5 e 7,7%, respectivamente, para incisões na linha média ou no flanco (p=0,315. Um paciente apresentou abaulamento da musculatura oblíqua por denervação. Foi realizada uma laparotomia transversa, que não apresentou hérnia no pós-operatório tardio. CONCLUSÕES: A incidência de hérnia incisional na cirurgia aberta para correção de aneurisma de aorta abdominal é alta, ocorre com maior frequência em incisões da linha média e tem relação direta com a técnica empregada para o fechamento da aponeurose, exigindo do cirurgião atenção especial para este tempo cirúrgico para evitar a causa mais comum de reoperação em tal grupo de pacientes.BACKGROUND: The incidence of incisional hernia in the post operatory of patients submitted to open abdominal aortic aneurysm repair is high, ranging from 10 to 37%, and is more than three times higher than the incidence of hernias in patients operated for aorto-iliac occlusion. OBJECTIVE: To evaluate the incidence of

  20. Cold abscess of the anterior abdominal wall: An unusual primary presentation

    Mohinder Kumar Malhotra

    2012-01-01

    Full Text Available Tuberculosis is considered as ubiquitous disease as it involves any organ, but primary involvement of abdominal muscles is very rare. In most cases, the muscle involvement is secondary and is caused by either hematogenous route or direct inoculation from a tuberculous abdominal lymph node or extension from underlying tubercular synovitis and osteomyelitis. Autopsy studies have shown abdominal wall involvement in less than 1% of patients who died of tuberculosis. Antitubercular therapy is main form of management. Surgical intervention is always secondary in the form of either sonography or computerized tomography-guided aspiration or open drainage which is usually reserved for patients in whom medical treatment has failed. A case is hereby reported about primary tubercular anterior abdominal wall abscess without any evidence of pulmonary, skeletal or gastrointestinal tuberculosis in an apparently healthy individual with any past history of contact or previous antituberculosis therapy.

  1. Fat deposition in the urinary bladder wall: Incidental finding on abdominal computed tomography: A case report

    Park, Min Ho; Moon, Sung Kyoung; Ahn, Sung Eun; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho [Dept. of Radiology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul (Korea, Republic of)

    2015-02-15

    In a computed tomography (CT) scan, fat deposition in the urinary bladder wall is seen as a linear hypoattenuating band surrounded by soft tissue density. It is uncommon, but is often seen in normal cases. However, there is no report of fat deposition in the urinary bladder wall in Korea. The authors encountered a 62-year-old male patient who showed an incidental hypoattenuating band in the urinary bladder wall on abdominal CT. The patient showed no clinical signs related to fat deposition in the urinary bladder wall. When the patient's previous abdominal CT was retrospectively reviewed, the same CT finding was seen. This linear hypoattenuating band within the urinary bladder wall should be considered as a normal CT finding, although it is uncommon.

  2. Ectodermal Wnt signaling regulates abdominal myogenesis during ventral body wall development.

    Zhang, Lingling; Li, Hanjun; Yu, Jian; Cao, Jingjing; Chen, Huihui; Zhao, Haixia; Zhao, Jianzhi; Yao, Yiyun; Cheng, Huihui; Wang, Lifang; Zhou, Rujiang; Yao, Zhengju; Guo, Xizhi

    2014-03-01

    Defects of the ventral body wall are prevalent birth anomalies marked by deficiencies in body wall closure, hypoplasia of the abdominal musculature and multiple malformations across a gamut of organs. However, the mechanisms underlying ventral body wall defects remain elusive. Here, we investigated the role of Wnt signaling in ventral body wall development by inactivating Wls or β-catenin in murine abdominal ectoderm. The loss of Wls in the ventral epithelium, which blocks the secretion of Wnt proteins, resulted in dysgenesis of ventral musculature and genito-urinary tract during embryonic development. Molecular analyses revealed that the dermis and myogenic differentiation in the underlying mesenchymal progenitor cells was perturbed by the loss of ectodermal Wls. The activity of the Wnt-Pitx2 axis was impaired in the ventral mesenchyme of the mutant body wall, which partially accounted for the defects in ventral musculature formation. In contrast, epithelial depletion of β-catenin or Wnt5a did not resemble the body wall defects in the ectodermal Wls mutant. These findings indicate that ectodermal Wnt signaling instructs the underlying mesodermal specification and abdominal musculature formation during ventral body wall development, adding evidence to the theory that ectoderm-mesenchyme signaling is a potential unifying mechanism for the origin of ventral body wall defects.

  3. Anterior Abdominal Wall Leiomyoma Arising De Novo in a Perimenopausal Woman

    Hamed A. Al-Wadaani

    2012-07-01

    Full Text Available Extrauterine or extraintestinal leiomyomas are extremely uncommon especially in the pre-peritoneal area or within the anterior abdominal wall muscles. These tumors have been ascribed to intraoperative seeding during resection of a fibroid or a leiomyoma of gut, to exogenous hormone replacement therapy or a major derangement of glucose and/or lipid metabolism. So far, there is no published report of de novo origin of anterior abdominal wall pure leiomyoma in the literature. The author herein reports a case of perimenopausal multiparous woman without any listing of previous gynecological surgery or hormone therapy who presented with a large pre-peritoneal intramuscular leiomyoma of the anterior abdominal wall. The patient underwent complete primary resection with amelioration of her symptoms.

  4. Early metastasis to anterior abdominal wall following radical cystectomy: A rare presentation.

    Sawant, Ajit; Bansal, Sumit; Pawar, Prakash; Kasat, Gaurav

    2016-01-01

    Abdominal wall metastasis from urothelial cancer is extremely rare and very few such cases have been reported in the literature. As such the treatment protocols are not so well defined. We present an interesting case of a 65-year-old male patient, known case of chronic kidney disease, who presented with a large, fungating infraumbilical mass 8 months postradical cystectomy. The mass involved full thickness anterior abdominal wall and small bowel including the ileal conduit. Wide excision of the mass along with adhered bowel loops and partial excision of the ileal conduit with right ureteric reimplant was performed. The large defect in the anterior abdominal wall was closed using a mesh (permanent with a bioresorbable coating inside) and myocutaneous thigh flap. The histopathological examination of the excised mass was consistent with secondary from the urothelial tumor.

  5. Early metastasis to anterior abdominal wall following radical cystectomy: A rare presentation

    Ajit Sawant

    2016-01-01

    Full Text Available Abdominal wall metastasis from urothelial cancer is extremely rare and very few such cases have been reported in the literature. As such the treatment protocols are not so well defined. We present an interesting case of a 65-year-old male patient, known case of chronic kidney disease, who presented with a large, fungating infraumbilical mass 8 months postradical cystectomy. The mass involved full thickness anterior abdominal wall and small bowel including the ileal conduit. Wide excision of the mass along with adhered bowel loops and partial excision of the ileal conduit with right ureteric reimplant was performed. The large defect in the anterior abdominal wall was closed using a mesh (permanent with a bioresorbable coating inside and myocutaneous thigh flap. The histopathological examination of the excised mass was consistent with secondary from the urothelial tumor.

  6. 无张力疝修补术与传统疝修补术治疗老年腹外疝的疗效对比%The efficacy of tension-free hernia repair versus that of traditional hernia repair for external abdominal hernias in elderly patients

    岑坚慈

    2013-01-01

    目的 对比用巴德网塞和补片行无张力疝修补术与传统疝修补术治疗老年腹外疝的临床效果.方法 选择2008年1月至2010年1月我院收治的120例老年腹外疝患者,随机分为对照组和观察组各60例,对照组采用传统疝修补术治疗,观察组采用无张力疝修补术治疗,把两组的临床资料进行分析比较,以手术时间、下床时间、伤口疼痛程度、局部不适、并发症及有无复发等为比较对象.结果 无张力疝修补术治疗的患者手术效果明显优于传统疝修补术的患者,并发症少,随访2年无复发病例.结论 无张力疝修补术具有手术时间短,成本低,术后患者痛苦小、恢复快、并发症少、无复发等优点,值得临床推广应用.%Objective To compare the clinical efficacy of tension-free hernia repair with Bard mesh plug and patch with that of traditional hernia repair for external abdominal hernias in elderly hernia.Methods 120 elderly patients with external abdominal hernia who had been hospitalized from January 2008 to January 2010 were randomly divided into a control group (60 patients) and a study group (60 patients).The control group received traditional hernia repair; while the study group received tension-free hernia repair.Surgical duration,time to ambulation,degree of wound pain,local discomforts,complications,and recurrence were compared.Results The study group was superior to the contro group in the efficacy.The patients who underwent tension-free hernia repair had fewer complications and had no recurrence in a 2-year follow-up.Conclusions The patients undergoing tension-free hernia repair have shorter surgical duration,less medical cost,less postoperative pain,faster recovery,fewer complications,and no recurrence.This procedure is worth popularizing clinically.

  7. Excision of a large abdominal wall lipoma improved bowel passage in a Proteus syndrome patient

    Yoshifumi Nakayama; Shinichi Kusuda; Naoki Nagata; Koji Yamaguchi

    2009-01-01

    Proteus syndrome is an extremely rare congenital disorder that produces multifocal overgrowth tissue. This report presents a surgical case of a large lipoma in the abdominal wall of a patient with Proteus syndrome. She was diagnosed with Proteus syndrome based on certain diagnostic criteria. The neoplasm increased in size gradually, producing hemihypertrophy of her left lower extremity and trunk, and spread to her retroperitoneum and her left abdominal wall. She experienced gradually progressive constipation,nausea, vomiting, and abdominal pain. Computed tomography (CT) of the abdomen demonstrated large mass in the subcutaneous adipose tissue of the cm x 6 cm in diameter and encased the left colon. This mass in the abdominal wall was excised. The weight of the excised mass was 1550 g. The histopathological diagnosis of this mass was lipoma. After surgery, the encasement of the left colon was improved, and the patient was able to move her bowels twice per day. The excision of the large lipoma in the abdominal wall contributed to the improved bowel passage in this patient with Proteus syndrome.

  8. Invasive group A Streptococcus resulting in sepsis and abdominal wall abscess after adenotonsillectomy.

    Wilson, Paul F; Wannemuehler, Todd J; Matt, Bruce H

    2015-05-01

    Systemic infectious complications following adenotonsillectomy are exceedingly rare. We describe an otherwise healthy 2-year-old patient who developed group A beta-hemolytic Streptococcus sepsis and presumptive scarlet fever 3 days after an uncomplicated adenotonsillectomy. After resolution of fever, rash, and discharge home on antibiotics, the patient returned on postoperative day 10 with an abdominal wall abscess. This is the first reported case of an abdominal wall abscess as a complication of adenotonsillectomy. This case demonstrates that an awareness of unexpected infectious complications of adenotonsillectomy should be a part of postsurgical management. Laryngoscope, 125:1230-1232, 2015.

  9. Endoscopic treatment of esophagogastric varices accompanying abdominal external hernia%食管胃底静脉曲张合并腹外疝内镜下治疗分析

    孙潇; 刘迎娣; 孙国辉; 王娟; 江华; 杨竞

    2013-01-01

    Objective To study the endoscopic treatment of esophagogastric varices and the surgical time of abdominal external hernia. Methods Location, type, diagnosis and clinical features of abdominal external hernia in 11 patients with esophagogastric varices accompanying abdominal external hernia admitted to our hospital from 2000 to 2013 were retrospectively analyzed.ResultsOf the 11 patients with indirect inguinal hernia, 3 werediagnosed with left-indirect hernia, 7 with right-indirect hernia, 1 with bilateral indirect hernia, 10 with reducible hernia, and 1 with irreducible hernia accompanying umbilical hernia and hydrocele of right testis. The patients had no history of operation except 1 who had relapse after repair of hernia. The patients underwent 1.6 times of gastroscopy and 3.6 times of endoscopic treatment, during which the hernias ring was compressed or bandaged with bellyband to prevent relapse of hernia. No incarcerated hernia occurred during operation and incarcerated hernia occurred in 3 patients after operation. The incarcerated hernias were returned to enterocoelia manually.Conclusion The risk to develop incarcerated hernia increases due to multiple endoscopic treatment procedures of esophagogastric varices accompanying abdominal external hernia and gas injection. Repair of hernia should be considered before endoscopic treatment.%目的:探讨食管胃底静脉曲张合并腹外疝患者内镜下治疗的临床特点以及疝修补术手术时机的选择。方法回顾2000-2013年我院收治的11例食管胃底静脉曲张合并腹外疝患者,其入院时疝的部位、类型、诊断时间,以及行内镜下食管胃底静脉曲张治疗术中、术后疝的临床特点。结果11例均为腹股沟斜疝,左侧3例,右侧7例,双侧1例。可复性疝10例,难复性疝1例且合并脐疝、右侧睾丸鞘膜积液。除1例为已行疝修补术后复发,余10例均无手术史。患者行胃镜检查平均1.6

  10. Bilaterally Incarcerated Morgagni Hernia

    Zuhal Demirhan Yananli

    2013-06-01

    Full Text Available Morgagni hernia is a rare congenital diaphragmatic hernia. It is seen rarely bilaterally. Patients are usually asymptomatic. Therefore, diagnosis may be delayed until adulthood. Significant morbidity can occur in case complications arise and diagnosis is delayed. The patient, a 74 year-old female, presented in this article, was admitted to the emergency department with abdominal pain, vomiting, and shortness of breath. The plain abdominal radiograph of the patient revealed bowel obstruction and suspicious appearence in favor of the diaphragmatic hernia on both sides of the sternum. Computed tomography revealed bilaterally incarcerated Morgagni hernia with strangulated omentum in the right side of the sternum and a part of colon in the left side of sternum. Incarcerated organs were withdrawn to peritoneal cavity and defects of hernia were sutured primarily on laparatomy. Because bilateral incarcerated Morgagni hernia can be seen rarely, this case was reported.

  11. [Spigelian hernia: clinical, diagnostic and therapeutical aspects].

    Versaci, A; Rossitto, M; Centorrino, T; Barbera, A; Fonti, M T; Broccio, M; Ciccolo, A

    1998-01-01

    The Authors describing a case of Spigelian hernia observed point out clinical, diagnostic and therapeutic considerations about this rare pathology of abdominal wall. They specify the anatomic characteristics of the region and underline as any diagnostic difficulties are by passed by use of USG and TC imaging for formulation of correct preoperative diagnosis. They confirm as surgical treatment by a correct access isn't different by a normal hernioplasty and guarantee the long term surgical outcome.

  12. 腹部疝疾病腹腔镜手术治疗30例体会%Experience in laparoscopic treatment of abdominal hernia In 30 cases

    苏洋; 吴硕东; 许东; 咸国哲

    2009-01-01

    Objective To investigate the clinical skill and experience of laparoscopic herniorrhaphy in the treatment of abdominal hernia. Methods Clinical data of 30 cases of abdominal hernia undergoing laparoscopic her-niorrhaphy in Shengjing Hospital from May 2004 to December 2008 were analyzed retrospectively. There were 23 in-guinal hernia,4 incision hernia and 3 hiatal hernia. TEP in 20 cases,TAPP in 3 cases,lPOM in 4 cases and Nissen hiatal hernia repair in 3 cases were performed. Results The mean operating duration was 72 min for TEP, 127 for TAPP,150 min for IPOM,and ]60 min for hiatal hernia repair and the mean time for hospitalization was 4.6,5.8, 7.5, and 5.3 days. No conversion to open surgery happened among these cases. No recurrence was found. Conclu-sions Laparoscopic herniorrhaphy appears to be an effective and convenient technique for the treatment of abdomi-nal hernia and has many advantages of minimally invasive surgery.%目的 探讨腹腔镜手术治疗腹部各类疝疾病的技巧和体会.方法 回顾分析2004年5月至2008年12月腹腔镜手术治疗的腹部疝疾病患者30例的临床资料.腹股沟疝23例,行完全腹膜外疝修补术(TEP)20例,行TAPP 3例.腹壁切口疝4例,行腹膜内补片植入疝修补术(IPOM).食管裂孔疝3例,采用Nissen法胃底折叠术.结果 TEP平均手术时间72 min,平均住院时间4.6 d.TAPP平均手术时间127 min,平均住院时间5.8 d.IPOM平均手术时间150 min,平均住院时间7.5 d.食管裂孔疝修补Nissen式胃底折叠术平均手术时间160 min.平均住院时间5.3 d.各组患者无中转开腹手术病例,术后恢复良好,未见复发病例.结论 腹腔镜下疝修补术治疗各种腹部疝疾病操作简便,效果确切,可以充分发挥腹腔镜技术的微创优势.

  13. Polymicrobial abdominal wall necrotizing fasciitis after cesarean section.

    DeMuro, Jp; Hanna, Af; Chalas, E; Cunha, Ba

    2012-09-01

    We report a case of a previously healthy woman after an uneventful caesarean section who developed polymicrobial necrotizing fasciitis. She was given a non-steroidal anti-inflamatory drug (NSAID) after her delivery. Her post-delivery course was complicated by septic shock, and required multiple debridements before abdominal reconstruction. This case describes the increased risk of necrotizing fasciitis with NSAID use. Unusual were the organisms causing the polymicrobial necrotizing fasciitis: Staphylococcus aureus, Enterobacter agglomerans, Acinetobacter baumannii, and two strains of Enterobacter cloacae.

  14. "EFFECTIVENESS OF ABDOMINAL WALL ELEVATOR IN REDUCING INTRA-ABDOMINAL PRESSURE AND CO2 VOLUME DURING LAPAROSCOPIC CHOLECYSTECTOMY"

    A. Yaghoobi Notash

    2004-06-01

    Full Text Available Since CO2 pneumoperitoneum is the dominant method of laparoscopic exposure due to facility and good view, its physiologic effects are most relevant to the surgeons. CO2 pneumoperitoneum may affects hemodynamics by increased intra-abdominal pressure (IAP and the physiologic effects of absorbed CO2. The adverse effects of both mechanisms relate directly to the duration of the pneumoperitoneum and the elevation of IAP. Gasless laparoscopy involves obtaining exposure for laparoscopy by placing an internal retracting device through a small incision and lifting the anterior abdominal wall. We designed and made a mechanical wall elevator and used it in 24 patients, compared with a control group (52 cases using a conventional laparoscopic cholecystectomy. A prospective trial was undertaken in Sina Hospital, Tehran University of Medical Sciences from 1998 to 2000. The patients were assigned randomly to two groups. There was a significant decrease in IAP and CO2 consumption in the group using mechanical wall elevator as compared to conventional laparoscopic cholecystectomy, (mean IAP of 3.5 mmHg compared to 11.4 mmHg in the control group, mean CO2 volume 17 liters compared to 73 liters in the control group. We recommend this semigasless method in laparoscopy due to safety in performance and significant reduction in IAP through the surgery. This method provides a satisfactory view and easy performance without any increase in time or complications. The hospital stay and costs did not increase.

  15. Diaphragmatic hernia of Morgagni.

    LaRosa, D V; Esham, R H; Morgan, S L; Wing, S W

    1999-04-01

    Most cases of Morgagni hernia are asymptomatic and diagnosed incidentally on routine chest x-ray film, but they may occasionally become symptomatic. Symptomatic Morgagni hernias may present in many different ways, making the diagnosis challenging. We describe a patient with a Morgagni hernia, resulting in intractable nausea and vomiting, give a brief review of symptoms, note the different types of abdominal contents herniated, and describe the methods used to make the diagnosis.

  16. Laparoscopic Repair of Morgagni Hernia

    ilker murat arer

    2015-03-01

    Full Text Available Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect and make up about 1 % - 5 % of all types of congenital diaphragmatic hernias. Surgical repair of Morgagni hernias is usually indicated when patients are symptomatic and have a high risk of strangulation or incarceration of the contained viscera. 71-year-old male patient admitted to emergency department with a 2-day history of abdominal pain, vomiting and obstipation. Laparoscopic repair for Morgagni hernia was performed. Laparoscopic repair for Morgagni hernia with mesh repair is secure, satisfactory and easily performed. [Cukurova Med J 2015; 40(Suppl 1: 71-74

  17. Reconstruction with latissimus dorsi, external abdominal oblique and cranial sartorius muscle flaps for a large defect of abdominal wall in a dog after surgical removal of infiltrative lipoma

    2016-01-01

    This animal was presented with a large-sized infiltrative lipoma in the abdominal wall that had been noted for 4 years. This lipoma was confirmed by histological examination from a previous biopsy, and the infiltrative features were identified by a computerized tomography scan. The surgical removal created a large-sized abdominal defect that was closed by a combination of latissimus dorsi and external abdominal oblique muscle flaps in a pedicle pattern. A small dehiscence at the most distal e...

  18. Incisional Hernia: An Experimental and Clinical Study

    M. van 't Riet (Martijne)

    2004-01-01

    markdownabstract__Abstract__ Incisional hernia is one of the most common long-term complications of abdominal surgery. In prospective studies with sufficient follow-up, incidences of incisional hernia after laparotomy up to 20% are reported. Incisional hernia can be defined as an internal abdominal

  19. [Primary actinomycosis of the abdominal wall. Description of 2 cases and review of the literature].

    García García, J C; Núñez Fernández, M J; Cerqueiro González, J M; García Martín, C; Rodríguez García, J C; Anibarro García, L; de Lis Muñoz, J M; Piñeiro Gómez-Durán, L

    2001-02-01

    We report two cases of isolated abdominal wall actinomycosis and review 18 previously reported cases to further characterize the clinical findings and the therapeutic management of this syndrome. This diagnosis would be advocated in patients with a palpable abdominal mass of subacute appearance with a previous history of digestive medical illness, diabetes, abdominal surgery, or prolonged IUD use. In contrast with other actinomycosis locations, remarkable data were a more elevated mean age of patients; a female predominance; a prevalent location of mass in abdominal lower left quadrant; and a shorter duration of symptomatology before to diagnosis. The CT is the first choice for imaging study and percutaneous needle aspiration would be recommended for definite diagnosis. The long-term antibiotic therapy, with or without percutaneous drainage, is the first treatment choice because is very effective and made unnecessary a more invasive surgical management. The prognosis is excellent with adequated treatment.

  20. TFE-PLASMA POLYMERIZED DERMAL SHEEP COLLAGEN FOR THE REPAIR OF ABDOMINAL-WALL DEFECTS

    VANDERLAAN, JS; LOPEZ, GP; VANWACHEM, PB; NIEUWENHUIS, P; RATNER, BD; BLEICHRODT, RP; SCHAKENRAAD, JM

    1991-01-01

    The aim of this study was to design and evaluate a degradable biomaterial for the repair of abdominal wall defects. Hexamethylenediisocyanate-tanned dermal sheep collagen (HDSC) was plasma-polymerized with tetrafluoroethylene (TFE) which resulted in a hydrophobic surface on the visceral side (TFE-HD

  1. Diaphragmatic hernia repair - slideshow

    ... presentations/100014.htm Diaphragmatic hernia repair - series—Normal anatomy To use the sharing ... Overview The chest cavity includes the heart and lungs. The abdominal cavity includes the liver, the stomach, ...

  2. Abdominal closure reinforcement by using polypropylene mesh functionalized with poly-Ԑ-caprolactone nanofibers and growth factors for prevention of incisional hernia formation

    Plencner M

    2014-07-01

    Full Text Available Martin Plencner,1,2,* Barbora East,3,* Zbynek Tonar,4 Martin Otáhal,5 Eva Prosecká,1,2 Michala Rampichová,2,6 Tomáš Krejčí,3 Andrej Litvinec,2,7 Matej Buzgo,2,6 Andrea Míčková,1,2,6 Alois Nečas,8 Jirí Hoch,3 Evžen Amler1,2,9 1Institute of Biophysics, Second Faculty of Medicine, Charles University in Prague, Prague, 2Laboratory of Tissue Engineering, Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Prague, 3Department of Surgery, Second Faculty of Medicine, Charles University in Prague, Prague, 4Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, 5Department of Anatomy and Biomechanics, Faculty of Physical Education and Sport, Charles University in Prague, Prague, 6University Center for Energy Efficient Buildings, Czech Technical University in Prague, Buštehrad, 7Department of Breeding and Zoohygiene of Laboratory Animals, Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, 8Department of Surgery and Orthopedics, Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Science Brno, Central European Institute of Technology, Brno, 9Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic *These authors contributed equally to this work Abstract: Incisional hernia affects up to 20% of patients after abdominal surgery. Unlike other types of hernia, its prognosis is poor, and patients suffer from recurrence within 10 years of the operation. Currently used hernia-repair meshes do not guarantee success, but only extend the recurrence-free period by about 5 years. Most of them are nonresorbable, and these implants can lead to many complications that are in some cases life-threatening. Electrospun nanofibers of various polymers have been used as tissue scaffolds and have been explored extensively in the last decade, due to their low cost and good biocompatibility. Their

  3. [What do general, abdominal and vascular surgeons need to know on plastic surgery - aspects of plastic surgery in the field of general, abdominal and vascular surgery].

    Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F

    2015-02-01

    There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options.

  4. Recurrent femoral hernia and associated ovarian pathology.

    Gately, Ryan Patrick; Concannon, Elizabeth Sarah; Hogan, A; Ryan, R S; O'Leary, M; Barry, K

    2012-08-27

    The following case describes an ovarian tumour presenting in a highly unusual manner-in the form of a recurrent femoral hernia. Recurrent femoral herniae are unusual and should prompt awareness of underlying pathology causing increased intra-abdominal pressure.

  5. Case of a sigmoid colon cancer with metachronous metastases to the mesorectum and the abdominal wall

    Hadjimarcou Andreas

    2010-03-01

    Full Text Available Abstract Backround Sigmoid colon cancer metachronous metastases commonly occur in the liver and lungs with sporadic reports also to the spleen, stomach, thyroid gland, abdominal wall and upper urinary tract. This is a rare case of metachronous metastases invading the mesorectum and the abdominal wall. Case presentation A 72-year-old female underwent sigmoidectomy for stage I (T2N0 M0 sigmoid colon cancer in May 2008. In June 2009, an abdominal computed tomography scan revealed a tumor 2 cm in size at the lower anterior mesorectum and a second mass 2 cm in size at the anterior abdominal wall midline. Total colonoscopy showed no mucosal lesion. The serum carcinoembryonic antigen level was normal. A biopsy of the mesorectum tumor showed similar histologic characteristics with the primary tumor. Since no other site of recurrence was identified, an abdominoperineal resection was attempted. During the operation and after the removal of the incision recurrence, sinus bradycardia and signs of myocardial ischemia were noticed. A loop transverse colostomy was immediately perfomed and the operation was terminated. Postoperative cardiologic examination revealed an acute myocardium infract. Chemo-radiation of the mesorectum tumor and re-evaluation for surgical excision was decided. Conclusion Metachronous metastasis of the mesorectum from sigmoid colon cancer is extremely rare. Although patterns of lymphatic spread from rectal cancer to sigmoid colon have recently been demonstrated, there is no evidence of metachronous mesorectum invasion from sigmoid colon cancer. This could be the issue for future trials.

  6. Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients

    Feierman DE

    2014-08-01

    Full Text Available Dennis E Feierman, Mark Kronenfeld, Piyush M Gupta, Natalie Younger, Eduard Logvinskiy Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA Background: Achieving adequate control of postsurgical pain remains a challenge in patients undergoing abdominal surgery. Transversus abdominis plane (TAP infiltration has been shown to provide postsurgical analgesia following lower abdominal surgery. We assessed the safety and efficacy of a prolonged-release liposomal formulation of the local anesthetic bupivacaine administered via infiltration into the TAP in a cohort of patients undergoing open abdominal umbilical hernia repair. Methods: Patients included in the study were 18–75 years of age, had American Society of Anesthesiologists physical classification status 1–3, and underwent open abdominal umbilical hernia repair with ultrasound-guided TAP infiltration immediately after surgery using an equal-volume bilateral infusion of liposomal bupivacaine 266 mg (diluted to 30 mL in normal saline. Outcome measures included patient-reported pain intensity (11-point numeric rating scale, satisfaction with postsurgical analgesia (5-point Likert scale, incidence of opioid-related adverse events, and time to first use of supplemental rescue analgesia. Results: Thirteen patients underwent surgery and received bilateral TAP infiltration with liposomal bupivacaine; TAP infiltration failed in the first patient. Mean numeric rating scale pain scores were 0.6 immediately before TAP infiltration and remained 2.3 through 120 hours after infiltration; mean scores at 120 hours and 10 days were 0.9 and 0.4, respectively. Ten patients (77% required supplemental analgesia; median time to first use was 11 hours. At discharge and day 10, 54% and 62% of patients, respectively, were “extremely satisfied” with postsurgical analgesia (Likert score 5. There were no opioid-related or other adverse events. Conclusion: Although the current study was

  7. Examinations of a new long-term degradable electrospun polycaprolactone scaffold in three rat abdominal wall models.

    Jangö, Hanna; Gräs, Søren; Christensen, Lise; Lose, Gunnar

    2017-02-01

    Alternative approaches to reinforce native tissue in reconstructive surgery for pelvic organ prolapse are warranted. Tissue engineering combines the use of a scaffold with the regenerative potential of stem cells and is a promising new concept in urogynecology. Our objective was to evaluate whether a newly developed long-term degradable polycaprolactone scaffold could provide biomechanical reinforcement and function as a scaffold for autologous muscle fiber fragments. We performed a study with three different rat abdominal wall models where the scaffold with or without muscle fiber fragments was placed (1) subcutaneously (minimal load), (2) in a partial defect (partial load), and (3) in a full-thickness defect (heavy load). After 8 weeks, no animals had developed hernia, and the scaffold provided biomechanical reinforcement, even in the models where it was subjected to heavy load. The scaffold was not yet degraded but showed increased thickness in all groups. Histologically, we found a massive foreign body response with numerous large giant cells intermingled with the fibers of the scaffold. Cells from added muscle fiber fragments could not be traced by PKH26 fluorescence or desmin staining. Taken together, the long-term degradable polycaprolactone scaffold provided biomechanical reinforcement by inducing a marked foreign-body response and attracting numerous inflammatory cells to form a strong neo-tissue construct. However, cells from the muscle fiber fragments did not survive in this milieu. Properties of the new neo-tissue construct must be evaluated at the time of full degradation of the scaffold before its possible clinical value in pelvic organ prolapse surgery can be evaluated.

  8. Intestinal obstruction induced by a giant incarcerated Spigelian hernia: case report and review of the literature

    Edson Augusto Ribeiro

    Full Text Available CONTEXT: Spigelian hernia is an uncommon spontaneous lateral ventral hernia with an incarceration ratio of around 20%. However, complications such as intestinal obstruction are extremely rare. We report on a case of giant incarcerated Spigelian hernia with a clinical condition of complete intestinal obstruction that was treated using prosthetic polypropylene mesh. CASE REPORT: A 72-year-old woman was admitted to the emergency department complaining of diffuse abdominal pain. Abdominal examination revealed a firm 10 x 10 cm tender mass in the lower left quadrant, without surrounding cellulite or tenderness. Plain abdominal radiographs displayed the formation of levels, thus indicating the existence of intestinal obstruction. An abdominal computed tomography scan clearly showed a fluid and air-filled mass in the soft tissue area of the lower left-side abdominal wall. Spigelian incarcerated hernia was diagnosed and the patient underwent emergency surgical repair by means of local incision. The large defect in the abdominal wall was closed up as successive anatomical layers, and a prosthetic polypropylene mesh was set into the lateral aspect of the rectus sheath. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day.

  9. The relationship between wall shear stress distributions and intimal thickening in the human abdominal aorta

    Butany Jagdish

    2003-11-01

    Full Text Available Abstract Purpose The goal of this work was to determine wall shear stress (WSS patterns in the human abdominal aorta and to compare these patterns to measurements of intimal thickness (IT from autopsy samples. Methods The WSS was experimentally measured using the laser photochromic dye tracer technique in an anatomically faithful in vitro model based on CT scans of the abdominal aorta in a healthy 35-year-old subject. IT was quantified as a function of circumferential and axial position using light microscopy in ten human autopsy specimens. Results The histomorphometric analysis suggests that IT increases with age and that the distribution of intimal thickening changes with age. The lowest WSS in the flow model was found on the posterior wall inferior to the inferior mesenteric artery, and coincided with the region of most prominent IT in the autopsy samples. Local geometrical features in the flow model, such as the expansion at the inferior mesenteric artery (common in younger individuals, strongly influenced WSS patterns. The WSS was found to correlate negatively with IT (r2 = 0.3099; P = 0.0047. Conclusion Low WSS in the abdominal aorta is co-localized with IT and may be related to atherogenesis. Also, rates of IT in the abdominal aorta are possibly influenced by age-related geometrical changes.

  10. Suture granuloma of the abdominal wall with intraabdominal extension 12 years after open appendectomy

    Goran Augustin; Dragan Korolija; Mate Skegro; Jasminka Jakic-Razumovic Goran

    2009-01-01

    Most complications after appendectomy occur within ten days;however,we report the unusual case of a suture granuloma 12 years after open appendectomy.The afebrile 75-year-old woman presented with a slightly painful palpable mass in the right lower abdomen.There was no nausea or vomiting and bowel movements were normal.She lost 10 kg during the 3 mo before presentation.The patient had undergone an appendectomy 12 years previously.Physical examination revealed a tender mass,10 cm in diameter,under the appendectomy scar.The preoperative laboratory findings,tumor markers and plain abdominal radiographs were normal.Multi-slice computed tomography scanning showed an inhomogenous abdominal mass with minimal vascularization in the right lower abdomen 8.6 cm×8 cm×9 cm in size which communicated with the abdominal wall.The abdominalwall was thickened,weak and bulging.The abdominalwall mass did not communicate with the cecumor the ascending colon.Complete excision of the abdominalwall mass was performed via median laparotomy.Histopathological examination revealed a granuloma with a central abscess.This case report demonstrates that a preoperative diagnosis of abdominal wall mass after open appendectomy warrants the use of a wide spectrum of diagnostic modalities and consequently different treatment options.

  11. The use of an anterior abdominal wall peritoneal flap in the laparoscopic repair of vesicouterine fistula.

    Tasdemir, Nicel; Abali, Remzi; Celik, Cem; Yazici, Cenk Murat; Akkus, Didem

    2014-01-01

    Vesicouterine fistula (VUF) is a rare type of genitourinary fistula. Lower-segment cesarean section is the leading cause of VUF. Patients mostly present with the classical triad of menouria, amenorrhea, and urinary incontinence, with the history of a previous cesarean section. Conservative management with catheterization and open, laparoscopic, and robotic surgeries are the prescribed treatment options. We present the case of a 35-year-old woman who presented with cyclical menouria and urinary incontinence. After diagnosis of VUF by cystoscopy, the laparoscopic approach was chosen. During the procedure, we used anterior abdominal wall peritoneum and adjacent adipose tissue interposition for the first time, instead of omental interposition, because of the unavailability of omentum. The postoperative period was uneventful, and the procedure was successful. In conclusion, the laparoscopic approach is feasible and the anterior abdominal wall peritoneal flap can be used instead of omentum for tissue interposition when the omentum is not available.

  12. [Laparoscopic treatment of a large trichobezoar in the stomach with gastric perforation and abdominal wall abscess].

    Zaharie, F; Iancu, C; Tanţău, M; Mocan, L; Bartoş, A; Mihăileanu, F; Iancu, D; Tomuş, C; Zaharie, R; Vlad, L

    2010-01-01

    Trichobezoar represents a mass of swallowed hair inside the stomach. Here we report a 17-year-old girl who presented in our department with symptoms of gastric ulcer. Ultrasound examination followed by upper endoscopy revealed a large trichobezoar in the stomach with simultaneous gastric perforation. Laparoscopy also revealed a penetration into the anterior abdominal wall accompanied by abscess at this level. We performed a laparoscopic gastrotomy with trichobezoar extraction and laparoscopic treatment of perforation and abdominal wall abscess. The postoperative evolution was normal and the patient was discharged on the fifth postoperative day. We show that laparoscopic approach may be safely used in the treatment of the large gastric complicated trichobezoar. Several laparoscopic approaches were described for the treatment of tricobezoar and its complications but as far as we know this is the first report of laparoscopic treatment of large tricobezoar and associate gastric perforation.

  13. Desmoid Tumor of the Anterior Abdominal Wall in Female Patients: Comparison with Endometriosis

    H. Krentel

    2012-01-01

    Full Text Available In female patients presenting a tumor of the lower abdominal wall especially after cesarian section, an endometriotic tumor as well as an aggressive desmoid tumor should be considered. Symptoms in correlation with the monthly period can facilitate the presurgical differentiation between endometriosis and fibromatosis. Ultrasound reveals the typical location of both tumors and its remarkable sonographic appearance. In the clinical practice, the desmoid fibromatosis of the lower abdominal wall is a very rare disease. We present a case of a 25-year-old pregnant and discuss diagnostic and therapeutic options by a PubMed literature review. With the knowledge of the prognosis of the desmoid fibromatosis and the respective treatment options including wait and see, complete surgical resection with macroscopically free margins and adjuvant approaches is essential to avoid further interventions and progression of the locally destructive tumor.

  14. A giant inguinoscrotal hernia associated with other abdominal wall defects A case report.

    Iovino, Francesco; Auriemma, Pasquale Pio; Dani, Luca; Giordano, Giovanni; Barbarisi, Alfonso

    2016-04-29

    Le ernie giganti sono rare nei Paesi sviluppati ed ancora più raramente sono associate ad altre ernie della parete addominale, come un’ernia inguinale controlaterale o un’ernia ombelicale. La presenza di più difetti di parete facilità il riposizionamento in addome del contenuto di una voluminosa ernia inguinale senza compromettere la funzionalità cardiorespiratoria, ma il rischio di intasamento o strozzamento intestinale negli altri orifizi erniari aumenta. In letteratura non esistono opinioni convergenti se riparare simultaneamente o in maniera sequenziale, cioè in maniera distanziata nel tempo, le diverse ernie di parete, quando sono associate ad un’ernia gigante. Riportiamo in questo lavoro il caso clinico di un uomo di 60 anni, italiano, che si recò nel nostro ambulatorio di chirurgia lamentando da molti anni la presenza di un’ernia inguinale gigante associata ad un’ernia inguinale controlaterale ed un’ernia ombelicale. Il paziente alla visita presentava difficoltà di deambulazione, ma non riferiva disturbi di canalizzazione. Aveva diverse comorbidità e tra queste quella più importante era una insufficienza respiratoria severa. Dopo un accurato studio cardiologico, respiratorio e metabolico il paziente fu sottoposto a riparazione delle ernie a partire da quella gigante, in maniera sequenziale ed in anestesia spinale secondo la tecnica di Lichtenstein. L’ernia ombelicale fu riparata per ultima con tecnica diretta, senza protesi, ed anch’essa in anestesia spinale. Il decorso operatorio fu regolare dopo i tre interventi e non si ebbe alcuna complicanza respiratoria, cardiologica né di canalizzazione. In conclusione riteniamo che nei pazienti con importanti comorbidità la riparazione di un’ernia gigante associata ad altre ernie di parete debba avvenire in maniera sequenziale, monitorando con attenzione la canalizzazione e soprattutto il progressivo adattamento dei visceri in addome attraverso la palpazione degli orifizi erniari. I dati della letteratura sono pochi ed ulteriori esperienze sono richieste.

  15. Umbilical hernia in patients with liver cirrhosis: A surgical challenge

    Julio CU Coelho; Christiano MP Claus; Antonio CL Campos; Marco AR Costa; Caroline Blum

    2016-01-01

    Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment.

  16. Umbilical hernia in patients with liver cirrhosis: A surgical challenge.

    Coelho, Julio C U; Claus, Christiano M P; Campos, Antonio C L; Costa, Marco A R; Blum, Caroline

    2016-07-27

    Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment.

  17. Mixed endometrioid and serous carcinoma developing in abdominal wall endometriosis following Cesarean section

    Da Ines, David; Montoriol, Pierre Francois; Petitcolin, Virginie; Garcier, Jean-Marc (Dept. of Radiology and Medical Imaging, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France)), email: ddaines@chu-clermontferrand.fr; Bourdel, Nicolas; Canis, Michel (Dept. of Obstetrics and Gynecology, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France)); Charpy, Cecile (Dept. of Pathology, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France))

    2011-06-15

    Abdominal wall endometriosis is unusual and mostly occurs in scars following Cesarean section. Although malignant transformation is rare, it must be recognized in order to benefit from radical resection. We report a very rare case of mixed endometrioid and serous carcinoma developing in a Cesarean section endometriosis scar and the way we managed it using surgery and chemotherapy. 18-FDG PET-CT imaging was performed to correctly stage the disease

  18. Intrauterine Contraceptive Device Migration Presenting as Abdominal Wall Swelling: A Case Report

    Imtiaz Wani

    2011-01-01

    Full Text Available A number of complications are reported with the use of intrauterine contraceptive devices. These may pursue asymptomatic course or present as an acute abdomen after migration into peritoneal cavity. The authors here are reporting an abdominal wall swelling caused by transuterine migration of a copper intrauterine contraceptive device in a 28-year-old female. An open approach was used, and impacted foreign body was retrieved.

  19. Ultrasound-guided microwave ablation for abdominal wall metastatic tumors: A preliminary study

    Cai Qi; Xiao-Ling Yu; Ping Liang; Zhi-Gang Cheng; Fang-Yi Liu; Zhi-Yu Han; Jie Yu

    2012-01-01

    AIM:To evaluate the feasibility,safety and efficacy of ultrasound-guided microwave (MW) ablation for abdominal wall metastatic tumors.METHODS:From August 2007 to December 2010,a total of 11 patients with 23 abdominal wall nodules (diameter 2.59 cm ±1.11 cm,range 1.3 cm to 5.0cm) were treated with MW ablation.One antenna was inserted into the center of tumors less than 1.7 cm,and multiple antennae were inserted simultaneously into tumors 1.7 cm or larger.A 21 gauge thermocouple was inserted near important organs which required protection (such as bowel or gallbladder) for real-timetemperature monitoring during MW ablation.Treatment outcome was observed by contrast-enhanced ultrasound and magnetic resonance imaging (MRI) [or computed tomography (CT)] during follow-up.RESULTS:MW ablation was well tolerated by all patients.Six patients with 11 nodules had 1 thermocouple inserted near important organs for real-time temperature monitoring and the maximum temperature was 56 ℃.Major complications included mild pain (54.5%),post-ablation fever (100%) and abdominal wall edema (25%).All 23 tumors (100%) in this group were completely ablated,and no residual tumor or local recurrence was observed at a median follow-up of 13 mo (range 1 to 32 mo).The ablation zone was well defined on contrast-enhanced imaging (contrast-enhanced CT,MRI and/or contrast-enhanced ultrasound)and gradually shrank with time.CONCLUSION:Ultrasound-guided MW ablation may be a feasible,safe and effective treatment for abdominal wall metastatic tumors in selected patients.

  20. A Case of an Abdominal Wall Abscess Associated with Spilled Gallstones: Imaging Findings and Clinical Significance

    Son, Youn Mi; Kim, Hyuk Jung; Bak, Cheol Hee [Seoul Medical Center, Seoul (Korea, Republic of)

    2011-06-15

    Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gall stones for the last 20 years. The spillage of stones is reported in up to one-third of all LCs but clinical squeals caused by dropped gallstones are uncommon. We recently observed a patient with late abdominal wall abscess formation as a result of dropped gall stones after LC, who in the end, underwent open surgery because the medical therapy including antibiotics and percutaneous catheter drainage was not fully effective

  1. Unilateral agenesis of the abdominal wall musculature: An early muscle deficiency.

    Gerard-Blanluet, Marion; Port-Lis, Marylin; Baumann, Clarisse; Perrin-Sabourin, Laurence; Ebrad, Patrick; Audry, Georges; Delezoide, Anne-Lise; Verloes, Alain

    2010-11-01

    Prune-belly sequence (PBS) usually results from early urethral obstruction. In rare cases, PBS seems to be due to a faulty primary development of the parietal mesenchyme leading to underdevelopment of the abdominal wall musculature, and disorganization of the smooth muscles in the urinary tract. We report on two patients with segmental, unilateral wall musculature deficiency associated with homolateral agenesis of ribs. One patient also had hemivertebrae and the other one ipsilateral diaphragmatic eventration and aplasia cutis. This combination of anomalies may represent a localized deficiency in the development of somitic mesoderm mesenchyme during early embryogenesis.

  2. Reconstruction of the abdominal wall by using a combination of the human acellular dermal matrix implant and an interpositional omentum flap after extensive tumor resection in patients with abdominal wall neoplasm:A preliminary result

    Yan Gu; Rui Tang; Ding-Quan Gong; Yun-Liang Qian

    2008-01-01

    AIM:To present our trial using a combination of the human acellular dermal matrix (HADM) implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection.METHODS:Between February and October of 2007,three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADM and omentum flap.Postoperative morbidities and signs of herniation were monitored.RESULTS:The abdominal wall reconstruction was successful in these three patients,there was no severe morbidity and no signs of herniation in the follow-up period.CONCLUSION:The combination of HADM and omentum flap offers a new,safe and effective alternative to traditional forms in the repair of giant abdominal wall defects.Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique.

  3. [Hematoma of the abdominal wall. A case report: pitfall of Seldinger method via femoral artery].

    Hiramatsu, Hisaya; Sugiura, Yasushi; Takeda, Ririko; Nanba, Hiroki

    2009-02-01

    We reported a case of an abdominal wall hematoma which caused by Seldinger method via the femoral artery. A 48-year-old female, suffered from direct carotid cavernous fistula, was treated by transfemoral transvenous embolization (TVE). The whole procedure was completed without difficulty except minor resistance of guide wire manipulation during left femoral artery catheterization. Four hours later, the patient became hypotensive and showed the sign of impending shock without definitive causes. Nine hours after the embolization a huge hematoma of the abdominal wall was found. It required the total 1200 m/ of blood transfusion before her blood pressure returned to normal. She recovered fully from this event and discharged uneventfully. There is a speculation that a deep circumflex iliac artery (DCIA) was injured with an angle-shaped guide wire and bled into the abdominal wall. And subsequent systemic heparinization prevented the coagulation process, resulting a large hematoma. Anatomically, an angle-shaped guide wire is easily able to migrate into DCIA. To prevent a vascular injury, it is very important to manipulate a guide wire under fluoroscopic control and to select a J-shaped guide wire instead of an angle-shaped one.

  4. Impact of poroelasticity of intraluminal thrombus on wall stress of abdominal aortic aneurysms

    Polzer Stanislav

    2012-08-01

    Full Text Available Abstract Background The predictions of stress fields in Abdominal Aortic Aneurysm (AAA depend on constitutive descriptions of the aneurysm wall and the Intra-luminal Thrombus (ILT. ILT is a porous diluted structure (biphasic solid–fluid material and its impact on AAA biomechanics is controversially discussed in the literature. Specifically, pressure measurements showed that the ILT cannot protect the wall from the arterial pressure, while other (numerical and experimental studies showed that at the same time it reduces the stress in the wall. Method To explore this phenomenon further a poroelastic description of the ILT was integrated in Finite Element (FE Models of the AAA. The AAA model was loaded by a pressure step and a cyclic pressure wave and their transition into wall tension was investigated. To this end ILT’s permeability was varied within a microstructurally motivated range. Results The two-phase model verified that the ILT transmits the entire mean arterial pressure to the wall while, at the same time, it significantly reduces the stress in the wall. The predicted mean stress in the AAA wall was insensitive to the permeability of the ILT and coincided with the results of AAA models using a single-phase ILT description. Conclusion At steady state, the biphasic ILT behaves like a single-phase material in an AAA model. Consequently, computational efficient FE single-phase models, as they have been exclusively used in the past, accurately predict the wall stress in AAA models.

  5. A case of endometriosis presenting as an inguinal hernia.

    Husain, Fahd; Siddiqui, Zain Ahmed; Siddiqui, Midhat

    2015-03-11

    Endometriosis is a common clinical presentation for gynaecologists. Occasionally it can present to general surgeons as a swelling in the groin or abdominal wall. This condition should be included in the differential diagnosis in female patients. A 32-year-old woman with a 2-year history of a painful persistent lump in her right groin was referred to the general surgeons by her general practitioner. She was referred with a diagnosis of a suspected inguinal hernia. MRI excluded a hernia and exploration of the groin and subsequent histology confirmed the lesion to be an endometrial deposit.

  6. Laparoscopic repair of a lumbar hernia: report of a case and extensive review of the literature.

    Suarez, Sebastian; Hernandez, Juan D

    2013-09-01

    Lumbar hernias are a protrusion of intra-abdominal contents through a weakness or rupture in the posterior abdominal wall. They are considered to be a rare entity with approximately 300 cases reported in the literature since it was first described by Barbette in 1672. Petit described the inferior lumbar triangle in 1783 and Grynfeltt described the superior lumbar triangle in 1866; both are anatomical boundaries where 95% of lumbar hernias occur, whereas the other 5% are considered to be diffuse. Twenty percent of lumbar hernias are congenital and the other 80% are acquired; the acquired lumbar hernias can be further classified into either primary (spontaneous) or secondary. The typical presentation of lumbar hernias is a patient with a protruding semispherical bulge in the back with a slow growth. However, they may present with an incarcerated or strangulated bowel, so it is recommended that all lumbar hernias must be repaired as soon as they are diagnosed. The "gold standard" for diagnosing a lumbar hernia is a CT scan, because it is able to delineate muscular and fascial layers, detect a defect in one or more of these layers, evaluate the presence of herniated contents, differentiate muscle atrophy from a real hernia, and serve as a useful tool in the differential diagnosis, such as tumors. Recent studies have demonstrated the advantages of a laparoscopic repair instead of the classic open approach as the ideal treatment option for lumbar hernias. We report a case of a spontaneous lumbar hernia initially diagnosed as a lipoma and corrected with the open approach, but after relapsing 2 years later it was corrected using a laparoscopic approach. It is followed by an extensive review of lumbar hernias literature regarding history, anatomy, and surgical techniques.

  7. Richter Type of Incarcerated Obturator Hernia; Misery Still Continues

    Jayant Kumar

    2015-02-01

    Full Text Available Obturator hernia is a rare type of hernia which accounts for only 0.07-1.4% of all intra-abdominal hernias and 0.2-5.8% of small-intestinal obstructions. It develops predominantly in elderly underweight women. It has nonspecific early symptoms, so these hernias are usually discovered only after they have become incarcerated. Incarcerated obturator hernias are usually discovered on abdominal computed tomography scan or emergency surgery due to bowel obstruction.

  8. Sciatic Hernia Mimicking Perianal Abscess in a Cirrhotic Patient

    Wellington Andraus

    2012-01-01

    Full Text Available Abdominal hernias are very frequent in cirrhotic patients with ascites. The hernias usually present as umbilical, inguinal, incisional, or femoral. However, these patients can also develop uncommon hernias such as pelvic hernias because of pelvic floor weakness and high abdominal pressure due to ascites. We present the first case of a cirrhotic patient with ascites that developed a giant sciatic hernia mimicking a perianal abscess.

  9. A STUDY OF POSTOPERATIVE COMPLICATIONS FOLLOWING OPEN MESH INGUINAL HERNIA REPAIR

    Abdul Kalam

    2016-09-01

    Full Text Available BACKGROUND Inguinal hernia is the most common type of hernia. Inguinal region consists of deep inguinal ring, inguinal canal and superficial inguinal ring, which make the region weak and susceptible to hernia. 65% of inguinal hernias are indirect hernias and 35% direct hernias. Hernioplasty is the strengthening of posterior wall of inguinal canal. It can be done either with the help of mesh repair or darning. Hernioplasty is indicated in recurrent hernia cases, inguinal hernia with weak abdominal muscle tone where mesh plasty is preferred and inguinal hernia with good muscle tone where darning can be done. In mesh repair, posterior wall (Lichtenstein repair of inguinal canal is strengthened by a Prolene or Marlex mesh. Over time, fibroblasts and capillaries grow over the mesh converting it into a thick sheath strengthening the posterior wall. Complications which can be encountered postsurgery are pain, bleeding, urinary retention, scrotal swelling, abdominal distension, seroma and wound infections, chronic pain, keloid and testicular atrophy. MATERIALS AND METHODS  The study was conducted in the Department of General Surgery, Travancore Medical College, Kollam.  The study was done from January 2015 to January 2016.  One hundred cases were identified and were chosen for the study. INCLUSION CRITERIA 1. Inguinal hernia cases treated by open mesh repair. EXCLUSION CRITERIA 1. Other types of inguinal hernia repair. RESULTS All the cases studied belonged to male sex. In our study, age group twenty to forty years amounted to sixty one cases followed by age group forty to sixty years, which amounted to twenty eight cases. Age group zero to twenty years amounted to six cases and age group more than sixty years amounted to five cases. In the study group, seventy two cases were indirect inguinal hernias and twenty eight cases were direct inguinal hernias. Based on the complications encountered, pain at the site was the commonest complaint, which

  10. 多层螺旋CT辅助瓦氏呼吸对补片重建腹壁的指导意义%MSCT cooperate with Valsalva maneuver:its clinical significance for abdominal wall reconstruction with mesh

    闫玉昌; 潘振宇; 刘军; 蒋涛

    2014-01-01

    Objective To explore the clinical significance of MSCT cooperate with Valsalva maneuver in abdominal wall reconstruction with mesh.Methods All patients with ventral hernia received spiral CT examination before the abdominal reconstruction was performed.Patients were scanned under quiet breathing and maximum Valsalva maneuver respectively,to measure diametervariations of hernia ring.The CT values of abdominal wall muscle in different distance to hernia ring,as well as the CT values in patients with negative results,were recorded.Results Abdominal MSCT examination under Valsalva maneuver revealed an increasing hernia ring diameter compared with those in quiet breathing(t=1 5.477,1 5.41 8,all P=0.000).The CT values of abdominal wall muscle from 97 cases of ventral hernia,within distance of 1 , 2,3,4,5,6 cm to hernia ring,showed significant differences(F=1 4.534,P=0.000).While the CT values of ventral hernia in remote region (6-cm)were lower than those of normal people(t=-6.1 97,P=0.000).Conclusions MSCT examinations cooperate with Valsalva maneuver will be helpful to screen ventral hernia and detect the true hernia ring in patients with increasing intraabdominal pressure.Abdominal muscle CT valuesmeasuring surrounding hernia ring can be able to understand the physiological state of patients′abdominal muscle,and help to determine the safe positions for fixing mesh.%目的:探讨多层螺旋CT(MSCT)辅助瓦氏呼吸在补片重建腹壁中的指导意义。方法对拟行补片修补的腹壁疝患者,术前在平静呼吸状态下及做最大瓦氏呼吸时分别行螺旋CT检查,测量疝环径线的变化,测量距离疝环不同距离腹壁肌肉的CT值。测量螺旋CT检查结果阴性患者的腹壁肌肉CT值。结果辅助瓦氏呼吸的腹部MSCT检查患者的疝环径线较平静呼吸状态下屏住气的检查增大:疝环左右径线平均增大10.73 mm,差异有统计学意义(t=15.477,P=0.000

  11. ESOPHAGUS-STOMACH-ABDOMINAL WALL DRAINAGE FOR DELAYED INTRATHORACIC ESOHPAGEAL PERFORATIONLI

    李国庆; 单根法; 张辅贤; 钟竑

    2003-01-01

    Objective To design a technique of esophagus stomach abdominal wall drainage for the delayed intrathoracic esophageal perforation and to improve the therapeutic results.MethodsFour patients were treated by this simplified technique. There were 1 case of lower intrathoracic esophageal perforation to the left thorax, 1 high and 2 middle perforation to the right. This technique used two plastic tubes (chest tube) in a diameter about 1.2cm. One tube served as an intercostal drainage tube to drain purulent effusion, the other was inserted abdominally through stomach to the esophagus about 10cm above the esophageal perforation.ResultsThe four patients were treated successfully by the esophagus stomach abdominal wall drainage. There was no mortality or severe morbidity or complication. Hospitalizations were shortened. ConclusionThis technique is simple, safe and effective. It may provide a more promising alternative method of treatment for delayed esophageal perforation, especially in the critically ill patients. The procedure can also be extended to deal with esophagus stomach anastomotic leak.

  12. Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings

    Rafailidis Vasileios

    2013-01-01

    Full Text Available Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-old man with a history of pain at the lower left quadrant of the abdomen for 20 days and a visible mass in this site. Ultrasonography and computed tomography revealed this mass to be an abscess of the abdominal wall which had been formed by the spread of ruptured sigmoid diverticulitis by continuity of tissue through the lower left abdominal wall. Local drainage of the abscess was performed and the patient was discharged after alleviation of symptoms and an uneventful course. We also discuss causes of abdominal wall abscesses along with the possible pathways by which an intra-abdominal abscess could spread outside the abdominal cavity.

  13. A comparison of modelling techniques for computing wall stress in abdominal aortic aneurysms

    McGloughlin Timothy M

    2007-10-01

    Full Text Available Abstract Background Aneurysms, in particular abdominal aortic aneurysms (AAA, form a significant portion of cardiovascular related deaths. There is much debate as to the most suitable tool for rupture prediction and interventional surgery of AAAs, and currently maximum diameter is used clinically as the determining factor for surgical intervention. Stress analysis techniques, such as finite element analysis (FEA to compute the wall stress in patient-specific AAAs, have been regarded by some authors to be more clinically important than the use of a "one-size-fits-all" maximum diameter criterion, since some small AAAs have been shown to have higher wall stress than larger AAAs and have been known to rupture. Methods A patient-specific AAA was selected from our AAA database and 3D reconstruction was performed. The AAA was then modelled in this study using three different approaches, namely, AAA(SIMP, AAA(MOD and AAA(COMP, with each model examined using linear and non-linear material properties. All models were analysed using the finite element method for wall stress distributions. Results Wall stress results show marked differences in peak wall stress results between the three methods. Peak wall stress was shown to reduce when more realistic parameters were utilised. It was also noted that wall stress was shown to reduce by 59% when modelled using the most accurate non-linear complex approach, compared to the same model without intraluminal thrombus. Conclusion The results here show that using more realistic parameters affect resulting wall stress. The use of simplified computational modelling methods can lead to inaccurate stress distributions. Care should be taken when examining stress results found using simplified techniques, in particular, if the wall stress results are to have clinical importance.

  14. Abdominal Wall Desmoid Tumor in a Pregnant Woman and Cesarean Section Managment

    M Mojibian

    2013-08-01

    Full Text Available Increased risk of sporadic desmoid tumor occurs in increased estrogen level (pregnancy and surgical incisions (abdominal and thorasic. The frequency of desmoid tumors in the general population is 2.4 to 4.3 cases. The case is 30 year old woman with history of previous cesarean section. In fourth month of pregnancy,ultrasonography revealed a 5×7 cm mass in lower segment of the uterus(leiomyoma. The tumor diameter was 20 cm in term gestation. The time of cesarean , incision of skin was done above the umbilicus and below the sternum and incision of uterus was done from fondus vertically down. After delivery, the mass which was separated from uterus and located in the abdominal wall was extracted. The histological investigation diagnosed a desmoid tumor.

  15. The effect of tension free repair in the treatment of abdominal external hernia and its application advantage%无张力修补术治疗腹外疝的效果及应用优势探究

    吴传华

    2016-01-01

    目的:研究无张力修补术治疗腹外疝的效果及应用优势。方法:研究资料来源于我院2014年2月—2015年9月期间收治腹外疝患者65例,根据随机数字表法,分为2组,无张力疝修补组和传统疝修补组。传统疝修补组行传统疝修补术;无张力疝修补组行无张力修补术。就两组患者手术操作所需时间、术中失血量、下床活动时间、住院天数和并发症出现率进行比较。结果:无张力疝修补组并发症出现率低于传统疝修补组,P<0.05。无张力疝修补组患者手术操作所需时间、术中失血量、下床活动时间、住院天数均少于传统疝修补组,P<0.05。结论:无张力修补术治疗腹外疝的效果确切,创伤小,出血少,手术操作简单,可减少并发症,缩短住院时间,值得推广。%Objective:To study the effect and advantages of no surgical treatment of abdominal hernia tension-free repair. Methods:the research data in our hospital from February 2014 to September 2015 were treated with abdominal external hernia in 65 cases, according to randomly divided into 2 groups, tension-free hernia repair group and traditional hernia repair group traditional hernia. Repair group received traditional hernia repair;tension-free hernia repair group underwent tension-free hernia repair. Two patients with operation time, intraoperative blood loss, ambulation time, hospitalization time and complication rate were compared. Results: no complications was lower than that of traditional hernia repair group and hernia repair group 0.05., Phernia repair of patients with operation time, intraoperative blood loss, ambulation time, hospitalization time were less than the traditional hernia repair group, P < 0.05. conclusion: the surgical treatment of abdominal hernia tension repair effect, small trauma , less bleeding, operation is simple, can reduce complications, shorten the hospital stay, is worth

  16. Observation of a Flowing Duct in the Abdominal Wall by Using Nanoparticles.

    Jang, HyunSuk; Yoon, Joohwan; Gil, HyunJi; Jung, Sharon Jiyoon; Kim, Min-Suk; Lee, Jin-Kyu; Kim, Young-Jae; Soh, Kwang-Sup

    2016-01-01

    The primo vascular system (PVS) is being established as a circulatory system that corresponds to acupuncture meridians. There have been two critical questions in making the PVS accepted as a novel liquid flowing system. The first one was directly to show the flow of liquid in PVS and the second one was to explain why it was not observed in the conventional histological study of animal tissues. Flow in the PVS in the abdominal cavity was previously verified by injecting Alcian blue into a primo node. However, the tracing of the dye to other subsystems of the PVS has not been done. In the current work we injected fluorescent nanoparticles (FNPs) into a primo node and traced them along a primo vessel which was inside a fat tissue in the abdominal wall. Linea alba is a white middle line in the abdominal skin of a mammal and a band of fat tissue is located in parallel to the linea alba in the parietal side of the abdominal wall of a rat. In this fat band a primo vessel runs parallel to the prominent blood vessels in the fat band and is located just inside the parietal peritoneum. About the second question on the reason why the PVS was not in conventional histological study the current work provided the answer. Histological analysis with hematoxyline and eosine, Masson's trichrome, and Toluidine blue could not discriminate the primo vessel even when we knew the location of the PVS by the trace of the FNPs. This clearly explains why the PVS is hard to observe in conventional histology: it is not a matter of resolution but the contrast. The PVS has very similar structure to the connective tissues that surround the PVS. In the current work we propose a method to find the PVS: Observation of mast cell distribution with toluidine blue staining and the PN has a high density of mast cells, while the lymph node has low density.

  17. Observation of a Flowing Duct in the Abdominal Wall by Using Nanoparticles.

    HyunSuk Jang

    Full Text Available The primo vascular system (PVS is being established as a circulatory system that corresponds to acupuncture meridians. There have been two critical questions in making the PVS accepted as a novel liquid flowing system. The first one was directly to show the flow of liquid in PVS and the second one was to explain why it was not observed in the conventional histological study of animal tissues. Flow in the PVS in the abdominal cavity was previously verified by injecting Alcian blue into a primo node. However, the tracing of the dye to other subsystems of the PVS has not been done. In the current work we injected fluorescent nanoparticles (FNPs into a primo node and traced them along a primo vessel which was inside a fat tissue in the abdominal wall. Linea alba is a white middle line in the abdominal skin of a mammal and a band of fat tissue is located in parallel to the linea alba in the parietal side of the abdominal wall of a rat. In this fat band a primo vessel runs parallel to the prominent blood vessels in the fat band and is located just inside the parietal peritoneum. About the second question on the reason why the PVS was not in conventional histological study the current work provided the answer. Histological analysis with hematoxyline and eosine, Masson's trichrome, and Toluidine blue could not discriminate the primo vessel even when we knew the location of the PVS by the trace of the FNPs. This clearly explains why the PVS is hard to observe in conventional histology: it is not a matter of resolution but the contrast. The PVS has very similar structure to the connective tissues that surround the PVS. In the current work we propose a method to find the PVS: Observation of mast cell distribution with toluidine blue staining and the PN has a high density of mast cells, while the lymph node has low density.

  18. Diagnosis and management of Spigelian hernia: A review of literature and our experience

    Mittal T

    2008-01-01

    Full Text Available Spigelian hernia occurs through slit like defect in the anterior abdominal wall adjacent to the semilunar line. Most of spigelian hernias occur in the lower abdomen where the posterior sheath is deficient. The hernia ring is a well-defined defect in the transverses aponeurosis. The hernial sac, surrounded by extraperitoneal fatty tissue, is often interparietal passing through the transversus and the internal oblique aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique. Spigelian hernia is in itself very rare and more over it is difficult to diagnose clinically. It has been estimated that it constitutes 0.12% of abdominal wall hernias. The spigelian hernia has been repaired by both conventional and laparoscopic approach. Laparoscopic management of spigelian hernia is well established. Most of the authors have managed it by transperitoneal approach either by placing the mesh in intraperitoneal position or by raising the peritoneal flap and placing the mesh in extraperitoneal space. There have also been case reports of management of spigelian hernia by total extraperitoneal approach. We retrospectively reviewed our experience of ten patients between 1997 and 2007. Eight patients (8/10 presented with abdominal pain and two patients (2/10 were asymptomatic. In six patients (6/10 we performed an intraperitoneal onlay IPOM repair, in two patients (2/10 transabdominal preperitoneal repair (TAPP, and in two (2/10 total extraperitoneal repair (TEP. There were no recurrences, or other morbidity at mean follow up period of 3.2 years (range 6 months to 10 years.

  19. Heavy Metal Bioaccumulation in an Atypical Primitive Neuroectodermal Tumor of the Abdominal Wall.

    Roncati, Luca; Gatti, Antonietta Morena; Capitani, Federico; Barbolini, Giuseppe; Maiorana, Antonio; Palmieri, Beniamino

    2015-01-01

    Heavy metals are able to interfere with the function of vital cellular components. Besides in trace heavy metals, which are essential at low concentration for humans, there are heavy metals with a well-known toxic and oncogenic potential. In this study, for the first time in literature, we report the unique adulthood case of an atypical primitive neuroectodermal tumor of the abdominal wall, diagnosed by histology and immunohistochemistry, with the molecular hybridization support. The neoplasia occurred in a patient chronically exposed to a transdermal delivery of heavy metal salts (aluminum and bismuth), whose intracellular bioaccumulation has been revealed by elemental microanalysis.

  20. A large infiltrating fibrous hamartoma of infancy in the abdominal wall with rare associated tuberous sclerosis

    Han, Hye-Jeong; Lim, Gye-Yeon [The Catholic University of Korea, Department of Radiology, St. Mary' s Hospital, Seoul (Korea); You, Chang-Young [The Catholic University of Korea, Department of Pathology, St. Mary' s Hospital, Seoul (Korea)

    2009-07-15

    Tuberous sclerosis is a complex autosomal-dominant neurocutaneous syndrome characterized by hamartomatous malformations of fibrous and connective tissues in various organs. Although various histologic types of soft-tissue masses can occur with tuberous sclerosis, we present a unique case of fibrous hamartoma of infancy presenting as large infiltrating cutaneous and subcutaneous masses in the abdominal wall in a 4-year-old boy with tuberous sclerosis. Although the co-occurrence of tuberous sclerosis and fibrous hamartoma of infancy is very rare, it should be considered in the differential diagnosis of subcutaneous soft-tissue masses found in children with tuberous sclerosis. (orig.)

  1. Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola

    Kim Si-Hyun

    2012-03-01

    Full Text Available Abstract Background Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known. Case presentation We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement. Conclusions R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.

  2. Metastasis of Dermatofibrosarcoma from the Abdominal Wall to the Thyroid Gland: Case Report

    Alexander Kreze

    2012-01-01

    Full Text Available Metastases in the thyroid gland are very rare. Even the rarer are sarcoma metastases. A 52-year-old woman was referred to our department for evaluation of a nodule in the right lobe of the thyroid gland. She had a history dermatosarcoma of the abdominal wall with known metastasis in the lung. Clinically she had neck pain and worsened swallowing. Objective assessment (ultrasound, computed tomography, and magnetic resonance indicated a voluminous right lobe nodule with mechanical syndrome, and a fine-needle aspiration biopsy revealed a very suspicious malignant finding. After surgery, the diagnosis was metastasis of dermatofibrosarcoma protuberans. Subsequent treatment was radio- and chemotherapy.

  3. Management of Anterior Abdominal Wall Defect Using a Pedicled Tensor Fascia Lata Flap: A Case Report

    K. D. Ojuka

    2012-01-01

    Full Text Available Degloving injuries to anterior abdominal wall are rare due to the mechanism of injury. Pedicled tensor fascia lata is known to be a versatile flap with ability to reach the lower anterior abdomen. A 34-year-old man who was involved in a road traffic accident presented with degloving injury and defect at the left inguinal region, sigmoid colon injury, and scrotal bruises. At investigation, he was found to have pelvic fracture. The management consisted of colostomy and tensor fascia lata to cover the defect at reversal. Though he developed burst abdomen on fifth postoperative day, the flap healed with no complications.

  4. Intramedullary spinal cord ganglioglioma presenting with abnormal abdominal wall movement. Case report.

    Aslanabadi, Saeid; Azhough, Ramin; Motlagh, Parviz Samad; Hadidchi, Shahram; Tabrizi, Ali Dastranj; Zonouzy, Keivan Kashy

    2004-10-15

    The authors present a case of intramedullary ganglioglioma in a 6-year-old girl. Since the age of 4 months the patient had experienced a spontaneous wavy undulating movement of her anterior abdominal wall resembling a severe peristalsis. The movement was continuous even during sleep, and this symptom was named "belly dance." Magnetic resonance images revealed an intramedullary tumor with ill-defined borders, and the lesion was partially resected. The patient made a good recovery, although 4 years postsurgery her scoliosis had progressed.

  5. 腹腔镜腹膜前疝修补术与普理灵疝装置无张力疝修补术的比较分析%Comparative Study of Abdominal Preperitoneal Laparoscopic and Prolene Hernia System of Tension-Lee of Hernia Repair

    金海敏; 黄海; 李晔

    2011-01-01

    [Objective]To compare the efficacy of treatment of inguinal hernia by abdominal preperitoneal laparoscopjc hernia repair (Transabdominal Preperitoneal Herniorrhaphy, TAPP) and by Prolene hernia system tension-free hernia repair(Prolene Hernia System,PHS). [Methods]A retrospective analysis from September 2008 to May 2010 a total of 90 patients with clinica'l data of inguinal hernia repair,TAPP group of 36 cases,PHS group of 54 patients. [Results]Both complications were low;compared with PHS, TAPP group,the average hospital stay shorter(3. 54±1. 42 vs. 5. 36±1.35,P<0. 05),Operation time and relatively high cost of surgery(P<0. 05). [Conclusion] TAPP and PHS are both safe and effective surgical inguinal hernia repairs. TAPP has feature of shorter postoperative hospital stay,rapid recovery,especially for recurrent hernia,bilateral hernia,and hidden hernia.%[目的]比较腹腔镜腹膜前疝修补术(Transabdominal Preperitoneal Herniorrhaphy,TAPP)与普理灵疝装置无张力疝修补术(Prolene Hernia System,PHS)治疗腹股沟疝的疗效。[方法]回顾性分析2008年9月至2010年5月共90例腹股沟疝修补术病例资料,TAPP组36例,PHS组54例。[结果]二者术后并发症均低下;与PHS组相比,TAPP组平均住院时间更短(P<0.05),手术时间及手术费用相对较高(P<0.05),TAPP另具探查对侧及隐匿疝的独特优势。[结论]TAPP术后住院时间短、恢复快,尤其对复发性疝、双侧疝及隐匿疝更具优势。

  6. Acute appendicitis presenting with abdominal wall and right groin abscess: A case report

    Mustafa Yildiz; Ahmet Sevki Karakayali; Saadet Ozer; Hilal Ozer; Aydin Demir; Bugra Kaptanoglu

    2007-01-01

    We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.

  7. Obesidad mórbida: caso excepcional de reconstrucción de pared abdominal Morbid obesity: an exceptional patient. Apronectomy and new abdominal wall reconstruction

    F.J. Gabilondo Zubizarreta

    2006-09-01

    Full Text Available Presentamos una nueva técnica para la reconstrucción de la pared abdominal, con material sintético en una paciente que padeciendo un cuadro de obesidad mórbida sin cirugía ni traumatismo previo, sufre una diástasis de músculos rectos de su pared abdominal por la que se produce una evisceración intestinal que al alojarse en el faldón abdominal y añadirse un proceso de acumulación de líquidos en el intersticio semejante al linfedema, supuso como tratamiento una resección superior a los 60 Kg. entre sólidos y líquidos y una estrategia y técnica nuevas de reconstrucción del defecto de la pared abdominal.The aim of this work is to show a new technique for reconstruction of the abdominal wall with synthetic matherial in a patient with morbid obesity. The disease has no relation with antecedents of previous surgery or trauma and is asociated with a dyasthasis of the rectus abdomini muscles which has conditionated a intestinal evisceration.This evisceration is accommodated in the abdominal apron and is associated with a great accumulation of fluid (liquid in the interstitium, which seems a linphedema. Taking account the combination of liquid and soft tissues the resection is larger than 60 Kg. and this has forced us to develop new strategies for the menagement of the patient and techniques for the reconstruction of the abdominal wall defect.

  8. Whole abdominal wall segmentation using augmented active shape models (AASM) with multi-atlas label fusion and level set

    Xu, Zhoubing; Baucom, Rebeccah B.; Abramson, Richard G.; Poulose, Benjamin K.; Landman, Bennett A.

    2016-03-01

    The abdominal wall is an important structure differentiating subcutaneous and visceral compartments and intimately involved with maintaining abdominal structure. Segmentation of the whole abdominal wall on routinely acquired computed tomography (CT) scans remains challenging due to variations and complexities of the wall and surrounding tissues. In this study, we propose a slice-wise augmented active shape model (AASM) approach to robustly segment both the outer and inner surfaces of the abdominal wall. Multi-atlas label fusion (MALF) and level set (LS) techniques are integrated into the traditional ASM framework. The AASM approach globally optimizes the landmark updates in the presence of complicated underlying local anatomical contexts. The proposed approach was validated on 184 axial slices of 20 CT scans. The Hausdorff distance against the manual segmentation was significantly reduced using proposed approach compared to that using ASM, MALF, and LS individually. Our segmentation of the whole abdominal wall enables the subcutaneous and visceral fat measurement, with high correlation to the measurement derived from manual segmentation. This study presents the first generic algorithm that combines ASM, MALF, and LS, and demonstrates practical application for automatically capturing visceral and subcutaneous fat volumes.

  9. The muscles of the infrapubic abdominal wall of a 6-month-old Crocodylus niloticus (Reptilia: Crocodylia).

    Fechner, R; Schwarz-Wings, D

    2013-06-01

    The muscles of the infrapubic abdominal wall of crocodilians play an important role in their ventilatory mechanism. Yet the anatomy and homology of these muscles is poorly understood. To gain new insights into the anatomy of the crocodilian infrapubic abdominal wall, we dissected a specimen of Crocodylus niloticus. Origin and insertion of the muscles, as well as their arrangement relative to each other was examined in great detail. The findings were compared with those of other crocodilian taxa to detect potential variability of the muscles of interest. The homology of the muscles was studied by comparing the muscles of the crocodilian infrapubic abdominal wall with those of other diapsids. In Crocodylus niloticus, the infrapubic abdominal wall consists of four muscles: Musculus truncocaudalis, M. ischiotruncus, and Mm. rectus abdominis externus and internus. The arrangement of the muscles of the infrapubic abdominal wall of Crocodylus niloticus is consistent with that found in most other crocodilian taxa. In some crocodilian taxa, an additional muscle, M. ischiopubis, is found. In the remaining diapsids, only M. rectus abdominis is present. The crocodilian M. truncocaudalis, M. ischiotruncus and, if present, M. ischiopubis appear to be derivates of M. rectus abdominis; the development of those might be related to the evolution of the unique crocodilian ventilatory mechanism.

  10. Mechanically relevant consequences of the composite laminate-like design of the abdominal wall muscles and connective tissues.

    Brown, Stephen H M

    2012-05-01

    Together, three abdominal wall muscles (external oblique, internal oblique and transversus abdominis) form a tightly bound muscular sheet that has been likened to a composite-laminate structure. Previous work has demonstrated the ability of force generated by these three muscles to be passed between one another through connective tissue linkages. Muscle fibres in each muscle are obliquely oriented with respect to its neighbouring muscles. It is proposed here is that this unique morphology of the abdominal wall muscles functions, through the application of constraining forces amongst the muscles, to increase force- and stiffness-generating capabilities. This paper presents a mathematical formulation of the stress-strain relationship for a transversely isotropic fibrous composite, and establishes a strengthening and stiffening effect when stress can be transferred between the fibrous layers. Application of empirical mechanical properties to this formulation demonstrates this effect for the abdominal wall muscles and, in greater proportion, for the anterior aponeurosis of the abdominal wall. This has implications for increasing the stiffness and passive load bearing ability of the abdominal wall muscles, and has the potential to modulate the whole muscle force-length and force-velocity relationships during contraction.

  11. Neuromuscular independence of abdominal wall muscles as demonstrated by middle-eastern style dancers.

    Moreside, Janice M; Vera-Garcia, Francisco J; McGill, Stuart M

    2008-08-01

    Previous studies analyzing neuromuscular independence of the abdominal wall have involved a participant population with no specific training in separating individual muscle segments. We chose to study nine women trained in the art of middle-eastern dance, anticipating they may have unique skills in motor control. Specifically, we were searching for evidence of separation of upper rectus abdominis (URA) from lower rectus abdominis (LRA), as well as understanding what role the oblique muscles play in abdominal wall synergies. EMG analysis was done on eight trunk muscles bilaterally as the dancers participated in 30 dance, planar, and curl-up activities. The filtered data were then cross-correlated to determine the time lag between pairs of signals. Only three dance movements demonstrated consistent evidence of an ability to separate URA/LRA activation timing. The external and internal oblique muscles tend to align themselves temporally with the LRA. However, these findings were only evident in these three specific "belly-roll" conditions, all with low levels of muscle activation, and no external torque. Evidence of significantly different activation levels (% MVC) between URA/LRA was demonstrated in eight conditions, all of which required various pelvis movements with minimal thorax motion.

  12. Pain pressure threshold algometry of the abdominal wall in healthy women

    M.L.L.S. Montenegro

    2012-07-01

    Full Text Available The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years were included. All volunteers had regular menstrual cycles (27-33 days and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test. There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

  13. Controversies in laparoscopic repair of incisional hernia

    Sarela Abeezar

    2006-01-01

    Full Text Available Background: Incisional hernias can be a significant problem after open abdominal surgery. Laparoscopic incisional hernia repair (LIHR is conceptually appealing: a large, abdominal wall re-incision with potential wound-related ill effects is avoided and an intra-peritoneal onlay mesh is expected to provide security that is equivalent to open, retro-muscular mesh repair. As such, LIHR has gained substantial popularity despite sparse, randomised clinical data to compare with conventional, open repair. Aim: To enumerate and discuss important, controversial issues in patient-selection, technique and early post-operative care for LIHR. Materials and Methods: Pragmatic summary of comprehensive review of English language literature, discussion with experts and personal experience. Outcomes: Six important areas of some dispute were identified: 1. Size of abdominal-wall defect that is suitable for LIHR: Generally, defect-diameter > 10 cm is better served by open retromuscular repair with tension-free re-approximation of the edges of the defect. 2. Extent of adhesiolysis: Complete division of adhesions to the anterior abdominal wall may identify sub-clinical "Swiss-cheese" defects but incurs some risk of additional complications. 3. Intra-operative recognition of enterotomy: Possible options are either laparoscopic suture of bowel injury and simultaneous completion of LIHR, or staged LIHR or conversion to open suture-repair. 4. Choice of mesh: "Composite" meshes are regarded as the current standard of care but there is paucity of data regarding potential dangers of intra-peritoneal polypropylene mesh. 5. Technique of mesh-fixation: Trans-parietal sutures are more secure than tacks, with limited data to correlate with post-operative pain. 6. Alarm over post-operative pain: Unlike other advanced laparoscopic operations, the specificity of pain as a marker of intra-abdominal sepsis after LIHR remains unclear. Conclusion : Recognition of and attention to

  14. [Inguinal and femoral hernia repair].

    Geissler, B; Anthuber, M

    2011-05-01

    With an incidence of 200,000 new cases per year in Germany, inguinal hernia has a significant socioeconomic impact. The 2009 guidelines from the European Hernia Society established treatment recommendations. Hernia repair is based on reinforcing the posterior wall of the inguinal canal by suture or mesh repair by an anterior or posterior approach. Lightweight mesh reduces recurrence rates and is the treatment of choice even in primary hernias. Laparoscopic hernia repair is associated with specific risks but is superior in postoperative pain and earlier return to work.

  15. Bilateral congenital lumbar hernias in a patient with central core disease--A case report.

    Lazier, Joanna; Mah, Jean K; Nikolic, Ana; Wei, Xing-Chang; Samedi, Veronica; Fajardo, Carlos; Brindle, Mary; Perrier, Renee; Thomas, Mary Ann

    2016-01-01

    Congenital lumbar hernias are rare malformations caused by defects in the development of the posterior abdominal wall. A known association exists with lumbocostovertebral syndrome; however other associated anomalies, including one case with arthrogryposis, have been previously reported. We present an infant girl with bilateral congenital lumbar hernias, multiple joint contractures, decreased muscle bulk and symptoms of malignant hyperthermia. Molecular testing revealed an R4861C mutation in the ryanodine receptor 1 (RYR1) gene, known to be associated with central core disease. This is the first reported case of the co-occurrence of congenital lumbar hernias and central core disease. We hypothesize that ryanodine receptor 1 mutations may interrupt muscle differentiation and development. Further, this case suggests an expansion of the ryanodine receptor 1-related myopathy phenotype to include congenital lumbar hernias.

  16. Incarceration of a sessile uterine fibroid in an umbilical hernia during pregnancy.

    Seims, A D; Lube, M W

    2009-06-01

    On rare occasions, uterine fibroids complicate pregnancy. More commonly, fibroids exert a mass effect that either prevents implantation of an egg or becomes problematic as a fetus grows. Less frequently, pregnancies are affected by fibroid herniation through a fascial defect. Several publications describing herniation of pedunculated fibroids exist, two of which were in umbilical hernia sacs. There is, to our knowledge, only one publication describing the presence of a sessile uterine fibroid in an umbilical hernia. This case report adds to the literature by describing a 34-year-old primigravid woman with an umbilical hernia that contained a sessile uterine fibroid and provides parameters that can be used in the initial evaluation of a pregnant woman with an abdominal wall hernia.

  17. Isolated Abdominal Wall Actinomycosis Associated with an Intrauterine Contraceptive Device: A Case Report and Review of the Relevant Literature

    Sinan Carkman

    2010-01-01

    Full Text Available Isolated abdominal wall actinomycosis in the presence of an intrauterine contraceptive device (IUCD is extremely rare and only six such cases have been reported in the literature. We report a case where clinical and radiological examinations revealed a pseudotumor within the anterior abdominal wall. After being lost to follow-up, the patient presented two years later with the enlargement of the mass. The mass including the affected anterior abdominal wall was completely excised. The diagnosis of actinomycosis was established postoperatively by histopathological examination. Further questioning concerning her gynecological history revealed long-term use of the same IUCD. Surgical excision of the actinomycotic pseudotumour and removal of the IUCD followed by antibiotic therapy resulted in the full recovery of the patient.

  18. Spontaneous extrusion of peritoneal catheter of ventriculoperitoneal shunt through the intact abdominal wall: Report of two cases

    Souvagya Panigrahi

    2012-01-01

    Full Text Available Among the various complications associated with ventriculoperitoneal shunt (VPS surgery, migration of the peritoneal catheter is one of the rarest complications. We report two cases of spontaneous extrusion of the peritoneal portion of the VPS through the intact abdominal wall at an area unrelated to the surgical incision. Both were conscious and had no neurological deficits. There were no signs of infection. The peritoneal end of the shunt was removed through the abdomen. Shunt revision was performed. The patients were discharged 8 days after the revision without any complications. At 6-month follow-up, both of them are doing well. Possible mechanisms of abdominal wall perforation are discussed. Pulling the extruded peritoneal end through abdominal wall decreases the possibility of infection and is probably the best way of management.

  19. Modified sliding rectus abdominus myofascial flap for huge planned abdominal hernia after intra-abdominal volume increment%改良腹直肌推徙术治疗腹腔扩容术后巨大计划性腹疝

    孙士锦; 杨越涛; 吴文元; 马柏强; 谭浩; 王韬; 李英才; 张连阳

    2014-01-01

    目的 探讨改良腹直肌推徙术治疗腹腔扩容术后巨大计划性腹疝的效果. 方法 回顾性分析7例巨大计划性腹疝患者的临床资料,其中男4例,女3例;平均年龄43.4岁.合并造口4例,胰瘘1例,肠瘘1例,胆囊炎1例.所有患者均接受改良腹直肌推徙术治疗,行确定性腹壁重建,计划性腹疝至确定性重建的平均时间为6.4个月. 结果 7例均救治成功.平均手术时间180 min,术中平均失血量150 ml.术后发生皮下血清肿1例,皮缘坏死1例,均经引流治愈,无严重感染并发症.无复发性腹腔间隙综合征发生,无脏器功能障碍等发生.腹直肌功能恢复良好,无其他不适症状.随访l ~21个月,平均12.3个月,轻度复发l例,暂时观察中. 结论 改良腹直肌推徙术治疗巨大计划性腹疝,效果良好,为腹腔扩容术后巨大计划性腹疝患者临床治疗提供了新的可供选择的手术方法.%Objective To examine the effect of modified sliding myofascial flap of the rectus abdominis to intervene the huge planned hernia following intra-abdominal volume increment.Methods A retrospective review was made on 7 cases (4 males and 3 females at mean age of 43.4 years).Colostomy or ileumstomy co-occurred in 4 cases,pancreatic fistula in 1,intestinal fistula in 1,cholecystitis in 1.Definite abdominal wall reconstruction was performed using the modified sliding rectus abdominus myofascial flap and mean delay time was 6.4 months.Results Surgical success rate was 100%.Mean operation time was 180 minutes and mean intraoperative blood loss was 150 ml.One case of subcutaneous hematoma and one skin marginal necrosis were noted after operation,but cured later by volume drainage.There were no postoperative complications such as infection,reproductive abdominal compartment syndrome (ACS),and organ function impairment.Rectus abdominis functioned well without any other symptoms.At the follow-up of 1-21 months (mean,12.3 months),1 case had mild relapse

  20. Functional electrical stimulation to the abdominal wall muscles synchronized with the expiratory flow does not induce muscle fatigue

    Okuno, Yukako; Takahashi, Ryoichi; Sewa, Yoko; Ohse, Hirotaka; Imura, Shigeyuki; Tomita, Kazuhide

    2017-01-01

    [Purpose] Continuous electrical stimulation of abdominal wall muscles is known to induce mild muscle fatigue. However, it is not clear whether this is also true for functional electrical stimulation delivered only during the expiratory phase of breathing. This study aimed to examine whether or not intermittent electrical stimulation delivered to abdominal wall muscles induces muscle fatigue. [Subjects and Methods] The subjects were nine healthy adults. Abdominal electrical stimulation was applied for 1.5 seconds from the start of expiration and then turned off during inspiration. The electrodes were attached to both sides of the abdomen at the lower margin of the 12th rib. Abdominal electrical stimulation was delivered for 15 minutes with the subject in a seated position. Expiratory flow was measured during stimulus. Trunk flexor torque and electromyography activity were measured to evaluate abdominal muscle fatigue. [Results] The mean stimulation on/off ratio was 1:2.3. The declining rate of abdominal muscle torque was 61.1 ± 19.1% before stimulus and 56.5 ± 20.9% after stimulus, not significantly different. The declining rate of mean power frequency was 47.8 ± 11.7% before stimulus and 47.9 ± 10.2% after stimulus, not significantly different. [Conclusion] It was found that intermittent electrical stimulation to abdominal muscles synchronized with the expiratory would not induce muscle fatigue. PMID:28356636

  1. Functional electrical stimulation to the abdominal wall muscles synchronized with the expiratory flow does not induce muscle fatigue.

    Okuno, Yukako; Takahashi, Ryoichi; Sewa, Yoko; Ohse, Hirotaka; Imura, Shigeyuki; Tomita, Kazuhide

    2017-03-01

    [Purpose] Continuous electrical stimulation of abdominal wall muscles is known to induce mild muscle fatigue. However, it is not clear whether this is also true for functional electrical stimulation delivered only during the expiratory phase of breathing. This study aimed to examine whether or not intermittent electrical stimulation delivered to abdominal wall muscles induces muscle fatigue. [Subjects and Methods] The subjects were nine healthy adults. Abdominal electrical stimulation was applied for 1.5 seconds from the start of expiration and then turned off during inspiration. The electrodes were attached to both sides of the abdomen at the lower margin of the 12th rib. Abdominal electrical stimulation was delivered for 15 minutes with the subject in a seated position. Expiratory flow was measured during stimulus. Trunk flexor torque and electromyography activity were measured to evaluate abdominal muscle fatigue. [Results] The mean stimulation on/off ratio was 1:2.3. The declining rate of abdominal muscle torque was 61.1 ± 19.1% before stimulus and 56.5 ± 20.9% after stimulus, not significantly different. The declining rate of mean power frequency was 47.8 ± 11.7% before stimulus and 47.9 ± 10.2% after stimulus, not significantly different. [Conclusion] It was found that intermittent electrical stimulation to abdominal muscles synchronized with the expiratory would not induce muscle fatigue.

  2. A large incarcerated Meckel's diverticulum in an inguinal hernia

    Michael J. Horkoff

    2014-01-01

    CONCLUSION: Littre's hernia, although rare, should be a consideration at the time of repair for any abdominal hernia involving small bowel as resection of the Meckel's diverticulum is critical in avoiding recurrent complications.

  3. 腹壁脓肿16例误诊分析%Misdiagnosis of abdominal 16 cases wall abscess

    李泉洪

    2011-01-01

    Objective To analyze the causes of misdiagnosis of abdominal wall abscess and countermeasures.Methods A retrospective analysis of our hospital 3 years ( 2008-2010 ) treatment of 16 cases of abdominal wall abscess misdiagnosed cases.Results Of this study 16 patients were diagnosed as abdominal wall abscess last.Conclusion Careful physical examination,abdominal wall abscess could be way to avoid misdiagnosis.Puncture could improve the early diagnosis of abdominal abscess,reduce misdiagnosis rate.%目的 分析腹壁脓肿的误诊原因及对策.方法 回顾性分析诊治的16例腹壁脓肿误诊病例.结果 误诊腹部肿块8例,胆囊炎2例,肝脓肿1例,阑尾周围脓肿2例,腹壁纤维瘤3例.结论 仔细的体检,警惕腹壁脓肿的可能,从而避免误诊.穿刺术能提高腹壁脓肿的早期诊断水平,降低误诊率.

  4. Torsion of an Abdominal-Wall Pedunculated Lipoma: A Rare Differential Diagnosis for Right Iliac Fossa Pain

    Daniel Lee John Bunker

    2013-01-01

    Full Text Available Pedunculated lipomas arising from the peritoneal wall are a rare finding during abdominal surgery. These benign tumours of mesenchymal origin can arise anywhere in the body and are usually asymptomatic. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. To our knowledge, such a case has never been reported in the literature previously. We suggest that torsion of a pedunculated parietal lipoma is a rare differential of acute abdominal pain.

  5. Torsion of an abdominal-wall pedunculated lipoma: a rare differential diagnosis for right iliac fossa pain.

    Bunker, Daniel Lee John; Ilie, Victor George; Halder, Tushar K

    2013-01-01

    Pedunculated lipomas arising from the peritoneal wall are a rare finding during abdominal surgery. These benign tumours of mesenchymal origin can arise anywhere in the body and are usually asymptomatic. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. To our knowledge, such a case has never been reported in the literature previously. We suggest that torsion of a pedunculated parietal lipoma is a rare differential of acute abdominal pain.

  6. An atypical lateral hernia and concomitant inguinal and umbilical hernias in a patient with polycystic kidney disease and an intracranial aneurysm - a combined approach of clinical and radiological investigation, endoscopic hernia repair, and anatomical cadaver model documentation and a systematic review of the literature.

    Veréb-Amolini, László; Betschart, Thomas; Kiss, Emilia; Ullrich, Oliver; Wildi, Stefan; Eppler, Elisabeth

    2015-01-01

    Atypical hernias are difficult to diagnose due to their rarity and often unspecific symptoms. In the literature there exist hints to peri-inguinal hernias, i.e. direct lateral hernia, but most of them are forms of Spigelian hernias. Since the majority were described during the first half of the past century or even earlier, only very few cases have been documented using modern diagnostic techniques. We report a unique case of a 51 year old patient presenting with an atypical inguinal hernia with concomitant inguinal and umbilical hernias in combination with cystic kidney disease and intracranial aneurysm. The atypical position of the hernia was assumed from clinical inspection, ultrasound and CT scan and verified during pre-peritoneoscopy. Using an anatomical cadaver dissection approach, we followed the unusual position of the hernia through the abdominal wall below the aponeurosis of the external oblique muscle. After a thorough literature search, we assume that the present hernia containing a hernial sac has not been documented before, especially not in such a multidisciplinary approach comprising radiological, surgical and anatomical localisation and endoscopic treatment in a patient with a clinical situation being aggravated by large cystic kidneys leading to dialysis-dependency. Rare hernias have been described as being often associated with concomitant inguinal or other hernias, a predisposition for the male gender and a pathogenic mechanism related to other soft tissue defects such as cystic kidney disease or cranial aneurysm. Thus, we consider this a unique case that has not been documented in this constellation previously, which may increase the awareness for these rare hernias.

  7. Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation.

    Zadeh, Jonathan R; Buicko, Jessica L; Patel, Chetan; Kozol, Robert; Lopez-Viego, Miguel A

    2015-01-01

    The Grynfeltt-Lesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro- and intraperitoneal structures through the upper lumbar triangle. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. In order to avoid that outcome, it is advisable to electively repair Grynfeltt hernias in patients without significant contraindications to surgery. Due to the limited number of lumbar hernioplasties performed, there has not been a large study that definitively identifies the best repair technique. It is generally accepted that abdominal hernias such as these should be repaired by tension-free methods. Both laparoscopic and open techniques are described in modern literature with unique advantages and complications for each. We present the case of an unexpected Grynfeltt hernia diagnosed following an attempted lipoma resection. We chose to perform an open repair involving a combination of fascial approximation and dual-layer polypropylene mesh placement. The patient's recovery was uneventful and there has been no evidence of recurrence at over six months. Our goal herein is to increase awareness of upper lumbar hernias and to discuss approaches to their surgical management.

  8. Incarcerated femoral hernia containing the right uterine tube. A pre-operative diagnosis is possible.

    Engin, Omer; Cicek, Ebru; Oner, Soner Recai; Yildirim, Mehmet

    2011-01-01

    The incarcerated femoral hernia containing the right uterine tube is very rare to see. The case report is important to accumulate knowledge of very rare cases. The diagnosis of the case was established pre-operatively with abdominal computerized tomography (CT) On CT examination, the mass in the hernia sac was not connected with the intestines and a tubal structure on the right side of the uterus was shown to extend out of the abdomen. In the operation, the right uterine tube(RUT) was reduced into the abdomen after its blood supply was shown to be normal. A hernia repair was performed. Sometimes in obese patients, incarcerated femoral or inguinal hernias may not been noted. Ultrasonography, CT and magnetic resonance imaging (MRI) is used frequently to diagnose abdominal wall hernias. The organs in the incarcerated sac must be examined carefully and the viability must be checked. The surgeon must decide whether or not to resect the organs. In our case, strangulation was not found and polypropylene mesh was not used for hernia repair due to a fear of infection of the prosthesis. Incarceration of the uterine tube in the sac is traumatic and this condition may lead to infection. Such conditions may lead to ectopic pregnancy. The patient must be informed about ectopic pregnancy due to a previous incarceration of the tube because ectopic pregnancy may be fatal.

  9. Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation

    Zadeh, Jonathan R.; Buicko, Jessica L.; Patel, Chetan; Kozol, Robert; Lopez-Viego, Miguel A.

    2015-01-01

    The Grynfeltt-Lesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro- and intraperitoneal structures through the upper lumbar triangle. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. In order to avoid that outcome, it is advisable to electively repair Grynfeltt hernias in patients without significant contraindications to surgery. Due to the limited number of lumbar hernioplasties performed, there has not been a large study that definitively identifies the best repair technique. It is generally accepted that abdominal hernias such as these should be repaired by tension-free methods. Both laparoscopic and open techniques are described in modern literature with unique advantages and complications for each. We present the case of an unexpected Grynfeltt hernia diagnosed following an attempted lipoma resection. We chose to perform an open repair involving a combination of fascial approximation and dual-layer polypropylene mesh placement. The patient's recovery was uneventful and there has been no evidence of recurrence at over six months. Our goal herein is to increase awareness of upper lumbar hernias and to discuss approaches to their surgical management. PMID:26697256

  10. Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation

    Jonathan R. Zadeh

    2015-01-01

    Full Text Available The Grynfeltt-Lesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro- and intraperitoneal structures through the upper lumbar triangle. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. In order to avoid that outcome, it is advisable to electively repair Grynfeltt hernias in patients without significant contraindications to surgery. Due to the limited number of lumbar hernioplasties performed, there has not been a large study that definitively identifies the best repair technique. It is generally accepted that abdominal hernias such as these should be repaired by tension-free methods. Both laparoscopic and open techniques are described in modern literature with unique advantages and complications for each. We present the case of an unexpected Grynfeltt hernia diagnosed following an attempted lipoma resection. We chose to perform an open repair involving a combination of fascial approximation and dual-layer polypropylene mesh placement. The patient’s recovery was uneventful and there has been no evidence of recurrence at over six months. Our goal herein is to increase awareness of upper lumbar hernias and to discuss approaches to their surgical management.

  11. Kinetics of implant-induced inflammatory angiogenesis in abdominal muscle wall in mice.

    Castro, Pollyana R; Marques, Suzane M; Campos, Paula P; Cardoso, Cibele C; Sampaio, Fernanda P; Ferreira, Monica A N D; Andrade, Silvia P

    2012-07-01

    Injury of skeletal abdominal muscle wall is a common medical condition and implantation of synthetic or biological material is a procedure to repair musculofascial defects. We proposed to characterize the dynamics of inflammatory cell recruitment, newly formed blood vessels, cytokine production and fibrogenesis in the abdominal skeletal muscle in response to polyether-polyurethane sponge implants in mice. At 2, 4, 7 and 10days after implantation the muscle tissue underneath the sponge matrix was removed for the assessment of the angiogenic response (hemoglobin content, vascular endothelial growth factor and morphometric analysis of the number of vessels) and inflammation (myeloperoxidase and n-acethyl-B-d-glucosaminidase activities, cytokines). In addition, muscle fibrogenesis was determined by the levels of TGF-β1 and collagen deposition. Hemoglobin content, wash out rate of sodium fluorescein (indicative of blood flow) and the number of vessels increased in the abdominal muscle bearing the synthetic matrix in comparison with the intact muscle. Neutrophil recruitment peaked in the muscle at day 2, followed by macrophage accumulation at day 4 post-injury. The levels of the cytokines, VEGF, TNF-α, CCL-2/MCP-1 were higher in the injured muscle compared with the intact muscle and peaked soon after muscle injury (days 2 to 4). Collagen levels were higher in sponge-bearing muscle compared with the non-bearing tissue soon after injury (day 2). The implantation technique together with the inflammatory and vascular parameters used in this study revealed inflammatory, angiogenic and fibrogenic events and mechanisms associated with skeletal muscle responses to synthetic implanted materials.

  12. Trocar-related abdominal wall bleeding in 200 patients after laparoscopic cholecistectomy: Personal experience

    Girolamo Geraci; Carmelo Sciumè; Franco Pisello; Francesco Li Volsi; Tiziana Facella; Giuseppe Modica

    2006-01-01

    AIM: To determine the complications and incidence of the first and second access-related vascular injuries induced by videolaparoscopic cholecistectomy.METHODS: We retrospectively reviewed vascular injuries in 200 consecutive patients who underwent videolaparoscopic cholecistectomy from 2003 to 2005.One hundred and one patients with placement of radial expanding trocars were assigned into group A and 99patients with placement of pyramidal tipped trocars into group B. All the patients were submitted to open access according to Hasson for the first trocar.RESULTS: Bleeding did not occur at the intraoperative cannula-site in group A. However, it occurred at the intraoperative cannula-site of 7 patients (7.1%) in group B, with a statistically significant difference (P < 0.01).No mortality was registered. More vascular lesions were found in group B.CONCLLSION: The advantage of Hasson technique is that peritoneal cavity access is gained under direct vision, preventing most severe injuries. The open technique with radial expanding trocars is recommended for secure access to the abdominal cavity in videolaparoscopy. Great care should be taken to avoid major complications and understanding the abdominal wall anatomy is important for reducing bleeding during or after s placement of trocars.

  13. Anterior abdominal wall abscess with epididymo-orchitis: An unusual presentation of acute pancreatitis

    P M Kamble

    2011-01-01

    Full Text Available Pancreatitis indicates inflammation of the pancreas. Clinically acute pancreatitis typically presents as upper abdominal pain mostly in epigastric region, nausea, vomiting and elevated levels of amylase and lipase. Depending upon severity of acute pancreatitis patient may presents with minimal symptoms to more severe signs of acute abdomen like generalized guarding and rigidity. Inspite of absence of disease-specific signs and symptoms for acute pancreatitis, diagnosis is usually not difficult using a combination of clinical, laboratory and radiological findings. Sometimes pancreatitis may presents atypically, which may be misleading in the management especially when typical presentation of pancreatitis as described above is absent. We have described a case of pancreatitis where patient presented with anterior abdominal wall abscess with epididymo-orchitis because of tracking of pancreatic fluid into the retroperitoneum till scrotum. Patients presentation may be different depending upon complication occurred during the course of pancreatitis. After reviewing the literature we found very few cases in which you may not get a clue to diagnose pancreatitis because of atypical presentation. In the described case, patient managed conservatively with percutaneous drainage of the abscess by pigtail catheter placement and scrotal support for epididymoorchitis. This avoided unnecessary exploration in above patient.

  14. Inguinal hernia

    2008-01-01

    The main risk factors for inguinal hernia are male sex and increasing age. Complications of inguinal hernia include strangulation, intestinal obstruction, and infarction. Recurrence can occur after surgery.

  15. Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh

    Avendano-Peza, Héctor; Novitsky, Yuri W.

    2016-01-01

    Summary: Breast reconstruction with a pedicled transverse rectus abdominis muscle (TRAM) flap can result in significant abdominal wall donor-site morbidity. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. We present our novel technique of posterior components separation with transversus abdominis muscle release and retromuscular mesh reinforcement for donor-area closure during pedicled TRAM flap breast reconstruction.

  16. MR imaging of acute pancreatitis: Correlation of abdominal wall edema with severity scores

    Yang, Ru, E-mail: yangru0904@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: jzl325@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: zhangxm@nsmc.edu.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Tang, Wei, E-mail: tw-n-g-up@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Xiao, Bo, E-mail: xiaoboimaging@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: nc_hxh1966@yahoo.com.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: llinyangmd@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Feng, Zhi Song, E-mail: fengzhisong@medmail.com.cn [Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)

    2012-11-15

    Objective: To study MRI findings of abdominal wall edema (AWE) in acute pancreatitis as well as correlations between AWE and the severity of acute pancreatitis according to the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation III (APACHE III) scoring system. Materials and methods: A total of 160 patients with AP admitted to our institution between December 2009 and March 2011 were included in this study. MRI was performed within 48 h after admission. MRI findings of acute pancreatitis were noted, including AWE on the MRI. The abdominal wall area was divided into quarters, and each area involved was recorded as 1 point to score the severity of AWE. The severity of acute pancreatitis was studied using both the MRSI and the APACHE III scoring system. Spearman correlation of AWE with the MRSI and the APACHE III scoring system was analyzed. Results: In 160 patients with acute pancreatitis, 53.8% had AWE on MRI. The average AWE score was 1.2 {+-} 1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively, according to MRSI. AWE on MRI was correlated with MRSI scores (r = 0.441, p = 0.000). According to APACHE III scores, the averages were 2.0 {+-} 1.1 and 2.6 {+-} 1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE was slightly correlated with the APACHE III scores (r = 0.222, p = 0.005). Conclusion: AWE on MRI in acute pancreatitis is common, which may be a supplementary indicator in determining the severity of AP.

  17. Comparison of two porcine-derived materials for repairing abdominal wall defects in rats.

    Zhengni Liu

    Full Text Available OBJECTIVE: The purpose of this study was to compare the mechanical properties, host responses and incorporation of porcine small intestine submucosa (PSIS and porcine acellular dermal matrix (PADM in a rat model of abdominal wall defect repair. MATERIALS AND METHODS: Prior to implantation, PSIS and PADM were prepared and evaluated in terms of structure and mechanical properties. Full-thickness abdominal wall defects were created in 50 Sprague-Dawley rats, and were repaired using either PSIS or PADM. Rats were sacrificed 1, 2, 4, 8 and 12 weeks post-repair and examined for herniation, infection, adhesions, contraction, and changes in the thickness and strength of the tissues incorporated at the defect sites. Histopathology and immunohistochemistry were performed to analyze inflammatory responses, collagen deposition and vascularization. RESULTS: PADM showed more dense collagen deposition and stronger mechanical properties than PSIS prior to implantation (P<0.01. However, the mechanical properties observed after integration with the surrounding native tissues was similar for PADM and PSIS. Both PADM and PSIS showed significant contraction by week 12. However, PADM tissue induced less adhesion and increased in thickness more slowly, and showed less infiltration by foreign giant cells, polymorphonuclear cells, and mononuclear cells. Improved remodeling of host tissue was observed after PSIS implantation, which was apparent from the orientation of bands of fibrous connective tissue, intermixed with newly formed blood vessels by Week 12. CONCLUSION: PSIS showed weaker mechanical properties prior to implantation. However, after implantation PSIS induced more pronounced host responses and showed better incorporation into host tissues than PADM.

  18. Torsion of an Abdominal-Wall Pedunculated Lipoma: A Rare Differential Diagnosis for Right Iliac Fossa Pain

    2013-01-01

    Pedunculated lipomas arising from the peritoneal wall are a rare finding during abdominal surgery. These benign tumours of mesenchymal origin can arise anywhere in the body and are usually asymptomatic. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. To our knowledge, such a case has never been reported in the literature previously. We suggest that torsion of a pedunculated parietal lipoma is a r...

  19. Immunohistochemical evaluation of fibrillar components of the extracellular matrix of transversalis fascia and anterior abdominal rectus sheath in men with inguinal hernia

    Rogério De Oliveira Gonçalves

    2014-01-01

    Full Text Available OBJECTIVE: to evaluate the role of fibrillar extracellular matrix components in the pathogenesis of inguinal hernias. METHODS: samples of the transverse fascia and of the anterior sheath of the rectus abdominis muscle were collected from 40 men aged between 20 and 60 years with type II and IIIA Nyhus inguinal hernia and from 10 fresh male cadavers (controls without hernia in the same age range. The staining technique was immunohistochemistry for collagen I, collagen III and elastic fibers; quantification of fibrillar components was performed with an image analysis processing software. RESULTS: no statistically significant differences were found in the amount of elastic fibers, collagen I and collagen III, and the ratio of collagen I / III among patients with inguinal hernia when compared with subjects without hernia. CONCLUSION: the amount of fibrillar extracellular matrix components did not change in patients with and without inguinal hernia.

  20. The omentum-polypropylene sandwich technique: an attractive method to repair large abdominal-wall defects in the presence of contamination or infection.

    Bleichrodt, R.P.; Malyar, A.W.; Vries Reilingh, T.S. de; Buyne, O.R.; Bonenkamp, J.J.; Goor, H. van

    2007-01-01

    BACKGROUND: Repair of abdominal wall defects in the presence of contamination or infection continues to be a significant problem for surgeons. The loss of tissue warrants reinforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive opera

  1. Lumbar hernia treated with lightweight partially absorbable mesh: report of a case.

    Yamaguchi, Shohei; Tsutsumi, Norifumi; Kusumoto, Eiji; Endo, Kazuya; Ikejiri, Koji; Yamashita, Yo-ichi; Uchiyama, Hideaki; Saeki, Hiroshi; Oki, Eiji; Kawanaka, Hirofumi; Morita, Masaru; Ikeda, Tetsuo; Maehara, Yoshihiko

    2013-12-01

    Superior lumbar hernia, also known as Grynfeltt-Lesshaft hernia, is an uncommon abdominal wall defect. We report a case of superior lumbar hernia, which was successfully treated with a lightweight partially absorbable mesh. A 73-year-old man visited our department with complaints of lumbar pain and a feeling of pressure associated with a right lumbar mass. A CT scan of the abdomen demonstrated a defect in the aponeurosis of the transversus abdominis muscle and a protrusion of the small intestine through the defect. The diagnosis of a right superior lumbar hernia was made. The lumbar hernia was surgically treated with a lightweight large-pore polypropylene mesh containing an absorbable component consisting of poliglecaprone (ULTRAPRO Plug). The patient had no evidence of recurrence after 4 years of follow-up without any sense of discomfort. This is the first case report of a lumbar hernia treated with a lightweight partially absorbable mesh. This partially absorbable mesh can be considered to be suitable for the treatment of a lumbar hernia.

  2. Needlescopic Surgery Versus Single-port Laparoscopy for Inguinal Hernia

    Hollinsky, Christian

    2015-01-01

    Background and Objectives: In recent years, 2 modifications of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair—needlescopic (nTAPP) surgery and single-port (sTAPP) surgery—have greatly improved patient outcomes over traditional approaches. For a comparison of these 2 modifications, we sought to investigate and compare the extent of surgical trauma and postoperative consequences for the abdominal wall in these two procedures. Methods: In a retrospective study, 50 nTAPP and 35 sTAPP procedures occurring at a community hospital from November 1, 2009, through July 31, 2012 were reviewed. Intraoperative data, including length of the umbilical skin incision and operative time, were recorded. A follow-up evaluation included investigation of hernia recurrence, postoperative pain, abdominal wall mobility, cosmetic satisfaction, and period of sick leave. Results: The mean umbilical skin incision was 13 ± 4 mm in nTAPP vs 27 ± 3 mm in sTAPP (P < .001). The nTAPP procedure required less operating time than the sTAPP procedure (54.8 ± 16.9 minutes vs 85.9 ± 19.7 minutes; P < .001). The mean immediate postoperative pain score on the visual analog scale was 2.7 ± 2.1 in the nTAPP group and 4.4 ± 1.9 in the sTAPP group (P = .016). In addition, patients who underwent nTAPP had a shorter period of sick leave (11.2 ± 8.4 days vs 24.1 ± 20.1 days; P = .02). At the follow-up evaluation after approximately 30 months, abdominal wall mobility and cosmetic satisfaction were equally positive, with no hernia recurrence. Conclusion: In patients with uncomplicated inguinal hernia, the nTAPP procedure, with less surgical trauma and operating time, has distinct advantages in reduction of immediate postoperative pain and sick leave time. PMID:26229421

  3. Effects of arterial blood flow on walls of the abdominal aorta: distributions of wall shear stress and oscillatory shear index determined by phase-contrast magnetic resonance imaging.

    Sughimoto, Koichi; Shimamura, Yoshiaki; Tezuka, Chie; Tsubota, Ken'ichi; Liu, Hao; Okumura, Kenichiro; Masuda, Yoshitada; Haneishi, Hideaki

    2016-07-01

    Although abdominal aortic aneurysms (AAAs) occur mostly inferior to the renal artery, the mechanism of the development of AAA in relation to its specific location is not yet clearly understood. The objective of this study was to evaluate the hypothesis that even healthy volunteers may manifest specific flow characteristics of blood flow and alter wall shear or oscillatory shear stress in the areas where AAAs commonly develop. Eight healthy male volunteers were enrolled in this prospective study, aged from 24 to 27. Phase-contrast magnetic resonance imaging (MRI) was performed with electrocardiographic triggering. Flow-sensitive four-dimensional MR imaging of the abdominal aorta, with three-directional velocity encoding, including simple morphological image acquisition, was performed. Information on specific locations on the aortic wall was applied to the flow encodes to calculate wall shear stress (WSS) and oscillatory shear index (OSI). While time-framed WSS showed the highest peak of 1.14 ± 0.25 Pa in the juxtaposition of the renal artery, the WSS plateaued to 0.61 Pa at the anterior wall of the abdominal aorta. The OSI peaked distal to the renal arteries at the posterior wall of the abdominal aorta of 0.249 ± 0.148, and was constantly elevated in the whole abdominal aorta at more than 0.14. All subjects were found to have elevated OSI in regions where AAAs commonly occur. These findings indicate that areas of constant peaked oscillatory shear stress in the infra-renal aorta may be one of the factors that lead to morphological changes over time, even in healthy individuals.

  4. QUANTITATIVE INVIVO ASSESSMENT OF THE TISSUE-RESPONSE TO DERMAL SHEEP COLLAGEN IN ABDOMINAL-WALL DEFECTS

    HUNT, JA; VANDERLAAN, JS; SCHAKENRAAD, J; WILLIAMS, DF

    1993-01-01

    We quantified the tissue response, tissue organization and patency of biodegradable patches for the repair of abdominal wall defects. We used dermal sheep collagen, cross-linked with hexamethylenediisocyanate in a model. The collagen patches were implanted either untreated or plasma polymerized with

  5. [Case of abdominal wall malignant peripheral nerve sheath tumor which is difficult to distinguish from a urachal disease].

    Tatenuma, Tomoyuki; Sakata, Ryoko; Sugiura, Shinpei; Tajiri, Takehiro; Gondo, Toshikazu; Kitami, Kazuo

    2013-09-01

    Malignant peripheral nerve sheath tumors (MPNST) are highly malignant soft tissue sarcomas. It is very rare for MPNST to arise in the abdominal wall. We report a case of abdominal wall MPNST that was difficult to distinguish from a urachal disease. A 72-year-old woman found a mass of the umbilicus in October 2011. She visited a digestive surgery department in November because it gradually enlarged. Diagnostic imaging suggested a urachal tumor. She was then referred to our clinic. Contrast enhanced CT showed that the 5-cm cystic tumor extended from the umbilicus to abdominal wall. The tumor showed low uptake value in PET-CT. We diagnosed her with a urachal cyst, but could not deny urachal carcinoma. Therefore, we performed surgical resection in January 2012. The pathological diagnosis was MPNST. She has not experienced recurrence for 9 months. MPNST mostly occur in the retroperitoneum close to the spine, extremities, head, and neck. It is very rare for them to occur in the abdominal wall. This is the sixth case including overseas reports. In addition, this is the first case in which it was difficult to distinguish from a urachal disease.

  6. EXPANDED POLYTETRAFLUOROETHYLENE PATCH VERSUS POLYPROPYLENE MESH FOR THE REPAIR OF CONTAMINATED DEFECTS OF THE ABDOMINAL-WALL

    BLEICHRODT, RP; SIMMERMACHER, RKJ; VANDERLEI, B; SCHAKENRAAD, JM

    1993-01-01

    Contaminated defects of the abdominal wall continue to be a significant problem for patients and surgeons. The lack of sufficient tissue may require the insertion of a prosthetic material. Polypropylene (PP) mesh is still the most widely used material for this purpose, although the propensity to ind

  7. Proteins associated with the size and expansion rate of the abdominal aortic aneurysm wall as identified by proteomic analysis

    Urbonavicius, Sigitas; Lindholt, Jes S.; Delbosc, Sandrine

    2010-01-01

    Identification of biomarkers for the natural history of abdominal aortic aneurysms (AAA) holds the key to non-surgical intervention and improved selection for AAA repair. We aimed to associate the basic proteomic composition of AAA wall tissue with the expansion rate and size in patients with AAA....

  8. Abdominal wall reconstruction by a regionally distinct biocomposite of extracellular matrix digest and a biodegradable elastomer.

    Takanari, Keisuke; Hong, Yi; Hashizume, Ryotaro; Huber, Alexander; Amoroso, Nicholas J; D'Amore, Antonio; Badylak, Stephen F; Wagner, William R

    2016-09-01

    Current extracellular matrix (ECM) derived scaffolds offer promising regenerative responses in many settings, however in some applications there may be a desire for more robust and long lasting mechanical properties. A biohybrid composite material that offers both strength and bioactivity for optimal healing towards native tissue behavior may offer a solution to this problem. A regionally distinct biocomposite scaffold composed of a biodegradable elastomer (poly(ester urethane)urea) and porcine dermal ECM gel was generated to meet this need by a concurrent polymer electrospinning/ECM gel electrospraying technique where the electrosprayed component was varied temporally during the processing. A sandwich structure was achieved with polymer fiber rich upper and lower layers for structural support and an ECM-rich inner layer to encourage cell ingrowth. Increasing the upper and lower layer fiber content predictably increased tensile strength. In a rat full thickness abdominal wall defect model, the sandwich scaffold design maintained its thickness whereas control biohybrid scaffolds lacking the upper and lower fiber-rich regions failed at 8 weeks. Sandwich scaffold implants also showed higher collagen content 4 and 8 weeks after implantation, exhibited an increased M2 macrophage phenotype response at later times and developed biaxial mechanical properties better approximating native tissue. By employing a processing approach that creates a sheet-form scaffold with regionally distinct zones, it was possible to improve biological outcomes in body wall repair and provide the means for further tuning scaffold mechanical parameters when targeting other applications. Copyright © 2013 John Wiley & Sons, Ltd.

  9. Double-layer mesh hernioplasty for repairing umbilical hernias in 10 goats*

    2011-01-01

    Umbilical hernias in goats are uncommon and can vary in their etiology and management. Hernioplasty can be done by closing the abdominal wall with a horizontal mattress pattern using absorbable sutures. However, larger defects (hernial ring size >3 cm) generally require the use of prosthetic materials that allow for a tension-free repair. In this study, 10 young female goats with umbilical hernias and hernial ring sizes ranging from 7-10 cm in width were treated using a double-layer polypr...

  10. Incarcerated appendix in a Spigelian hernia

    Caroline Reinke

    2010-12-01

    Full Text Available Spigelian hernias are rare, making up only 1-2% of all hernias. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect.(1 We describe here the case of a 71-year-old female with a 10-year history of right lower quadrant pain that remained undiagnosed despite multiple imaging studies. Prior to presentation the patient developed a new bulge and increasing pain at this site; an ultrasound revealed the presence of a bowel-containing hernia. The patient was taken urgently to the operating room for a laparoscopic Spigelian hernia repair, and was found to have an incarcerated appendix in the hernia. After the hernia was reduced, an appendectomy was performed and the hernia was repaired with biological mesh. Postoperatively, the patient did well, and her pain resolved.

  11. Histochemical and immunohistochemical analysis of ruptured atherosclerotic abdominal aortic aneurysm wall

    Tanasković Irena

    2010-01-01

    Full Text Available Background/Aim. The main complication of the atherosclerotic abdominal aortic aneurism (AAA is her rupture that begins with lesion in intima and rupture. The purpose of this work was to determine immunocytochemical and morphofunctional characteristics of the cells in aortic wall in ruptured atherosclerotic abdominal aortic aneurysm. Method. During the course of this study, 20 samples of atherosclerotic AAA were analyzed, all of them obtained during authopsy. The samples were fixed in 4% formalin and embedded in paraffin. Sections of 5 μm thickness were stained histochemically (of Heidenhain azan stain and Periodic acid Schiff - PAS stain and immunocytochemically using a DAKO LSAB+/HRP technique to identify α-smooth muscle actin (α-SMA, vimentin, myosin heavy chains (MHC, desmin, S-100 protein, CD45 and CD68 (DAKO specification. Results. The results of our study showed that ruptured atherosclerotic AAA is characterized by a complete absence of endothelial cells, the disruption of basal membrane and internal elastic lamina, as well as a presence of the remains of hypocellular complicated atherosclerotic lesion in intima. On the plaque margins, as well as in the media, smooth muscle cells (SMCs are present, which express a α-SMA and vimentin (but without MHC or desmin expression, as well as leukocyte infiltration, and a large number of foam cells. Some of the foam cells show a CD68-immunoreactivity, while the others show vimentin- and S-100 protein-immunoreactivity. Media is thinned out with a disorganized elastic lamellas, while adventitia is characterized by inflammatory inflitrate (infection. Conclusion. Rupture of aneurysm occurs from the primary intimal disruption, which spreads into thinned out media and adventitia. Rupture is caused by unstable atherom, hypocellularity, loss of contractile characteristics of smooth muscle cells in intima and media, neovascularization of the media, as well as by the activity of the macrophages in the

  12. Biomechanical and morphological study of a new elastic mesh (Ciberlastic) to repair abdominal wall defects.

    Calvo, B; Pascual, G; Peña, E; Pérez-Khöler, B; Rodríguez, M; Bellón, J M

    2016-06-01

    The aim of this study was to conduct a preclinical evaluation of the behaviour of a new type of abdominal LW prosthesis (Ciberlastic), which was designed with a non-absorbable elastic polyurethane monofilament (Assuplus, Assut Europe, Italy) to allow greater adaptability to mechanical area requirements and higher bio-mimicking with the newly formed surrounding tissues. Our hypothesis was that an increase in the elasticity of the mesh filament could improve the benefits of LW prostheses. To verify our hypothesis, we compared the short- and long-term behaviour of Ciberlastic and Optilene(®) elastic commercial meshes by repairing the partially herniated abdomen in New Zealand White rabbits. The implanted meshes were mechanically and histologically assessed at 14 and 180 days post-implant. We mechanically characterized the partially herniated repaired muscle tissue and also determined mesh shrinkage at different post-implant times. This was followed by a histological study in which the tissue incorporation process was analysed over time. The new prosthesis designed by our group achieved good behaviour that was similar to that of Optilene(®), one of the most popular LW prostheses on the market, with the added advantage of its elastic property. The mechanical properties are significantly lower than those of the polypropylene Optilene(®) mesh, and the new elastic mesh meets the basic mechanical requirements for positioning in the abdominal wall, which was also demonstrated by the absence of recurrences after implantation in the experimental model. We found that the growth of a connective tissue rich in collagen over the hernial defect and the proper deposit of the collagen fibres in the regenerated tissue substantially modified the original properties of the mesh, thereby increasing its biomechanical strength and making the whole tissue/mesh stiffer.

  13. 3-D segmentation and quantitative analysis of inner and outer walls of thrombotic abdominal aortic aneurysms

    Lee, Kyungmoo; Yin, Yin; Wahle, Andreas; Olszewski, Mark E.; Sonka, Milan

    2008-03-01

    An abdominal aortic aneurysm (AAA) is an area of a localized widening of the abdominal aorta, with a frequent presence of thrombus. A ruptured aneurysm can cause death due to severe internal bleeding. AAA thrombus segmentation and quantitative analysis are of paramount importance for diagnosis, risk assessment, and determination of treatment options. Until now, only a small number of methods for thrombus segmentation and analysis have been presented in the literature, either requiring substantial user interaction or exhibiting insufficient performance. We report a novel method offering minimal user interaction and high accuracy. Our thrombus segmentation method is composed of an initial automated luminal surface segmentation, followed by a cost function-based optimal segmentation of the inner and outer surfaces of the aortic wall. The approach utilizes the power and flexibility of the optimal triangle mesh-based 3-D graph search method, in which cost functions for thrombus inner and outer surfaces are based on gradient magnitudes. Sometimes local failures caused by image ambiguity occur, in which case several control points are used to guide the computer segmentation without the need to trace borders manually. Our method was tested in 9 MDCT image datasets (951 image slices). With the exception of a case in which the thrombus was highly eccentric, visually acceptable aortic lumen and thrombus segmentation results were achieved. No user interaction was used in 3 out of 8 datasets, and 7.80 +/- 2.71 mouse clicks per case / 0.083 +/- 0.035 mouse clicks per image slice were required in the remaining 5 datasets.

  14. Giant desmoid tumor of the abdominal wall in a patient with Gardner Syndrome

    Daniel Paulino Santana

    2012-09-01

    Full Text Available Gardner syndrome (GS is a rare entity characterized by a triad of familial colonic polyposis, multiple osteomas and soft tissue tumors, including desmoid tumor (DT. This is a case report of a 30 year-old patient with GS who developed giant DT in the abdominal wall after undergoing several laparotomies. The patient has taken a long time to search for medical care, and at first he saw another team that refused to operate him by judging the lesion unresectable. The surgery in our department was performed in three steps. Initially, we resected the lesion with macroscopic margins, and as there were small bowel adhesions in the tumor, we performed enterectomy and closed using the "Bogotá" technique, with skin closure on the bag. On the fourth postoperative day (POD, we reoperated the abdomen without identifying any signs of fistula. On the seventh POD there was another surgical intervention, this time to insert a double-sided mesh. The patient recovered well, and had no debilitating motor deficit, despite the extensive resection of the abdominal muscles. Curative treatment of DT is based on surgical resection and only sequential surveillance allows us an early diagnosis, when the lesion is still resectable.Tumor desmoide gigante de parede abdominal em paciente portador da Síndrome de Gardner. A Síndrome de Gardner (SG é uma entidade rara caracterizada pela tríade polipose colônica familial, múltiplos osteomas e tumores de tecidos moles, dentre eles o tumor desmoide (TD. Tratou-se de um relato de caso de um paciente de 30 anos, com SG que evoluiu com TD gigante em parede abdominal, após ser submetido a diversas laparotomias prévias. O paciente levou longo tempo para procurar o serviço de cirurgia, passando por outra equipe que se negou a abordá-lo por julgar a lesão irressecável. A cirurgia no nosso serviço se deu em três tempos. Inicialmente, foi feita a ressecção da lesão com margens macroscópicas e, por haver aderências de al

  15. Tumor desmóide da parede abdominal durante a gravidez: relato de caso Desmoid tumor of the abdominal wall during pregnancy: a case report

    Denise Gonçalves Priolli

    2005-05-01

    Full Text Available Tumores desmóides são neoplasias do tecido conjuntivo, caracterizadas por apresentarem crescimento exclusivamente loco-regional, recorrência freqüente e mínimo potencial metastático. Acometem principalmente portadores de polipose adenomatosa familial dos cólons, sendo sua ocorrência isolada extremamente rara. São mais freqüentes nas mulheres em idade reprodutiva e durante a gravidez. Descreve-se um caso de tumor desmóide de grandes proporções, localizado na parede abdominal, que surgiu a partir da 17ª semana em gestante sem antecedentes de polipose adenomatosa familial. A neoplasia foi totalmente extirpada utilizando-se prótese de polipropileno para reconstituição da parede abdominal. Atualmente a doente encontra-se bem, um ano após a cirurgia, em uso de antiinflamatório não hormonal para prevenção de recidivas.Desmoid tumors are neoplasms of the conjunctive tissue that are characterized by exclusive locoregional growth, frequent recurrence and minimal metastatic potential. They mainly affect individuals with familial adenomatous polyposis of the colon, and rarely occur isolated. The single form of this neoplasm most frequently appears in women of reproductive age, and during pregnancy. A case of a desmoid tumor of large proportions located in the abdominal wall is described. It appeared at the 17th week of pregnancy in a woman without any history of familial adenomatous polyposis. The neoplasm was totally extirpated, with the use of a polypropylene prosthesis for reconstitution of the abdominal wall. One year after the surgery, the patient continues to be well, while using non-steroidal anti-inflammatory drugs for the prevention of relapses.

  16. Pubic inguinal pain syndrome: the so-called sports hernia.

    Cavalli, Marta; Bombini, Grazia; Campanelli, Giampiero

    2014-03-01

    The "sportsman's hernia" commonly presents as a painful groin in those sports that involve kicking and twisting movements while running, particularly in rugby, football, soccer, and ice hockey players. Moreover, sportsman's hernia can be encountered even in normally physically active people. The pain experienced is recognized at the common point of origin of the rectus abdominis muscle and the adductor longus tendon on the pubic bone and the insertion of the inguinal ligament on the pubic bone. It is accepted that this chronic pain caused by abdominal wall weakness or injury occurs without a palpable hernia. We proposed the new name "pubic inguinal pain syndrome." In the period between January 2006 and November 2013 all patients afferent in our ambulatory clinic for chronic groin pain without a clinically evident hernia were assessed with medical history, physical examination, dynamic ultrasound, and pelvic and lumbar MRI. All patients were proposed for a conservative treatment and then, if it was not effective, for a surgical treatment. Our etiopathogenetic theory is based on three factors: (1) the compression of the three nerves of the inguinal region, (2) the imbalance in strength of adductor and abdominal wall muscles caused by the hypertrophy and stiffness of the insertion of rectus muscle and adductor longus muscle, and (3) the partial weakness of the posterior wall. Our surgical procedure includes the release of all three nerves of the region, the correction of the imbalance in strength with the partial tenotomy of the rectus and adductor longus muscles, and the repair of the partial weakness of the posterior wall with a lightweight mesh. This treatment reported excellent results with complete relief of symptoms after resumption of physical activity in all cases.

  17. Clinical Feasibility of 90 Cases of Abdominal Transverse Striation Small Incision Surgical Treatment of Pediatric Hernia%90例腹横纹小切口手术治疗小儿疝气临床可行性

    庞京文

    2015-01-01

    目的:探讨腹横纹小切口手术治疗小儿疝气的临床效果。方法选取我院收治的疝气患儿90例,按照手术方式划分,对照组42例行传统术式治疗,观察组48例行腹横纹小切口手术。结果观察组住院时间、止痛药使用次数、术中出血量以及手术时间均要优于对照组,两组对比差异有统计学意义(P<0.05)。结论对小儿疝气患者采用腹横纹小切口手术可行性高。%Objective To explore the abdominal transverse striation small incision surgery clinical effect for the treatment of pediatric hernia. Methods Select 90 children with hernia in our hospital, according to the operation method, divided into the control group, 42 cases treated by traditional surgery group 48 cases with abdominal transverse striation small incision surgery. Results Observation group usage, intraoperative blood loss, hospital stay, painkillers and operation time were superior to control group, compared the two groups was statistically significant difference (P<0.05). Conclusion For pediatric hernia were treated by abdominal transverse striation feasibility is high.

  18. Reconstrucción de las secuelas de la pared abdominal en pacientes con extrofia de cloaca Reconstruction of abdominal wall sequelae in patients with cloacal extrophy

    P. Iwanyk

    2009-06-01

    Full Text Available Los defectos abdominales congénitos de la línea media inferior, como la extrofia cloacal, se producen por fallos en el mesodermo entre la región umbilical y la membrana cloacal provocando severos defectos viscerales, musculares y óseos. Los reiterados intentos para la reconstrucción de los tractos intestinal y génitourinario en este tipo de malformaciones, pueden ocasionar secuelas graves en la pared malformada. La complejidad de esta malformación y los numerosos procedimientos a los que deben ser sometidos estos pacientes, requieren de un abordaje interdisciplinario desde el inicio del tratamiento y en cada una de las etapas reconstructivas a fin de evitar, al máximo, las lesiones de los tejidos abdominales para lograr, al final, una pared adecuada. Presentamos 2 casos de reconstrucción de la pared abdominal en sendos pacientes de sexo femenino con secuelas importantes de extrofia cloacal, utilizando tejidos expandidos, colgajos musculares y complementando el tratamiento en una de las pacientes con una malla protésica. En ambos casos, y a pesar de la falta de tejido provocada por la malformación y las secuelas de múltiples cirugías, obtuvimos un buen resultado funcional y estético.Abdominal congenital defects of the middle line have their origin in developmental faults of mesoderm between the umbilical region and the cloacal membrane, originating visceral, muscular and osseous defects in the abdominal wall. Repeated attempts to reconstruct the intestinal and genitourinary tract here and in other malformations, can cause serious sequeals in the previously deformed abdominal wall. We present 2 cases of abdominal wall reconstruction in patients with serious sequelae of cloacal extrophy. Complexity of this malformation calls for an interdisciplinary treatment to avoid the severe damage that may be caused during reconstructive attempts. In spite of lack of tissue because of the malformation and the sequelae of multiple surgeries we

  19. GAINT INGUINOSCROTAL HERNIA – LICHTENSTEIN’S TENSION FREE REPAIR WITHOUT LOSS OF DOMAIN: CASE REPORT

    Sreekant

    2015-03-01

    Full Text Available Inguinal hernia is one of the most surgical common diseases in clinical practice. The history of inguinal hernia repair originated in the ancient times and the treatment has evolved, developed and changed since. [1] The most recent one is the concept of tension - free repair which remains popular among surgeons today. It is interesting to note, though, that numerous literatures have been published on this disease in the small anatomical space despite its simplicity. In the past couple of years, most publications focused on laparoscopic surgery and the different types of prosthetic mesh. Giant inguinal hernia, however, is more unusual and significantly challenging in terms of surgical management. It is defined as an ingu inal hernia that extends below the midpoint of inner thigh when the patient is in standing position. [2] No treatment has been adopted as standard procedure for this uncommon disease and several repair techniques are suggested by published articles and case reports. Further, the absence of large scale comparative study is expected to continue due to the relatively low number of cases. As a result, choosing a surgical procedure is made difficult and the decision must be made intraoperatively. A 55 - year - old ma le patient presented with Left Giant inguinal hernia and compromised quality of life due to pain and sexual discomfort. Lichtenstein’s polypropylene mesh repair was done after reducing the sac contents (omentum and ileum with partial omentectomy. There wa s no loss of intra - abdominal domain. Postoperative period was uneventful. In literature many techniques are available to increase the intra - abdominal cavity (a Creating progressive preoperative pneumoperitoneum (b Creation of ventral wall defect (c surg ical debulking of hernia contents. Recurrence is prevented by reconstruction of the abdominal wall using Marlex mesh and a Tensor fasciae lata flap. Laparoscopic repair is associated with more recurrence

  20. [A case of left-sided Morgagni hernia complicating incarcerated small bowel hernia].

    Kim, Se Won; Jung, Sang Hun; Kang, Su Hwan

    2008-01-01

    Morgagni hernia is an uncommon presentation representing about 3% in incidence and usually located in the right-sided anterior diaphragm. We experienced a case of Morgagni hernia in a seventy four-year-old male who was admitted complaining of intermittent abdominal pain. The diagnosis was made initially by chest and abdominal radiography, and an incarcerated Morgagni hernia was finally diagnosed with abdominal CT scans. Emergent laparotomy was performed. Morgagni foramen was located on the left-sided anterior diaphragm and Morgagni hernia which contained greater omentum and strangulated small intestine was gently reducted. Morgagni foramen measuring 4 x 5 cm was repaired with a Gortex mesh. We reported the experience of left-sided Morgagni hernia complicating incarcerated small bowel hernia in an old male patient.

  1. Evaluation of the Components Separation Method for treatment of patients with large abdominal wall defects

    Geffen, H.J.A.A. van

    2007-01-01

    An incisional hernia occurs in 11 % to 18.7 % of patients, within 10 years after laparotomy. Morbidity of reconstruction is high and long term results are poor with recurrence rates varying from 32 - 63 % after 10 years of follow-up. Oscar Ramirez described good results by using the Components Separ

  2. Changing trend in congenital abdominal wall defects in Eastern region of Ireland.

    McDonnell, R

    2002-09-01

    In the past six years, there have been reports from abroad of an unexplained rise in the birth prevalence rate of the congenital abdominal wall defect gastroschisis, while rates for the macroscopically similar anomaly omphalocoele have remained stable. The Dublin EUROCAT Registry of congenital anomalies monitors trends in the birth prevalence of birth defects in the eastern region of Ireland. We analysed births of children with omphalocoele and gastroschisis born in the period 1981-2000, with comparisons of a number of demographic and obstetric variables. During the 20 year period the birth prevalence rate for omphalocoele remained stable at 2.5\\/10,000 births, whereas the rate for gastroschisis increased significantly during the 1990s from 1.0\\/10,000 in 1991 to 4.9\\/10,000 in 2000. Most of the increase occurred among mothers under 25 years of age. Omphalocoele was associated with a relatively high proportion of other major congenital anomalies. This study showed that there has been an unexpected rise in the birth prevalence of gastroschisis in the region, similar to that experienced in other countries in the same time period and likely to have common aetiological features.

  3. Metastatic breast carcinoma of the abdominal wall muscle: a case report.

    Ogiya, Akiko; Takahashi, Kaoru; Sato, Mutsumi; Kubo, Yoshiko; Nishikawa, Noriko; Kikutani, Mariko; Tadokoro, Yukiko; Tanaka, Kumiko; Uematsu, Takayoshi; Watanabe, Junichiro; Kasami, Masako; Yamasaki, Seiji

    2015-03-01

    Metastasis from breast carcinoma is an uncommon occurrence in skeletal muscle, compared to local invasion into muscle from direct tumor spread. A 49-year-old woman was referred to our hospital with an 8.5-cm mass in the right breast. Core needle biopsy revealed metaplastic carcinoma with squamous metaplasia. The mass was rapidly growing and metaplastic, so mastectomy with dissection of axillary lymph nodes was performed. Pathological examination showed metaplastic carcinoma, histological grade 3, triple negative, and a MIB-1 labeling index of 80%. Six months postoperatively, during adjuvant chemotherapy treatment, she reported numbness and pain in the right lateral thigh and a mass in the right lower abdomen. Computed tomography revealed multiple lined masses in the abdominal wall and iliac muscle. Core needle biopsy showed metastatic breast carcinoma. Radio- and chemotherapy were administered, but the mass in the muscle became enlarged. To control her pain, a combined treatment with morphine, fentanyl, ketamine, antiepilepsy drug, and NSAIDs was administered. Liver metastasis appeared 9 months (15 months postoperatively) after recognition of muscle metastasis, and the patient died 16 months postoperatively. Skeletal muscle metastasis is uncommon, and therapeutic intervention is mainly palliative. The most common symptom of skeletal muscle metastasis is pain; thus, pain control is a pivotal goal of treatment.

  4. A case of the vacuum phenomenon as a mechanism of gas production in the abdominal wall.

    Mishima, Kentaro; Omori, Kazuhiko; Ohsaka, Hiromichi; Takeda, Jun; Ishikawa, Kouhei; Obinata, Mariko; Oode, Yasumasa; Sugita, Manabu; Yanagawa, Youichi

    2015-06-01

    A 40-year-old man experienced a collision with a car while driving a motorcycle in which the car was in the opposite lane and made a right turn. The patient was thrown approximately 10 m from the point of collision and, as he exhibited a consciousness disturbance, was transferred to our department. He had a score of 13 on the Glasgow Coma Scale with sinus tachycardia on arrival. He showed guarding of the abdomen. A pan scan disclosed traumatic subarachnoid hemorrhage, intraventricular hemorrhage, fractures of the atlas, thoracic spine, sternum and left femur, and gas in the abdomen located just in front of the stomach. As the gas in the abdomen was initially judged to be free air, the patient underwent emergency laparotomy. However, no signs of perforation or injury were detected throughout the entire digestive tract. The accumulation of minute gas (vacuum phenomenon) occurs as traumatic impact. As representative mimics of free air were not observed during surgery in the present case, we believe that the traumatic impact to the patient's abdomen as a result of the collision caused the accumulation of gas in the abdominal wall due to vacuum phenomenon. Physicians should be aware of this clinical entity to accurately recognize the mechanism of gas formation in patients showing negative laparotomy findings for gas in the abdomen. This unique case adds additional information regarding the documented etiologies of mimics of pneumoperitoneum.

  5. Effect of alpha lipoic acid co-administration on structural and immunohistochemical changes in subcutaneous tissue of anterior abdominal wall of adult male albino rat in response to polypropylene mesh implantation.

    Mazroa, Shireen A; Asker, Samar A; Asker, Waleed; Abd Ellatif, Mohamed

    2015-06-01

    Polypropylene mesh is commonly used in the treatment of abdominal hernia. Different approaches were addressed to improve their tissue integration and consequently reduce long-term complications. This study aimed to investigate the effect of alpha-lipoic acid (ALA) co-administration on structural and immunohistochemical (IHC) changes in the subcutaneous tissues of the anterior abdominal wall of the adult rat in response to polypropylene mesh implantation. Forty adult male albino rats were divided into: group I (control), group II (receiving ALA), group III (polypropylene mesh implantation) and group IV (mesh implantation + ALA co-administration). After 4 weeks, subcutaneous tissue samples were prepared for light microscopy and IHC study of CD34 as a marker for angiogenesis. In groups I and II rats, positive CD34 expression was demonstrated by IHC reaction, localized to endothelial cells lining small blood vessels. Group III showed an excess inflammatory reaction, deposition of both regular and irregularly arranged collagen fibres around mesh pores and few elastic fibres. CD34-positive was detected not only in cells lining small blood vessels but also in other cells scattered in the connective tissue indicating angiogenesis. In group IV, ALA co-administration resulted in less inflammatory reaction, regular collagen deposition, enhanced elastic fibres synthesis and a significant increase in CD34-positive cells and small blood vessels reflecting improved angiogenesis. ALA co-administration with polypropylene mesh implantation controlled the inflammatory reaction, helped regular collagen deposition, enhanced elastic fibres synthesis and improved angiogenesis in the subcutaneous tissue of anterior abdominal wall of adult albino rats, suggesting a possible role of ALA in optimizing mesh integration in subcutaneous tissue.

  6. Malignant granular cell tumor of the abdominal wall mimicking desmoid tumor: A case report with CT imaging findings and literature review

    Yoon, Je Hong; Ahn, Sung Eun; Lee, Dong Ho; Park, Seong Jin; Moon, Sung Kyoung; Lim, Joo Won [Dept. Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul (Korea, Republic of)

    2016-08-15

    Granular cell tumors (GCTs) are extremely rare mesenchymal neoplasms of Schwann cell origin. Malignant GCTs (MGCTs) comprise 0.5-2% of all GCTs. In the present report, we describe a case of a 66-year-old man with MGCT of the abdominal wall. The patient visited our hospital due to a recently growing palpable soft tissue mass in the abdominal wall. Computed tomography scan revealed a 4.3 × 4.1 × 2.9 cm sized mass arising from the left abdominal wall, which was contemplated as a desmoid tumor before surgical excision. Histopathological examination confirmed MGCT.

  7. A rare cause of intestinal obstruction: incarcerated femoral hernia, strangulated obturator hernia.

    Uludag, M; Yetkin, G; Kebudi, A; Isgor, A; Akgun, I; Dönmez, A G

    2006-06-01

    Obturator hernia may occur bilaterally in association with another hernia, which is usually of the femoral type. We present a 77-year-old-woman who had abdominal pain with nausea and vomiting together with swelling of the right groin for 3 days. Incarcerated right femoral hernia and consequent mechanical small-bowel obstruction was diagnosed, and urgent operation was undertaken. As the incarcerated femoral hernia reduced spontaneously during the induction of anesthesia, a lower median incision was performed. During exploration, the real cause of mechanical intestinal obstruction was found to be a small intestinal loop strangulated in the left obturator hernia. Right femoral and left obturator hernia were repaired with preperitoneal polypropylene mesh. If there is enough time and general condition of the older patient is suitable, further diagnostic techniques for concomitant obturator hernias may be useful in patients who present with signs of incarcerated inguinal hernia and intestinal obstruction.

  8. The use of PROCEED mesh in ventral hernias: A pilot study on 22 cases

    Almoutaz A Eltayeb

    2013-01-01

    Full Text Available Background: The management of major omphalocoele and large incisional hernias is a common problem and constitutes a great challenge for paediatric surgeons. In most cases, the abdominal cavity is so small and does not allow immediate reduction. Prosthetic materials are becoming increasingly popular for such repair, but direct contact between the bowel and these synthetic materials carries the risk of adhesions and intestinal obstruction. The relatively new PROCEED mesh with absorbable layer in contact with the bowel and another polypropylene non-absorbable layer against the abdominal wall may not produce such adhesions. The aim of this study is to evaluate the feasibility and outcome of this relatively new prosthetic mesh for repair of ventral hernia . Patients and Methods: Between June 2009 and December 2012, a pilot study was conducted on 22 cases with large ventral hernias subjected to open surgical repair using PROCEED mesh. The inclusion criterion was cases with large ventral hernias (>4 cm. The evaluating parameters were all the early and late postoperative complications. Results: The defect size ranged from 5 to 12 cm. The early postoperative complication (≤1 month was seroma discharged from the wound in four cases, while the late complications were recurrent herniation and stitch sinus that occurred in three cases. No manifestations of intestinal obstruction, enterocutaneous fistula or mortality were encountered in any of the 22 cases. Conclusion: The use of PROCEED composite mesh in ventral hernias is feasible and has minimal complication rates.

  9. Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

    Sung Kyu Bae

    2013-01-01

    Full Text Available Background If a chronically infected abdominal wound develops, complications such asperitonitis and an abdominal wall defect could occur. This could prolong the patient’s hospitalstay and increase the possibility of re-operation or another infection as well. For this reason,a solution for infection control is necessary. In this study, surgery using a rectus abdominismuscle myofascial splitting flap was performed on an abdominal wall defect.Methods From 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture,cesarean section, or uterine myoma were chosen. In each case, during the first week afteroperation, the wound showed signs of infection. Surgery was chosen because the wounds didnot resolve with dressing. Debridement was performed along the previous operation woundand dissection of the skin was performed to separate the skin and subcutaneous tissue fromthe attenuated rectus muscle and Scarpa’s fascial layers. Once the anterior rectus sheath andmuscle were adequately mobilized, the fascia and muscle flap were advanced medially sothat the skin defect could be covered for reconstruction.Results Upon 3-week follow-up after a rectus abdominis myofascial splitting flap operation,no major complication occurred. In addition, all of the patients showed satisfaction in termsof function and esthetics at 3 to 6 months post-surgery.Conclusions Using a rectus abdominis myofascial splitting flap has many esthetic andfunctional benefits over previous methods of abdominal defect treatment, and notably, itenabled infection control by reconstruction using muscle.

  10. Meconial peritonitis in a rare association of partial ileal apple-peel atresia with small abdominal wall defect

    V. Insinga

    2014-06-01

    Full Text Available Intestinal atresia type III B (apple peel and gastroschisis are both congenital malformations who require early surgical correction in neonatal age. Their association is very rare. We present the case of a full term infant with partial apple peel ileal atresia and a small defect of the anterior abdominal wall, complicated by in utero intestinal perforation and subsequent meconial peritonitis. We observed a partial atresia of small intestine, with involvement of terminal ileus savings of jejunum and a large part of the proximal ileum, small anterior abdominal wall defect with herniation of few bowel loops, intestinal malrotation. Paralytic ileus and infections are the main causes of morbidity and mortality at neonatal age. In our case, in spite of the mild phenotype, prognosis has been complicated by the onset of functional bowel obstruction, caused by chemical peritonitis resulting from contact with either amniotic fluid and meconium.

  11. Treatment of delayed jejunal perforation after irreducible femoral hernia repair with open abdomen management and delayed abdominal closure with skin flap approximation

    Fahri Yetişir

    2015-01-01

    Conclusion: Delayed bowel perforation may develop after irreducible femoral hernia surgery. OA management with NPT and DAC with skin flap approximation are optimal treatment modalities for the hemodynamically instable patient.

  12. Effectiveness of porcine dermal collagen in giant hernia closure in patients with deleterious fascia constitution after orthotopic liver transplantation.

    Werkgartner, Georg; Cerwenka, Herwig; Rappl, Thomas; Kniepeiss, Daniela; Kornprat, Peter; Iberer, Florian; Bacher, Heinz; Wagner, Mathias; Mischinger, Hans J; Wagner, Doris

    2015-02-01

    Incisional hernias (IHs) occur universally after orthotopic liver transplantation (OLT). This study aimed to investigate the effectiveness of porcine dermal collagen (PDC) as a closing aid in giant hernias after OLT in a prospective trial. If direct closure (DC) was not feasible due to the hernia size and abdominal wall constitution, a PDC mesh was implanted. All patients from the PDC and DC groups were followed prospectively for 24 months. IH recurrence rates served as the primary endpoint, and the development of infections and wound healing disorders served as the secondary endpoints. Recurrence rate was 21% (4/19) in DC patients and 12% (2/16) in PDC patients (P = 0.045). Implant site infections occurred in five of PDC and one of DC patients (P < 0.05). All of them were managed with antibiotics; two of the PDC patients required surgical drainage. Histological analysis of PDC mesh biopsies indicated good angiogenesis and integration of the PDC into the abdominal wall. PDC was effective in our study for incisional hernia repair, and our results compared favourably with those of patients in whom direct hernia closure was feasible.

  13. Gross hematuria as the presentation of an inguinoscrotal hernia: a case report

    Ansari Kayvan

    2011-12-01

    Full Text Available Abstract Introduction Several complications have been reported with inguinal hernias. Although hematuria and flank pain, either as the presentation or as a complication of inguinal hernia, are infrequent, this condition may lead to the development of obstructive uropathy, which can have diverse manifestations. Case presentation A 71-year-old Iranian man with Persian ethnicity presented with new onset episodes of gross hematuria and left-sided flank pain. A physical examination revealed a large and non-tender inguinal hernia on his left side. An initial workup included an abdominal ultrasound, an intravenous pyelogram and cystoscopy, which showed left hydronephrosis and a bulging on the left-side of his bladder wall. On further evaluation, computed tomography confirmed that his sigmoid colon was the source of the pressure effect on his bladder, resulting in hydroureteronephrosis and hematuria. No tumoral lesion was evident. Herniorrhaphy led to the resolution of his signs and symptoms. Conclusion Our case illustrates a rare presentation of inguinal hernia responsible for gross hematuria and unilateral hydronephrosis. Urologic signs and symptoms can be caused by the content of inguinal hernias. They can also present as complications of inguinal hernias.

  14. Electromyographic activity of the anterolateral abdominal wall muscles during the vesical filling and evacuation

    Ahmed Shafik

    2007-06-01

    Full Text Available

    BACKGROUND: The role of the anterolateral abdominal wall muscles (AAWMs during the vesical filling and evacuation has not been sufficiently addressed in the literature. We have investigated the hypothesis that the AAWMs exhibit the increased electromyographic (EMG activity on the vesical distension and contraction which presumably assists vesical evacuation.

    METHODS: The effects of the vesical balloon distension on the vesical pressure (VP, vesical neck (VNP pressures and the AAWMs' EMG activity were studied in 28 healthy volunteers aged 40.7 ± 9.7 years (18 men, 10 women. These effects were tested after the individual anesthetization of the bladder and AAWMs and after saline infiltration.

    RESULTS: The VP and the VNP showed a gradual increase upon the incremental vesical balloon distension which started at a distending volume of 120–140 ml. At a mean volume of 364.6 ± 23.8 ml, the VP increased to a mean of 36.6 ± 3.2 cmH2O, the VNP decreased to 18.4 ± 2.4 cmH2O, and the AAWMs EMG registered a significant increase. This effect disappeared in the individual bladder and in the AAWMs' anesthetization. However, it did not disappear in the saline administration.

    CONCLUSIONS: The AAWMs appear to contract simultaneously with vesical contraction. This action presumably increases the IAP and it

  15. O uso de telas Parietex® e Surgisis® na correção de defeitos produzidos na parede abdominal de coelhos The repair of abdominal defects in rabbits with Parietex® and Surgisis® meshes abdominal wall

    João Batista Baroncello

    2008-12-01

    MMP8 e MMP13 em relação à Surgisis®.BACKGROUND: In general surgery, the repair of abdominal wall hernias has a prominent place, and the indications and uses of meshes have increased due to better results. AIM: To compare the repair of induced abdominal wall defects with Parietex® and Surgisis® meshes, in direct contact with abdominal viscera (intraperitoneal mesh. METHOD: For the experiments, were used 16 female young adult rabbits. Two full thickness triangular defects of 2 cm base by 2.5 cm high were created, lateral to the linea alba, one at each side. They were repaired with rectangular meshes of 3 cm base by 3.5 cm high, on the right side with Parietex® mesh (polyester/collagen-polyethylenglycol-glycerol, and on the left side with Surgisis® mesh (lyophilized porcine small bowel submucosa. The evaluation included clinical-surgical findings as well as histological and immunohistochemical parameters. Eight rabbits were subjected to euthanasia after 30 days, and the eight after 60 days. RESULTS: Both meshes induced skin erosions, despite the varying levels of mesh undermining evaluated, no incisional hernia occurred. There were peritoneal adhesions to the surface of both types of meshes after 30 days and in a lower extent and intensity after 60 days. Meshes' shrinking correspond to 1/3 of the original size and Parietex® caused less inflammatory process at the histologic evaluation. Deposition of collagen type I presented no significant difference between the meshes, but deposition of collagen type III was more intense after 60 days, in both groups. Regarding collagen's rearrangement, the production of MMP8 was higher on Parietex® after 30 days, and MMP13 enzyme was increased after 60 days, in both meshes (significant only for Parietex®. CONCLUSION: Both meshes were efficient in the correction of abdominal wall defects, and with similar results, but Parietex® presented less inflammatory process and greater amount of matrix-metalloproteinases MMP8 and MMP13

  16. Congenital hernia of the umbilical cord associated with extracelomic colonic atresia and perforation of gut in a newborn

    Kamalesh Pal

    2014-01-01

    Full Text Available Congenital hernia of the umbilical cord (CHUC is a rare congenital entity compared to more common post-natally occurring umbilical hernia. Although recognized as a distinct entity since 1920s, CHUC is often misdiagnosed as a small omphalocele, resulting in its underreporting. We present the first case report of CHUC associated with extracelomic colonic atresia, complicated by perinatal perforation in a newborn. We also discuss the differentiating features from other anterior abdominal wall defects such as omphalocele and gastroschisis including its embryogenesis.

  17. A case report of necrotizing fasciitis of the abdominal wall: A rare, life-threatening complication of a common disease process

    Anya Romanoff, MD

    2016-01-01

    Conclusion: It is imperative to maintain a high index of suspicion for intra-abdominal pathology in patients who present with necrotizing infections of the abdominal wall, flank, back, or groin. The importance of recognizing this complication early and proceeding immediately to the operating room cannot be overstated.

  18. Incisional subcutaneous endometrioma of the abdominal wall: report of two cases; Endometriose sous cutanee sur cicatrice de la paroi abdominale anterieure. A propos de deux observations

    Merran, S.; Karila-Cohen, P. [Federation Mutualiste Parisienne, Dept. d' Imagerie Medicale, 75 - Paris (France)

    2004-04-01

    Endometriosis occurs in up to 15% of menstruating women. Abdominal wall involvement is rare and always secondary to an invasive procedure. The authors report the imaging and clinical findings of two patients with subcutaneous endometrioma following cesarean section. (author)

  19. A Morgagni diaphragmatic hernia found after removal of mediastinal tumor.

    Kim, Eung-Soo; Kang, Jong-Yael; Pyo, Chang-Hae; Jeon, Eui-Yong

    2008-06-01

    Morgagni hernia is a disease in which the abdominal contents herniate into the thoracic cavity through a congenital parasternal defect of the diaphragm resulting from an increased intra-abdominal pressure. Obesity, pregnancy, and a history of trauma are considered predisposing factors of Morgagni hernia. However, there is slight evidence that trauma has been the factor. Moreover, Morgagni hernia related to an operation has been rarely reported. We report a case of a female patient, whose mediastinal tumor had been removed 6 months prior to her being diagnosed with postoperative Morgagni hernia. There was a satisfactory result after the repair by an upper abdominal incision.

  20. A Rare Presentation of Maydl’s Hernia

    Elroy Patrick Weledji

    2014-01-01

    Full Text Available We present a case of an unsual type of obstructed indirect inguinal hernia with impending strangulation. The operative findings revealed a sliding Maydl’s hernia with an ischemic inner ileal loop and an adherent inflamed appendix. This case highlights the importance of intraoperative examination of the intra-abdominal bowel loops proximal to the hernia sac of an incarcerated, obstructed, or strangulated hernia.

  1. Drain-Site Hernia Containing the Vermiform Appendix: Report of a Case

    Markus Gass

    2013-01-01

    Full Text Available The herniated vermiform appendix has been described as content of every hernia orifice in the right lower quadrant. While the femoral and inguinal herniated vermiform appendix is frequent enough to result in an own designation, port-site or even drain-site hernias are less frequently described. We report the case of a 62-year-old woman who presented with right lower quadrant pain seven years after Roux-en-Y Cystojejunostomy for a pancreatic cyst. CT scan showed herniation of the vermiform appendix through a former drain-site. A diagnostic laparoscopy with appendectomy and direct closure of the abdominal wall defect combined with mesh reinforcement was performed. Despite the decreasing use of intraperitoneal drains over the recent years, a multitude of patients had intraperitoneal drainage in former times. These patients face nowadays the risk of drain-site hernias with sometimes even unexpected structures inside.

  2. Transumbilical endoscopic technique for complete closure of inguinal hernias in female pediatric patients

    Zhou, Xuewu; Qi, Xi; Jiang, Bing; Sha, Yongliang; Song, Daiqiang

    2017-01-01

    Laparoscopic percutaneous extraperitoneal closure of inguinal hernia with variable devices as an effective technique in minimal-access surgery for pediatric inguinal hernias in children was investigated in the present study. A Veress needle was inserted into the abdomen. Trocars, laparoscope and needle holder were placed through the umbilical incision. Under laparoscopic monitoring, a round needle was introduced into the peritoneal cavity through the anterior abdominal wall. The end of the suture inside the peritoneal cavity was left outside the peritoneal cavity in favor of ligation. The needle was passed through the peritoneum to place an extraperitoneal purse-string suture around the internal inguinal ring, counterclockwise on the left and clockwise on the right. The needle was then passed back into the peritoneal cavity and out through the abdominal wall, and the needle ends of the stitch were cut. The ends of the suture were tied. We described a technique used for transumbilical endoscopic closure of pediatric inguinal hernias in girls. This technique is simple and can be performed quickly. The cosmetic result is excellent because the two umbilical incisions are only 5-mm long, which make it possible to perform surgery without a visible scar. We performed this procedure in over 96 patients and have had no recurrences. Thus, this method may become the laparoscopic repair of choice for females with inguinal hernias. PMID:28123465

  3. Haematogenous abdominal wall metastasis of differentiated, alpha-fetoprotein-negative hepatocellular carcinoma after previous antiandrogen therapy within a site of lipoma manifestation since childhood

    2012-01-01

    Abstract Background Cases with subcutaneous metastasis of differentiated hepatocellular carcinoma to the abdominal wall without prior seeding as a consequence of local interventions with a negative or normal alpha-fetoprotein level in the serum are extremely rare. Case report This is the first report of a case with AFP-negative, differentiated hepatocellular carcinoma metastasis to the abdominal wall within a pre-existing subcutaneous lipoma since childhood after antiandrogen therapy with leu...

  4. Cough induced rib fracture, rupture of the diaphragm and abdominal herniation

    Wurl Peter

    2006-11-01

    Full Text Available Abstract Cough can be associated with many complications. In this article, we present a 59 year old male patient with a very rare combination of a cough related stress fracture of the ninth rib, a traumatic rupture of the diaphragm, and an abdominal wall herniation. The hernia was repaired through surgical treatment without bowel resection, the diaphragm and the internal and oblique abdominal muscle were adapted, and the abdomen was reinforced with a prolene net. Although each individual injury is well documented in the literature, the combination of rib fracture, abdominal herniation and diaphragm rupture has not been reported.

  5. [Lumbar hernia].

    Teiblum, Sandra Sofie; Hjørne, Flemming Pii; Bisgaard, Thue

    2010-03-22

    Lumbar hernia is a rare condition. Lumbar hernia should be considered a rare differential diagnosis to unexplained back pain. Symptoms are scarce and diffuse and can vary with the size and content of the hernia. As there is a 25% risk of incarceration, operation is indicated even in asymptomatic hernias. We report a case of lumbar hernia in a woman with a slow growing mass in the lumbar region. She presented with pain and a computed tomography confirmed the diagnosis. She underwent open surgery and fully recovered with recurrence within the first half year.

  6. Specificity of intraabdominal endoprosthesis of umbilical and postoperative ventral hernias

    Grigoriev S.G.

    2012-03-01

    Full Text Available The research work objective was to examine the results of intraperitoneal plastics in the hernias of anterior abdominal wall. The experience of treatment of 89 patients with uncomplicated umbilical and postoperative ventral hernias was analized. The surgical treatment included an open intraperitoneal prosthetic hernioplasty. The hernial sac was not removed during the operation. The original techniques of treatment of hernia sac were used. Anatomical and morphological features in the structure of middle ventral hernias and their pathophysiological assessment were revealed. Practical recommendations for technology of intraperitoneal prosthesis were given. The early postoperative complications occurred: seroma (n=2, the outflow of serous fluid drainage for 5 days (n=1, infiltration of the umbilical area (n=3, suppuration of wounds (n=1. Vacuum drainage was performed in 24 patients after removal of large hernial defects. During the period from 6 months to 4 years recurrences were not revealed. The intraperitoneal surgery using a complex of musculo-aponeurotic tissues provided hernial implant fixation. Operation without the removal of the hernial sac reduced the trauma intervention. Method of suturing the surgical wound reduced the time of drainage and reduced the number of wound complications

  7. Is there a Place for Prebiotics in the Management of Neonatal Inguinal Hernia? A Preliminary Study

    Dhaou, Mahdi Ben; Zouari, Mohamed; Ammar, Saloua; Bouraoui, Amira; Gassara, Imene; Feki, Ines; Zitouni, , Hayet; Jallouli, Mohamed; Masmoudi, Jawaher; Gargouri, Abdellatif; Mhiri, Riadh

    2017-01-01

    The objective of this study was to assess the place of prebiotics in the management of neonatal inguinal hernia. Boys with a diagnosis of unilateral non-complicated inguinal hernia, aged less than 40 days, were prospectively followed from January 2012 to December 2014. Clinical and psychiatric data and outcomes were collected before and after prebiotics (Primalac AC) administration. Ninety-eight patients were included. There were 75 inguinal hernias and 23 inguino-scrotal hernias. Before prebiotics administration 72.2% of infants had abdominal distention and 98% had colic. After prebiotics, abdominal distention and colic regressed in 85.2% and 73.2% of patients, respectively. Hernias disappeared clinically in 66.3% of cases. The factors associated with the disappearance of hernias were the type of the hernia (pinguinal hernia. They decrease colic and abdominal distention, which seems helpful to prevent strangulation and probably get spontaneous resolution of small hernias. PMID:28083493

  8. Oral, intestinal, and skin bacteria in ventral hernia mesh implants

    Odd Langbach

    2016-07-01

    Full Text Available Background: In ventral hernia surgery, mesh implants are used to reduce recurrence. Infection after mesh implantation can be a problem and rates around 6–10% have been reported. Bacterial colonization of mesh implants in patients without clinical signs of infection has not been thoroughly investigated. Molecular techniques have proven effective in demonstrating bacterial diversity in various environments and are able to identify bacteria on a gene-specific level. Objective: The purpose of this study was to detect bacterial biofilm in mesh implants, analyze its bacterial diversity, and look for possible resemblance with bacterial biofilm from the periodontal pocket. Methods: Thirty patients referred to our hospital for recurrence after former ventral hernia mesh repair, were examined for periodontitis in advance of new surgical hernia repair. Oral examination included periapical radiographs, periodontal probing, and subgingival plaque collection. A piece of mesh (1×1 cm from the abdominal wall was harvested during the new surgical hernia repair and analyzed for bacteria by PCR and 16S rRNA gene sequencing. From patients with positive PCR mesh samples, subgingival plaque samples were analyzed with the same techniques. Results: A great variety of taxa were detected in 20 (66.7% mesh samples, including typical oral commensals and periodontopathogens, enterics, and skin bacteria. Mesh and periodontal bacteria were further analyzed for similarity in 16S rRNA gene sequences. In 17 sequences, the level of resemblance between mesh and subgingival bacterial colonization was 98–100% suggesting, but not proving, a transfer of oral bacteria to the mesh. Conclusion: The results show great bacterial diversity on mesh implants from the anterior abdominal wall including oral commensals and periodontopathogens. Mesh can be reached by bacteria in several ways including hematogenous spread from an oral site. However, other sites such as gut and skin may also

  9. Colon Perforations Causing Morgagni Hernia Case

    Mustafa Ugur

    2014-08-01

    Full Text Available Herniation of the intraabdominal organs through a diaphragmatic defect that occurs due to the joining anomaly of the sternal and costal segments of diaphragm is known as Morgagni Hernia. Although most of the patients with Morgagni Hernia are asymptomatic, intestinal obstruction, incarceration and strangulation can rarely occur. An 83 years old female patient admitted with acute abdomen to our clinic. Morgagni hernia was detected with preoperative thoracic and abdominal computed tomography. We aimed to present our management in Morgagni Hernia in this study.

  10. Abdominal wall metastasis in scar after open resection of an adrenocortical carcinoma

    Nikhil Gupta

    2011-12-01

    Full Text Available A 42-year-old man patient presented with progressively increasing, occasionally painful lump in the left upper and central abdomen. Investigations revealed well-defined capsulated left adrenocortical carcinoma. Tumor was resected successfully along with left kidney. Tumor recurred in the abdominal surgical scar 1.5 years after surgery. We are reporting this case because of rarity of metastatic recurrence of an adrenocortical carcinoma in the abdominal surgical scar 1.5 years after resection of primary tumor.

  11. Uncommon presentation of actinomycosis mimicking colonic cancer: Colon actinomycosis with invasion of the abdominal wall

    Ilhan Bali

    2015-04-01

    Full Text Available Actinomycosis is an uncommon chronic suppurative infectious disease that is caused by Actinomycetes organisms, which are gram-positive, microaerophilic, anaerobic bacteria. Herein, we present the case of a 42-year-old female patient who underwent surgical exploration following presentation with abdominal pain and an abdominal mass, initially thought to be a malignancy. Histological examination of the specimen revealed colon actinomycosis. [Arch Clin Exp Surg 2015; 4(2.000: 107-110

  12. Operative procedures of single-incision laparoscopic repair of pediatric epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle

    Kyoichi Deie

    2016-01-01

    Full Text Available We describe a simple and feasible procedure for single-incision laparoscopic repair of a pediatric epigastric hernia using a novel suture-assisting needle. A multichannel port was inserted through the umbilical vertical incision. After the orifice of the hernia was identified, a suture-assisting needle, which can hold a suture at its tip, with a 2-0 thread was pierced through the skin into one side of the rectus muscle sheath into the abdominal cavity. Next, after releasing the thread, the needle was pulled out to the subcutis and pierced through another side of the rectus muscle sheath. The needle, grasping the thread again, was subsequently pulled out through the abdominal wall outside, and the thread was tied extracorporeally. This knot was buried subcutaneously. Operative procedures of single-incision laparoscopic repair of an epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle with an excellent cosmetic result.

  13. Sliding inguinal hernia is a risk factor for recurrence

    Andresen, Kristoffer; Bisgaard, Thue; Rosenberg, Jacob

    2015-01-01

    PURPOSE: A sliding inguinal hernia is defined as a hernia where part of the hernial sac wall is formed by an organ, e.g., the colon or bladder. Thus, repair of a sliding inguinal hernia may have higher risk of complications and recurrence compared with non-sliding inguinal hernia. The aim...... of this study was to investigate the incidence and reoperation rates following sliding inguinal hernia repair. METHODS: This study was based on data from the Danish Hernia Database covering the period between January 1, 1998 and February 22, 2012. Data were collected prospectively and nationwide. RESULTS......: In total, 70,091 primary hernia repairs were included for analysis. The occurrence of sliding inguinal hernias of the total group of included hernia repairs was 9.4 % among males and 2.9 % among females (p inguinal hernias had a higher cumulated reoperation rate...

  14. Analysis of sublay prosthetic repair for abdominal incisional hernias%腹膜前置补片修补法治疗腹壁切口疝的临床探讨

    王嘉; 徐雪东; 安伟德; 李玉文; 邓中慧; 张伟国; 陈帅

    2014-01-01

    Objective To discuss clinical effective methods for repairing abdominal incisional hernias with mesh in the open surgery .Methods One hundred and twenty -eight cases of abdominal incisional hernia in the open surgery were ana-lyzed retrospectively in our hospital from Jan 2004 to Dec 2012 .Two cases were repaired with Inlay , 25 cases with Onlay and 101 cases with Sublay .The treatment effects of the three methods were compared .Results All of the cases were cured with no serious postoperative complications .Among all cases who were followed up during 5-48 months, 1 case recurred in the group of Inlay(50%), 5 cases recurred in the group of Onlay(20%)and 4 cases recurred in the group of Sublay (4%).Conclusion Sublay has a lower recurrence rate , thus is considered as a satisfactory model for repair of abdominal incisional hernias in the open surgery .%目的:探讨在开放手术中补片修补腹壁切口疝的有效方法。方法回顾性分析2004年1月-2012年12月经大连医科大学附属第一医院诊治的腹壁切口疝患者中开放手术128例患者的临床资料。其中2例行肌间置补片修补法(Inlay),25例行肌筋膜前置补片修补法(Onlay),101例行腹膜前置补片修补法(Sublay)。观察3种方法的疗效。结果128例均痊愈出院,无严重并发症,随访5~48个月, Inlay组复发1例(50%), Onlay组复发5例(20%), Sublay组复发4例(4%)。结论 Sublay法治疗腹壁切口疝复发率低,在开放手术中是治疗腹壁切口疝的理想方法。

  15. Coexisting ipsilateral right femoral hernia and incarcerated obturator hernia.

    Seppälä, Toni T; Tuuliranta, Mikko

    2015-02-25

    Obturator hernia (OH) is an uncommon cause of bowel obstruction and described in elderly females in the literature. The treatment has traditionally been laparotomy because of an acute nature of the condition. However, because of old age and comorbidities that OH is associated with, general anaesthesia may need to be avoided. In the current case, a transinguinal preperitoneal approach and management are presented after delayed preoperative diagnosis of bowel obstruction caused by a coexisting right incarcerated OH and ipsilateral non-reducible femoral hernia. A 91-year-old woman had a 6-day history of nausea and vomiting. She was referred to surgery because of persisting vomiting, but without any abdominal pain. A CT scan showed a hernia in the right groin area but the diagnosis was delayed. The hernias were repaired using a preperitoneal transinguinal approach. Bowel resection was not needed. The obturator canal and the femoral ring were both covered by a Bard Polysoft patch.

  16. Left paraduodenal hernia in an adult complicated by ascending colon cancer: A case report

    Kiyotaka Kurachi; Toshio Nakamura; Tadataka Hayashi; Yosuke Asai; Takayuki Kashiwabara; Akihito Nakajima; Shohachi Suzuki; Hiroyuki Konno

    2006-01-01

    Paraduodenal hernia is the most common internal hernia. The clinical symptoms of paraduodenal hernia may be intermittent and nonspecific. Therefore, it is difficult to diagnose preoperatively. Abdominal computed tomography (CT) scan currently plays an important role in the evaluation and management of paraduodenal hernia before surgical operation. We report one unique case of preoperatively diagnosed left paraduodenal hernia complicated by advanced ascending colon cancer and reviews of Japanese literature.

  17. Application of antimicrobial agents during perioperative period of abdominal external hernia%腹外疝手术围手术期抗菌药物应用分析

    付琴

    2012-01-01

    目的 了解腹外疝手术围手术期抗菌药物使用特点,探讨其存在的主要问题,为规范基层综合医院抗菌药物的应用提供依据,并制定抗菌药物使用的干预措施.方法 对2010年1-6月符合Ⅰ类切口的腹外疝手术的归档病历,进行回顾性调查分析.结果 腹外疝手术围手术期抗菌药物使用率为100.00%,抗菌药物联合应用率为25.35%,用药疗程平均(6.52±1.43)d;医院腹外疝围手术期抗菌药物应用方面尚存在一些用药指征把握不严、给药时机不佳、用药品种不当、给药疗程过长及盲目联合用药等问题.结论 必须加强抗菌药物使用管理,规范基层综合医院腹外疝手术围手术期抗菌药物的应用,才能遏制细菌耐药性快速增长的不良趋势.%OBJECTIVE To evaluate the application of antimicrobial agents during perioperative period of abdominal external hernia and investigate the existing problems so as to provide evidence for standardizing the antibiotic use in grass-root hospital and institute intervention measures.METHODS A retrospective analysis was conducted for the filed medical cases complying with the abdominal external hernia for class I incision from Jan.to Jun.2010.RESULTS Application rate of antibiotics was 100.00% during perioperative period of abdominal external hernia.The rate of combined use of antimicrobial agents was 25.35%; the mean medication course was (6.52 d ±1.43) d; results from present study indicated several existing problems.including not following drug indications strictly, timing errors in medication administration, improper medicationt excessive medication duration, blind combination therapy and so on.CONCLUSION The use of antimicrobial agents should be strengthened, the application of antibiotics during perioperative period of abdominal external hernia should be standardized in the grass-root general hospital so as to curb the rapid growth of bacterial resistance

  18. Giant Cutaneous Leiomyosarcoma Originating From the Abdominal Wall: A Case Report

    Eken, Huseyin; Karagul, Servet; Topgül, Koray; Yoruker, Savaş; Ozen, Necati; Gun, Seda; Balci, Mecdi Gurhan; Somuncu, Erkan; Cimen, Orhan; Soyturk, Mehmet; Karavas, Erdal

    2016-01-01

    Patient: Male, 44 Final Diagnosis: Cutaneous Leiomyosarcoma Symptoms: Abdominal mass Medication: — Clinical Procedure: Surgery Specialty: Surgery Objective: Rare disease Background: Leiomyosarcoma, a rare type of tumor, accounts for 5–10% of all soft tissue tumors. Case Report: A 44-year-old male patient was admitted to the emergency service of our medical faculty with the complaints of fatigue and abdominal mass. Conclusions: The pathology result was leiomyosarcoma. Leiomyosarcoma of the skin is rare and our case is the largest such lesion reported in the literature. PMID:26787636

  19. Submucosa de intestino delgado no reparo de defeito em parede abdominal de ratos Small intestinal submucosa to repair anterior abdominal wall defect in rats

    Fernando Hintz Greca

    2004-10-01

    defect involving the entire anterior abdominal wall of rats. METHODS:Twenty Wistar rats were allocated in 2 groups of 10 animals each. In the group 1 the defect was repaired with SIS and in the group2 it was repaired with polypropylene mesh. On the 30th post-operative day the animals were sacrificed for macroscopic , histological and tensiometric evaluation. RESULTS: Adhesions were present in the animals of both group , but in the polypropylene mesh group the intestinal adhesions were more frequent than in the SID group. The maximum tensile strength was greater in the polypropylene group, however is we consider the thickness of the implants, the tensile strength of submucosa was significantly greater. The mesothelium coverage and the collagen deposition was greater in the SID group. The foreign body reaction and the chronic inflammatory process was higher in the SID group. The percentage of mature collagen was significantly greater in the SIS group. CONCLUSION: We concluded that SIS can be an alternative to synthetic meshes when used to repair the defects of abdominal wall.

  20. A role of 18F-fluorodeoxyglucose positron emission/computed tomography in a strategy for abdominal wall metastasis of colorectal mucinous adenocarcinoma developed after laparoscopic surgery

    Kaneko Hironori

    2011-02-01

    Full Text Available Abstract Metastasis to the abdominal wall including port sites after laparoscopic surgery for colorectal cancer is rare. Resection of metastatic lesions may lead to greater survival benefit if the abdominal wall metastasis is the only manifestation of recurrent disease. A 57-year-old man, who underwent laparoscopic surgery for advanced mucinous adenocarcinoma of the cecum 6 years prior, developed a nodule in the surgical wound at the lower right abdomen. Although tumor markers were within normal limits, the metastasis to the abdominal wall and abdominal cavity from the previous cecal cancer was suspected. An abdominal computed tomography scan did not provide detective evidence of metastasis. 18F-fluorodeoxyglucose positron emission/computed tomography (18F-FDG PET/CT was therefore performed, which demonstrated increased 18F-fluorodeoxyglucose uptake (maximum standardized uptake value: 3.1 in the small abdominal wall nodule alone. Histopathological examination of the resected nodule confirmed the diagnosis of metastatic mucinous adenocarcinoma. Prognosis of intestinal mucinous adenocarcinoma is reported to be poorer than that of non-mucinous adenocarcinoma. In conclusion, this case suggests an important role of 18F-FDG PET/CT in early diagnosis and decision-making regarding therapy for recurrent disease in cases where a firm diagnosis of recurrent colorectal cancer is difficult to make.

  1. Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results

    Fischer, Tanja [Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Munich (Germany); Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Klinikum Innenstadt, Munich (Germany); Ladurner, Roland; Mussack, Thomas [Ludwig-Maximilians-University Munich, Department of Surgery and Traumatology, Klinikum Innenstadt, Munich (Germany); Gangkofer, Alexander; Reiser, Maximilian; Lienemann, Andreas [Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Munich (Germany)

    2007-12-15

    The aim of our study was to develop a method that allows the vizualiation and evaluation of implanted mesh in patients after incisional hernia repair with MRI. Furthermore, we assessed problems typically related with mesh implantation like adhesions and muscular atrophy. We enrolled 28 patients after incisional hernia repair. In 10 patients mesh implantation was done by laparoscopy (expanded polytetrafluoroethylene=ePTFE mesh) and in 18 by laparotomy (polypropylene mesh). Functional MRI was performed on a 1.5-T system in supine position. Sagittal and axial TrueFISP images of the entire abdomen were acquired with the patient repeatedly straining. Evaluation included: correct position and intact fixation of the mesh, furthermore visceral adhesions, recurrent hernia and atrophy of the rectus muscle. The ePTFE mesh was visible in all cases; the polypropylene mesh was not detectable. In seven of the ten ePTFE meshes the fixation was not intact; two recurrent hernias were detected. Twenty of 28 patients had intraabdominal adhesions. In 5 cases mobility of the abdominal wall was reduced, and 16 patients showed an atropy of the rectus muscle. Functional cine MRI is a suitable method for follow-up studies in patients after hernia repair. ePTFE meshes can be visualized directly, and typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed reliably. (orig.)

  2. Primary Hydatid Cyst of Umbilicus, Mimicking an Umbilical Hernia.

    Tarahomi, Mohammadreza; Alizadeh Otaghvar, Hamidreza; Ghavifekr, Nazila Hasanzadeh; Shojaei, Daryanaz; Goravanchi, Farhood; Molaei, Amir

    2016-01-01

    Hydatid cyst caused by Echinococcus granulosus demonstrates an endemic infection in several countries such as Middle Eastern countries. Liver is the most frequently involved organ, followed by the lung. The case we present is solitary primary localization of cyst in abdominal wall which is extremely rare. A 57-year-old woman presented with an abdominal wall lesion in umbilical area that had been evolving for about 2 years with recent complaint of pain and discomfort. We detected a midline abdominal mass 12⁎13 centimeters in diameter which was bulged out in umbilicus. Preoperative clinical diagnosis of incarcerated umbilical hernia was made due to its physical examination while surgical exploration disproved the primary diagnosis and we found cystic mass adherent to superficial fascia without any communication to peritoneal space. The cyst was excised completely without any injury or perforation of containing capsule. The diagnosis of hydatid cyst was confirmed by histopathological examination of specimen. The retrograde evaluation showed no involvement of other organs. The patient was followed for two years and no recurrence of hydatid disease has been observed. Hydatid cyst should be considered as a differential diagnosis of abdominal wall and umbilical lesions especially in endemic regions.

  3. Primary Hydatid Cyst of Umbilicus, Mimicking an Umbilical Hernia

    Mohammadreza Tarahomi

    2016-01-01

    Full Text Available Hydatid cyst caused by Echinococcus granulosus demonstrates an endemic infection in several countries such as Middle Eastern countries. Liver is the most frequently involved organ, followed by the lung. The case we present is solitary primary localization of cyst in abdominal wall which is extremely rare. A 57-year-old woman presented with an abdominal wall lesion in umbilical area that had been evolving for about 2 years with recent complaint of pain and discomfort. We detected a midline abdominal mass 12⁎13 centimeters in diameter which was bulged out in umbilicus. Preoperative clinical diagnosis of incarcerated umbilical hernia was made due to its physical examination while surgical exploration disproved the primary diagnosis and we found cystic mass adherent to superficial fascia without any communication to peritoneal space. The cyst was excised completely without any injury or perforation of containing capsule. The diagnosis of hydatid cyst was confirmed by histopathological examination of specimen. The retrograde evaluation showed no involvement of other organs. The patient was followed for two years and no recurrence of hydatid disease has been observed. Hydatid cyst should be considered as a differential diagnosis of abdominal wall and umbilical lesions especially in endemic regions.

  4. Ultrapro hernia system for inguinal hernia repair%腹股沟疝 UHS 手术

    陈吉彩; 陈晓曦

    2014-01-01

    Ultrapro hernia dystem ( UHS) is a bilayer polypropylene mesh which is composed of an anterior layer , a posterior layer and a connector .The posterior layer is placed between the transversalis fascia and peritoneum ( preperitoneal space ) and covers the myopectineal orifice , for repairing the preperitoneal space.By fixing of the anterior layer between the inguinal ligament and pubic tubercle , the posterior wall of the inguinal canal could be strengthened .The connector , which filled the abdominal wall defect and fixed layers, could prevent from recurrence caused by displacement of mesh .Double repairment of the posterior wall of the inguinal canal and the preperitoneal space by using UHS could significantly reduce the recurrence of inguinal hernia maximally .%超普疝修补装置( ULTRAPRO Hernia System, UHS)由上片、下片和中间连接柱构成。下片位于腹膜与腹横筋膜之间(腹膜前间隙),覆盖整个肌耻骨孔,起到了腹膜前间隙修补的作用;将上片分别固定于腹股沟韧带和耻骨结节,加强腹股沟管后壁;中间连接柱既充填了疝环缺损,又连接和稳定了上、下片,可防止网片移位造成的复发。 UHS同时对腹膜前间隙和腹股沟管后壁进行双重修补,理论上最大限度地减少了腹股沟疝的复发。

  5. Rare case of obturator hernia in a patient with Marfan's syndrome.

    Peter, R; Indiran, V; Kannan, K; Maduraimuthu, P; Varadarajan, C

    2014-06-01

    Obturator hernia is a very rare type of abdominal hernia which constitutes hernias. It is an important cause of small bowel obstruction which is associated with a high mortality rate if left untreated. Obturator hernia typically occurs in an elderly women or patients with chronically raised intraabdominal pressure or previous multiple pregnancies. We report a case of obstructed obturator hernia in a young female patient with Marfan's syndrome complicated with dissecting aortic aneurysm and chronic kidney disease. Though recurrent and incisional hernia constitutes one of the minor diagnostic criteria of Marfan's syndrome, obturator hernia being a very rare entity, has been reported very rarely in a patient with Marfan's syndrome.

  6. Diagnostic value of susceptibility-weighted imaging of abdominal wall endometriomas during the cyclic menstrual changes: A preliminary study

    Solak, Aynur, E-mail: aynursolak@yahoo.com [Radiology Department of Sifa University Hospital, 35240, Fevzipasa Boulvard 172/2, Basmane, Izmir (Turkey); Şahin, Neslin, E-mail: neslinshn@gmail.com [Radiology Department of Sifa University Hospital, 35240, Fevzipasa Boulvard 172/2, Basmane, Izmir (Turkey); Genç, Berhan, E-mail: be.genc@hotmail.com [Radiology Department of Sifa University Hospital, 35240, Fevzipasa Boulvard 172/2, Basmane, Izmir (Turkey); Sever, Ali Rıza, E-mail: arsever@hotmail.com [Department of Radiology, Maidstone Hospital, Breast Unit, Maidstone, Kent (United Kingdom); Genç, Mine, E-mail: drminegenc@hotmail.com [Department of Gynecology and Obstetrics, Sifa University Hospital, 35240, Fevzipasa Boulvard 172/2, Basmane, Izmir (Turkey); Sivrikoz, Oya Nermin, E-mail: onsoral@yahoo.com [Pathology Department of Sifa University Hospital, 35240, Bornova, Izmir (Turkey)

    2013-09-15

    Objective: The purpose of this study is to investigate the value of susceptibility-weighted imaging (SWI) for the evaluation of cyclic morphological and hemorrhagic changes in abdominal wall endometriomas (AWE). Materials and methods: Fourteen patients with a total of 17 lesions who were admitted with complaints of abdominal wall mass and cyclic pain were evaluated by MRI. Patients were scanned during the first three days of the menstrual cycle and during the mid-cycle phase (day 13–15). In addition to conventional images SWI was performed. The signal changes within the lesions on SWI were compared and graded on both studies. Results: There was no significant difference in the size of the lesions in the early days of the menstruation compared to the mid-menstrual period. The SWI taken on mid-cycle phase showed that the center was hyperintense and the peripheral zone was hypointense in all lesions. A signal void related to increased blood and the shrinkage of complete disappearance of hyperintensity in the venter of the lesion was seen 15 (88%) of the 17 cases on the SWI series performed during the menstrual phase scan. Conclusion: SWI is a sensitive technique and has the capability to show hemorrhage and deposition of hemosiderin within the lesions. For patients suspected with AWE, valuable diagnostic findings may be obtained if the MRI examination including SWI is performed during the early and mid phase menstrual cycle.

  7. Tacrolimus does not affect early wound healing in a rodent model of bowel anastomoses and abdominal wall closure.

    Martine C M Willems

    Full Text Available BACKGROUND: Use of immunosuppressant drugs has been associated with complications in wound healing. The calcineurin inhibitor tacrolimus is thought to have a relatively low complication rate, but preclinical research has yielded contradictory data, prompting the current comprehensive study. METHODS: Three groups of 33 male Wistar rats received a daily subcutaneous dose of 0,5, 2 or 5 mg/kg tacrolimus. A control group received saline. On day 0 a resection of 1 cm ileum and 1 cm colon was performed, and end-to-end anastomoses were constructed. Ten rats of each group were killed on day 3 and day 5 and the remaining animals on day 7. Both anastomoses and the wound in the abdominal wall were analyzed. Wound strength was the primary outcome parameter. RESULTS: Mean strength of the abdominal wall increased significantly over time in all groups (p<0.0001. Both the breaking strength and the bursting pressure of the ileum and colon anastomoses followed the same pattern. No differences were observed between control and experimental groups. In addition, no consistent differences were found between groups regarding wound hydroxyproline content and the activities of matrix metalloproteinase-2 and -9. CONCLUSION: Tacrolimus does not affect early wound healing.

  8. Passive mechanical properties of rat abdominal wall muscles suggest an important role of the extracellular connective tissue matrix.

    Brown, Stephen H M; Carr, John Austin; Ward, Samuel R; Lieber, Richard L

    2012-08-01

    Abdominal wall muscles have a unique morphology suggesting a complex role in generating and transferring force to the spinal column. Studying passive mechanical properties of these muscles may provide insights into their ability to transfer force among structures. Biopsies from rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) were harvested from male Sprague-Dawley rats, and single muscle fibers and fiber bundles (4-8 fibers ensheathed in their connective tissue matrix) were isolated and mechanically stretched in a passive state. Slack sarcomere lengths were measured and elastic moduli were calculated from stress-strain data. Titin molecular mass was also measured from single muscle fibers. No significant differences were found among the four abdominal wall muscles in terms of slack sarcomere length or elastic modulus. Interestingly, across all four muscles, slack sarcomere lengths were quite long in individual muscle fibers (>2.4 µm), and demonstrated a significantly longer slack length in comparison to fiber bundles (p muscle lengths. Titin molecular mass was significantly less in TrA compared to each of the other three muscles (p < 0.0009), but this difference did not correspond to hypothesized differences in stiffness.

  9. Blood Vessel Matrix Seeded with Cells: A Better Alternative for Abdominal Wall Reconstruction—A Long-Term Study

    Maciej Nowacki

    2015-01-01

    Full Text Available Purpose. The aim of this study was to present abdominal wall reconstruction using a porcine vascular graft seeded with MSC (mesenchymal stem cells on rat model. Material and Methods. Abdominal wall defect was prepared in 21 Wistar rats. Acellular porcine-vascular grafts taken from aorta and prepared with Triton X were used. 14 aortic grafts were implanted in place, of which 7 grafts were seeded with rat MSC cells (Group I, and 7 were acellular grafts (Group II. As a control, 7 standard polypropylene meshes were used for defect augmentation (Group III. The assessment method was performed by HE and CD31 staining after 6 months. The mechanical properties have been investigated by Zwick&Roell Z0.5. Results. The strongest angiogenesis and lowest inflammatory response were observed in Group I. Average capillaries density was 2.75, 0.75, and 1.53 and inflammatory effect was 0.29, 1.39, and 2.72 for Groups I, II, and III, respectively. The means of mechanical properties were 12.74±1.48, 7.27±1.56, and 14.4±3.7 N/cm in Groups I and II and control, respectively. Conclusions. Cell-seeded grafts have better mechanical properties than acellular grafts but worse than polypropylene mesh. Cells improved mechanical and physiological properties of decellularized natural scaffolds.

  10. A COMPARATIVE STUDY IN LAPAROSCOPIC INGUINAL HERNIA REPAIR BETWEEN FIXATION VS NON-FIXATION OF MESH

    Ayush

    2016-02-01

    Full Text Available INTRODUCTION An inguinal hernia is a weakness in the wall of the abdominal cavity that is large enough to allow escape of soft body tissue or internal organ, especially a part of the intestine. It usually appears as a lump and for some peoples can cause pain and discomfort, limit daily activities and the ability to work. If the bowel strangulates or becomes obstructed it can be life-threatening. A hernia is repaired generally using a synthetic mesh either with open surgery or increasingly using less invasive laparoscopic procedures. AIMS AND OBJECTIVES To compare and evaluate Laparoscopic hernia repair (trans-abdominal pre-peritoneal and total extra peritoneal repair (TAPP & TEP using Prolene mesh with or without fixation. MATERIAL AND METHODS Our study was conducted in dept. of surgery, Government Medical College and associated Dr. Susheela Tiwari Hospital. A total sample of 100 patients who underwent inguinal hernia repair as an elective surgery. 50 of whom underwent fixation of mesh (fixation will be done either by tacker or suture. Rest 5o underwent non fixation of mesh. RESULTS In our study Statistically there was non-significant heterogeneity in operating time (p = 0.15, post-operative pain (p = 0.45, post-operative complications (p = 0.55 and length of hospital stay (p = 0.11 were statistically comparable between two techniques of mesh fixation in LIHR. The risk of developing chronic groin pain (p = 0.67 and risk of hernia recurrence (p = 0.77 was also similar. CONCLUSION NMF in LIHR does not increase the risk of hernia recurrence. It is comparable with TMF in terms of operation time, post-operative pain, post-operative complications, length of hospital stay and chronic groin pain. Therefore, based upon the results of our study NMF approach may be adopted routinely and safely in LIHR.

  11. [Lumbar hernias in adults. Apropos of 4 cases and review of the literature].

    Le Neel, J C; Sartre, J Y; Borde, L; Guiberteau, B; Bourseau, J C

    1993-10-01

    Lumbar hernias are rare (2% of abdominal wall hernias). Symptomatology consists frequently only of an arch formation seen best with the patient sitting and when coughing. In adults it is twice as frequent in women and on the left side. Acute events, dominated by incarceration of a digestive segment, particularly colic, often suggest the diagnosis (10% of cases). Diagnosis is simple when confronted with a large hernia, but difficulties arise with those less than 5 cm in diameter, often diagnosed as a lipoma or parietal tumor. Conventional radiographs and ultrasound images are usually sufficient to establish the correct diagnosis and to determine the content of the hernial sac, but computed tomography scans can provide data on the exact limits of the defect and allow evaluation of possible problems during surgical repair. Rarely congenital (10%), these hernias occur either secondary to a violent lumbo-abdomino-pelvic injury (25%) or following surgical intervention to the lumbar region (50% of cases). Small hernias can be repaired using the direct approach but larger deficits require the insertion of a reinforcing non absorbable prosthesis. Long term results, both for the 4 cases reported and those published in the literature, were assessed as satisfactory.

  12. [The systematization and the etiopathogenicity of diaphragmatic hernias].

    Alecu, L

    2001-01-01

    The author, based on up to date published dates, intends to present the classification and ethiopathogeny of the diaphragmatic hernias, except the aesophagic hiatus oms. This is an interesting chapter of the borderline surgery (abdominal and thorax). They are placed on the second position in frequency (after the hiatal hernias) in the diaphragmatic pathology; they are internal hernias, through congenital or obtained holes which allow to abdominal viscera to pass into thorax. They are--in the most cases, even elderly ones-congenital, result of the abnormalities in the embrionary growth of the diaphragm. A special place' is represented by the traumatic hernias.

  13. A Rare Case of Laparoscopic Repair of Simultaneously Occurring Morgagni and Paraesophageal Hernias.

    Zhou, Zu-Li; Li, Hao; Li, Jian-Feng; Liu, Yan-Guo; Wang, Chong; Wang, Jun

    2016-01-01

    Simultaneously occurring Morgagni hernia and paraesophageal hernia is an extremely rare clinical condition with only six case reports in the English-language literature and only two laparoscopic repair reports. We report a 73-year-old woman with both Morgagni hernia and paraesophageal hernia who underwent successful laparoscopic repair of the hernia defects using transabdominal wall suturing. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications. This case report reported the concurring Morgagni and paraesophageal hernias and validated the feasibility of laparoscopic repair both hernias simultaneously.

  14. A rare and frequently unrecognised pathology in children: femoral hernia.

    Temiz, A; Akcora, B; Temiz, M; Canbolant, E

    2008-10-01

    A femoral hernia is the protrusion of the abdominal contents through the femoral canal. It accounts for less than 1% of all groin hernias in children and is often confused with inguinal hernia or other inguinal pathologies. Preoperative misdiagnosis has been reported to be between 40 and 75%. We believe that misdiagnosis and mistreatment usually occur due to insufficient physical examination, knowledge and experience about childhood femoral hernias. Here, we report and discuss the clinical appearance and treatment approach of three patients operated with the diagnosis of femoral hernias.

  15. Avoiding Complications in Abdominal Wall Surgery: A Mathematical Model to Predict the Course of the Motor Innervation of the Rectus Abdominis.

    Tessone, Ariel; Nava, Maurizio; Blondeel, Phillip; Spano, Andrea

    2016-02-01

    Ever since its introduction, the transverse rectus abdominis myocutaneous flap has become the mainstay of autologous breast reconstruction. However, concerns regarding donor site morbidity due to the breach of abdominal wall musculature integrity soon followed. Muscle-sparing techniques, eventually eliminating the muscle from the flap all-together with the deep inferior epigastric artery perforator flap, did not eliminate the problem of abdominal wall weakness. This led to the conclusion that motor innervation might be at fault. Studies have shown that even in the presence of an intact rectus abdominis muscle, and an intact anterior rectus sheath, denervation of the rectus abdominis muscle results in significant abdominal wall weakness leading to superior and inferior abdominal bulges, and abdominal herniation. Our aim was to establish a mathematical model to predict the location of the motor innervation to the rectus abdominis muscle, and thus provide surgeons with a tool that will allow them to reduce abdominal morbidity during deep inferior epigastric artery perforator and free muscle-sparing transverse rectus abdominis myocutaneous surgery. We dissected 42 cadaveric hemiabdomens and mapped the course of the thoracolumbar nerves. We then standardized and analyzed our findings and presented them as a relative map which can be adjusted to body type and dimensions. Our dissections show that the motor innervation is closely related to the lateral vascular supply. Thus, when possible, we support the preferred utilization of the medial vascular supply, and the preservation of the lateral supply and motor innervation.

  16. Richter type of incarcerated obturator hernia; misery still continues.

    Jayant, Kumar; Agarwal, Rajendra; Agarwal, Swati

    2015-02-03

    Obturator hernia is a rare type of hernia which accounts for only 0.07-1.4% of all intra-abdominal hernias and 0.2-5.8% of small-intestinal obstructions. It develops predominantly in elderly underweight women. It has nonspecific early symptoms, so these hernias are usually discovered only after they have become incarcerated. Incarcerated obturator hernias are usually discovered on abdominal computed tomography scan or emergency surgery due to bowel obstruction. Here we present a case of a 65-year-old female who presented with intermittent abdominal pain, distension and nausea for last 3 days. She was a known case of hypothyroidism, taking Levothyroxine in inadequate dose. Her intial abdominal Xray was showing few air-fluid level with air present in rectum. She was initially managed conservatively but later developed features of peritonitis for which she was operated. In laparotomy, Richter type of right-sided incarcerated obturator hernia was discovered with a small necrotic area and perforation of small bowel. Bowel resection was performed and obturator hernia was closed with interrupted sutures. The patient recovered without complications. Obturator hernia, due to its rarity and nonspecific early symptoms, can still be misleading even to the most experienced clinicians. Delay in diagnosis of obturator hernia can lead to bowel necrosis and perforation with significant postoperative morbidity and mortality.

  17. Appliedvalue of automated ultrasonic volume scanning in diagnostic classification of external abdominal hernia%全自动超声容积断层扫描在腹外疝诊断分类中的应用价值探讨

    裘之瑛; 陈悦; 唐健雄; 陈革; 黄磊; 李绍杰

    2011-01-01

    目的 探讨全自动超声容积断层扫描(AUVS)在腹外疝诊断分类中的应用价值.方法 术前对62例疑似腹外疝进行AUVS检查,对AUVS区域的任意切面(横断面、矢状面、冠状面)的立体结构、疝环位置、疝囊、疝内容物及回纳途径进行观察,诊断出腹外疝的类型,并将诊断结果 与术后诊断进行比较.结果 在对腹外疝病例的诊断分类中,AUVS对腹壁切口疝的诊断正确率高于对腹股沟疝的诊断;AUVS对难复性腹股沟疝的诊断正确率高于对易复性腹股沟疝的诊断.结论 AUVS具有传统二维超声无法显示的组织冠状面图像,为临床医生提供了立体三维的客观影像依据;在腹外疝的诊断分类中,AUVS对腹壁切口疝和难复性腹股沟疝的诊断比传统超声检查更具优势.%Objective To retrospectively evaluate the use of automated ultrasonic volume scanning(AUVS) in the diagnostic classification of external abdominal hernia. Methods Sixty - two suspected cases were submitted to AUVS before the tension - free hernioplasty. On the images of every section( transverse, sagittal, coronal)in AUVS, types of the hernia were classified after observing the position of hernial ring, the hernial sac, the hernial contents, reduction route, and three - dimensional structure of the area.The results of AUVS and surgical diagnoses were compared. Results By the means of AUVS,the diagnostic accuracy was not only higher in incisional hernia than that in inguinal hernia, but also higher in irreducible inguinal hernia than that in reducible inguinal hernia. Conclusion AUVS upgrades the coronal image over the traditional two - dimensional ultrasound, which provides clinicians with objective three - dimensional image data. AUVS has the advantage over the traditional ultrasound in the diagnostic classification of external abdominal hernia,especially for incisional hernia and irreducible inguinal hernia.

  18. 应用脱细胞真皮基质材料修补复杂腹壁切口疝%Repair of complex abdominal incisional hernia with acellular dermal matrix

    李小军; 王小强; 龙延滨; 邱健; 张瑞鹏

    2011-01-01

    目的 探讨脱细胞真皮基质材料对复杂的腹壁切口疝的修复治疗效果.方法 回顾性分析2008年1月至2010年6月间使用脱细胞真皮基质(acellular dermal matrix,ADM)材料修补的7例复杂的腹壁切口疝的治疗方法.其中男4例,女3例,年龄43~83岁,中位年龄53岁;7例中有2例伴有腹股沟斜疝,给予同时修补;5例同时进行了胃肠道手术,其中有2例伴有小肠瘘;疝环直径为9.2 ~16.5 cm,平均(11.6±2.8)cm;5例使用腹腔内修补(intraperitoneal onlay mesh,IPOM),2例为腹膜外修补(total extraperitoneal prothesis,TEP).结果 本组患者均手术顺利,放置ADM补片至关腹结束的平均手术时间(33±12) min;术中平均出血量(16±4) ml;住院时间7~12d.所有使用ADM的患者均痊愈出院,术后未发现有慢性疼痛、感觉异常、肺炎、尿路感染等并发症,手术切口无红肿、溃破、无血清肿.7例均获随访,随访时间5 ~26个月,中位随访时间为14个月,随访期间未发现浅部感染或深部感染,无疝复发.结论 脱细胞真皮基质材料作为一种新的生物补片,适用于复杂腹壁切口疝,尤其是伴有污染的腹壁切口疝的修补.%Objective To evaluate the repair of abdominal complicated incisional hernia using acellular dermal matrix (ADM).Methods Retrospective analysis was made on 7 cases with abdominal complicated incisional hernia treated by ADM in our hospital from January 2008 to June 2010,among them there were 4 males and 3 females.Age ranged from 43 to 83 years and the median age was 53 years.Two concurrent indirect inguinal hernia cases were repaired and concurrent gastrointestinal tract problems including 2 small bowd fistulas were operated one stage in 5 cases.Mean diameter of hernia ring was ( 11.6 ± 2.8 ) cm,ranged from 9.2 to 16.5 cm.5 cases were repaired by using intraperitoneal onlay mesh,others using total extraperitoneal prothesis.Results All patients were operated on successfully

  19. Clinical Study of Minimally Invasive Total Abdominal Hernia Repair Opera-tion in Treatment of Elderly Patients with Inguinal Hernia%腹腔镜完全腹膜外疝修补治疗老年腹股沟疝临床研究

    蒙炳杰

    2016-01-01

    Objective To investigate the clinical effect and safety of minimally invasive total abdominal hernia repair opera-tion in treatment of elderly patients with inguinal hernia. Methods Convenient selection 60 elderly patients with inguinal hernia were chosen in the period from April 2010 to April 2015 in our hospital and randomly divided into both group in-cluding control group (30 patients) with open abdominal hernia repair operation and minimally invasive group (30 patients) with minimally invasive total abdominal hernia repair operation; and the perioperative clinical index, postoperative VAS score and complication incidence of both groups were compared. Results The operation time of minimally invasive group was significantly longer than control group(P<0.05). The intraoperative blood loss amount and hospitalization staying timeof minimally invasive group was significantly better than control group(P<0.05). The VAS score in 7 d after operation of con-trol group and minimally invasive group were separately (4.31±1.33)points,(1.78±0.86)points. The score in 7 d after opera-tion of minimally invasive group was significantly better than control group (P<0.05). The postoperative complication inci-dence of control group and minimally invasive group were separately 23.33%, 3.33%. The postoperative complication inci-dence of minimally invasive group was significantly better than control group(P<0.05). Conclusion Minimally invasive to-tal abdominal hernia repair operation in treatment of elderly patients with inguinal hernia can efficiently reduce the surgical trauma degree, accelerate the recovery process and be helpful to decrease the postoperative complication incidence.%目的:探讨微创完全腹膜外疝修补治疗老年腹股沟疝临床效果及安全性。方法研究对象方便选取该院2010年4月—2015年4月收治老年腹股沟疝患者共60例,以随机区组法分为对照组(30例)和微创组(30例),分别采用开放和腹完全腹膜外

  20. Gastric femoral hernia in a male cadaver with gastroptosis: case report and review of the literature.

    Natsis, K; Apostolidis, S; Papadopoulou, A L; Vlasis, K; Totlis, T; Skandalakis, P

    2008-04-01

    The shape and the position of the stomach and its anatomic relations to the round viscera vary from individual to individual, but they also vary in the same subject depending on many factors. The downward displacement of the stomach is called gastroptosis. In the literature, there are only five case reports where the stomach constituted the content of a femoral hernia. The current study presents a case of a gastric femoral hernia in a cadaver along with a review of the relevant literature. During routine dissection of a 67-year-old male cadaver with a very large stomach and gastroptosis, a femoral hernia containing a part of the great curvature of the stomach was found. The length of the hernia sac was 5 cm, and its width was 3.5 cm. There was a disposition of the intestinal coils to the posterior wall and the lesser pelvis. The cadaver's former medical history and skin observation before dissection excluded any previous abdominal surgery. This is the second case of stomach herniation through the femoral ring in a male subject ever reported. The symptoms in this pathology vary from complete absence to symptoms due to high stenosis of the digestive tract, stomach strangulation and stomach wall necrosis.

  1. Laparoscopic lumbar hernia repair.

    Madan, Atul K; Ternovits, Craig A; Speck, Karen E; Pritchard, F Elizabeth; Tichansky, David S

    2006-04-01

    Lumbar hernias are rare clinical entities that often pose a challenge for repair. Because of the surrounding anatomy, adequate surgical herniorraphy is often difficult. Minimally invasive surgery has become an option for these hernias. Herein, we describe two patients with lumbar hernias (one with a recurrent traumatic hernia and one with an incisional hernia). Both of these hernias were successfully repaired laparoscopically.

  2. [Results of partial splenic resection and transposition to the lateral abdominal wall in portal hypertension in childhood].

    Bennek, J; Tröbs, R B; Mühlig, K; Richter, T

    1996-01-01

    Between 1977 and 1995, 19 children with portal hypertension (nine extrahepatic, ten intrahepatic) were treated by transpositioning the spleen into the left abdominal wall. Among the patients with intrahepatic portal hypertension three died. Two patients underwent secondary diminuition of the transposed spleen due to relapsed hypersplenism. In one of our first patients the transposed spleen atrophied after tangential resection. All surviving patients except one preserved hepatic function. The serum colloid osmotic pressure was stable. Plasma ammonia levels were normal. Serum immunoglobulins (IgG, IgM, IgA and IgG subclasses) and complement components (C3c, C4) were analyzed. After transposition patients had normal or slightly elevated values of these proteins compared with controls.

  3. A prospective study assessing the efficacy of abdominal computed tomography scan without bowel preparation in diagnosing intestinal wall and luminal lesions in patients presenting to the emergency room with abdominal complaints

    Michal Mizrahi; Yoav Mintz; Avraham Rivkind; David Kisselgoff; Eugene Libson; Mayer Brezis; Eran Goldin; Oren Shibolet

    2005-01-01

    AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal complaints.METHODS: For 1-year we prospectively evaluated all ER patients hospitalized after abdominal CT scan detected either intraluminal or intestinal wall lesions. These patients underwent colonoscopy serving as gold standard. Patients with prior abdominal pathology or CT findings of appendicitis or diverticulitis were excluded.RESULTS: Five hundred and sixty-eight abdominopelvic CT scans were performed in the ER, 96 had positive colonic findings. Sixty-two patients were excluded, 46 because of diverticulitis or appendicitis, 16 because of prior abdominal pathology. Of the remaining 34 patients, 14 did not undergo colonoscopy during hospitalization.Twenty eligible patients were included in the study. The positive predictive value of the CT scans performed in the ER was calculated to be 45% (95% CI 25-67).CONCLUSION: CT findings correlated with colonoscopic findings only in approximately half of the cases. Relying on non-prepared CT scan findings in planning patient management and colonoscopy may lead to unnecessary diagnostic work-ups.

  4. Application of temporary abdominal closure materials and techniques in abdominal wall defects%暂时性腹腔关闭材料及技术在腹壁缺损中的应用

    邵建川; 韩岩

    2011-01-01

    BACKGROUND: The treatment for abdominal defects is one of the problems of surgical treatment, especially primary closure is really a challenge to surgeons. As the surgical concept of defect control develops, and many technique and materials of temporary abdominal closure appear, some effective treatments for abdominal defects are emerged to solve this problem.OBJECTIVE: To review the current status of temporary abdominal closure materials and techniques in abdominal wall defects.METHODS: A computer-based online search of PubMed database (1986/2010) and CNKI (2005/2010) was retrieved with key words of "abdomen, abdominal wall, abdominal injuries/surgery, laparotomy, temporary abdominal closure, patch,vacuum-assisted closure , wound healing" in English and in Chinese. A total of 278 literatures were collected through computer retrieval, excluding irrelevant, obsolete, repeated and similar researches, finally 31 standard literatures were included.RESULTS AND CONCLUSION: The application of temporary abdominal closure is an important treatment of abdominal wall defects, it can improve the prognosis and increase the cure rate. There are various materials and techniques of temporary abdominal closure with advantages and disadvantages, and each one has its own indications. The use of specific material and operative technique should base on the principles and specific conditions of patients.%背景:腹壁缺损是外科治疗的难题之一,设法一期关闭腹腔是外科医生的一项挑战,随着损伤控制外科理念的发展,各种暂时性腹腔关闭技术及材料的出现为该难题提供了有效的治疗方案.目的:综述暂时性腹腔关闭材料及技术在腹壁缺损中的应用现状.方法:应用计算机检索Pubmed数据库(1986/2010),以"abdomen,abdominal wall,abdominal injuries/surgery,laparotomy,temporary abdominal closure,patch,vacuum-assited closure,wound healing"为检索词;应用计算机检索中国知网数据库(2005/2010),以"腹部

  5. Left-sided omental torsion with inguinal hernia

    Yasumitsu Hirano; Kaeko Oyama; Hiroshi Nozawa; Takuo Hara; Koichi Nakada; Masahiro Hada; Takeshi Takagi; Makoto Hirano

    2006-01-01

    We report a case of surgically proved left-sided torsion of the greater omentum that caused secondary by untreated inguinal hernia. Case A 36-year-old man presented to our hospital with abdominal pain. He had been diagnosed with a left inguinal hernia, but he had not received any treatments. Contrast-enhanced computed tomography (CT) of the abdomen showed a large fat density mass below the Sigmoid colon and left inguinal hernia with incarcerated fat. Exploratory laparotomy revealed torsion of the greater omentum with small bloody ascites. The greater omentum was twisted into one and a half circles and entered into a left inguinal hernia. An omentectomy with a repair of left inguinal hernia was performed. A resected omentum was submitted for pathological examination, which showed hemorrhagic infarction. Omental torsion is a rare cause of acute abdominal pain but should be included in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.

  6. Congenital Diaphragmatic Hernia

    Tovar Juan A

    2012-01-01

    Full Text Available Abstract Congenital Diaphragmatic Hernia (CDH is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is

  7. [Morgagni hernia mimicking intrathoracic lipomatous tumor].

    Pinto, Carlos Silva; Bernardo, João; Eugénio, Luís; Antunes, Manuel J

    2013-01-01

    Morgagni hernia is the rarest type of diaphragmatic hernia, accounting for 2% of all cases. It consists in the thoracic protrusion of fat and/or abdominal viscera through a congenital defect in a retro or parasternal position. The clinical importance of this pathological entity is associated with the fact that it can be asymptomatic, mimicking other diseases, such as a large intrathoracic lipoma, as it happened in the case presented here. Incorrect diagnosis can cause catastrophic complications during surgery.

  8. Biological findings from the PheWAS catalog: focus on connective tissue-related disorders (pelvic floor dysfunction, abdominal hernia, varicose veins and hemorrhoids).

    Salnikova, Lyubov E; Khadzhieva, Maryam B; Kolobkov, Dmitry S

    2016-07-01

    Pelvic floor dysfunction, specifically genital prolapse (GP) and stress urinary inconsistency (SUI) presumably co-occur with other connective tissue disorders such as hernia, hemorrhoids, and varicose veins. Observations on non-random coexistence of these disorders have never been summarized in a meta-analysis. The performed meta-analysis demonstrated that varicose veins and hernia are associated with GP. Disease connections on the molecular level may be partially based on shared genetic susceptibility. A unique opportunity to estimate shared genetic susceptibility to disorders is provided by a PheWAS (phenome-wide association study) designed to utilize GWAS data concurrently to many phenotypes. We searched the PheWAS Catalog, which includes the results of the PheWAS study with P value Catalog and the NHGRI Catalog data revealed enrichment of genes associated with bone mineral density in GP and with activated partial thromboplastin time in varicose veins of lower extremity. In cross-phenotype associations, genes responsible for peripheral nerve functions seem to predominate. This study not only established novel biologically plausible associations that may warrant further studies but also exemplified an effective use of the PheWAS Catalog data.

  9. Umbilical Hernia

    ... complicated umbilical hernia with liver cirrhosis and ascites. International Journal of Surgery. 2014;12:181. Cameron JL, et al. In: Current Surgical Therapy. 11th ed. Philadelphia, Pa.: Saunders Elsevier; ...

  10. Haematogenous abdominal wall metastasis of differentiated, alpha-fetoprotein-negative hepatocellular carcinoma after previous antiandrogen therapy within a site of lipoma manifestation since childhood

    Zachau L

    2012-05-01

    Full Text Available Abstract Background Cases with subcutaneous metastasis of differentiated hepatocellular carcinoma to the abdominal wall without prior seeding as a consequence of local interventions with a negative or normal alpha-fetoprotein level in the serum are extremely rare. Case report This is the first report of a case with AFP-negative, differentiated hepatocellular carcinoma metastasis to the abdominal wall within a pre-existing subcutaneous lipoma since childhood after antiandrogen therapy with leuprorelin and buserelin acetate for prostate cancer without seeding. Methods Clinical features including histology, immunohistochemistry, clinical course and surgical approach are presented. Results Histological examination revealed a hepatocellular carcinoma with a trabecular and pseudoglandular growth pattern with moderately atypical hepatocytes with multifocal bile formation within a lipoma. The postoperative course of abdominal wall reconstruction with a monocryl-prolene mesh and a local flap after potentially curative resection was uncomplicated. Discussion and conclusion It may be that previous antiandrogen treatment for prostate carcinoma contributed to the fact that our patient developed alpha-fetoprotein-negative and androgen receptor-negative subcutaneous abdominal wall metastasis within a pre-existing lipoma since childhood.

  11. Childhood Morgagni hernia: report of two cases

    Kamal Nain Rattan

    2017-01-01

    Full Text Available Morgagni diaphragmatic hernia is a rare congenital anomaly to be seen in the pediatric age group. We are reporting two cases of Morgagni hernia, which presented with non-specific symptoms and posed a diagnostic dilemma. One of the patients was 10 years old and associated with asplenia and Down’s syndrome; the second case presented as isolated Morgagni hernia in an 8 month baby. The diagnosis was confirmed with radiography and computed chest tomography. Both cases were managed successfully with surgical repair of the diaphragmatic defect through trans-abdominal approach.

  12. Lumbar hernia: a short historical survey.

    Cavallaro, Antonino; De Toma, Giorgio; Cavallaro, Giuseppe

    2012-01-01

    Lumbar hernia is a rare form of abdominal hernia, which has been recognized later along the early development of the modern surgery. it has been, on many occasions, the object of heavy debate regarding its anatomical background and as well its etiology. The authors reports the historical aspects of this rare pathology, focusing on the earliest descriptions of hernia arising in lumbar regions, on the first reports of surgical repair, and on the anatomical description of the lumbar weakness areas, that are currently named Petit's triangle and Grynfeltt and Lesshaft's triangle.

  13. Symptomatic Morgagni Hernia Misdiagnosed As Chilaiditi Syndrome

    Vallee, Phyllis A

    2011-02-01

    Full Text Available Chilaiditi syndrome, symptomatic interposition of bowel beneath the right hemidiaphragm, is uncommon and usually managed without surgery. Morgagni hernia is an uncommon diaphragmatic hernia that generally requires surgery. In this case a patient with a longstanding diagnosis of bowel interposition (Chilaiditi sign presented with presumed Chilaiditi syndrome. Abdominal computed tomography was performed and revealed no bowel interposition; instead, a Morgagni hernia was found and surgically repaired. Review of the literature did not reveal similar misdiagnosis or recommendations for advanced imaging in patients with Chilaiditi sign or syndrome to confirm the diagnosis or rule out other potential diagnoses. [West J Emerg Med. 2011;12(1:121-123.

  14. Right congenital pleuro-peritoneal hiatus hernia

    Sankar DK

    2009-12-01

    Full Text Available Congenital diaphragmatic hernias are of various types which are due to the defect in the diaphragm and can be encountered in any period of life. Left mediastinal shift with right congenital diaphragmatic hernia is rare and life threatening malformation. We describe a case of right congenital diaphragmatic hernia of a newborn male infant, which died shortly after birth. The lobes of the liver were enlarged and occupied whole of the abdominal cavity. The stomach and intestinal loops were herniated into the right pleural cavity and partly into the left pleural cavity. Severe hypoplastic right lung, trilobed left lung and dextrocardia also were observed.

  15. Tension-free procedures in the treatment of groin hernias

    Milić Dragan J.

    2003-01-01

    patch repair the PerFix plug and patch repair, the Prolene Hernia System bilayer patch repair and Trabucco’s sutureless preshaped hernioraphy. General surgeons today have access to a wider and more sophisticated range of synthetic biomaterials for use in hernia repair than ever before. The advantages and disadvantages of each of these devices must be understood however, before surgeons select any of these implants. Meanwhile, a 1997 study of various biomaterials used in abdominal wall hernia repair further reported that the risk of infection, seroma formation biomaterial-related intestinal obstructions, and other complications can be minimized or eliminated by understanding the process underlying these problems and taking proper precautions. The surgeon's choice of the prosthesis used in hernia repair is based on a combination of factors, including patient characteristics; clinical experience, training, interest, and skill; understanding of the range of products available and the clinical studies that may have been performed on each; and the surgeon's familiarity with a particular product and/or surgical approach. Innovations in technique and product design will no doubt continue to spur advances in hernia repair, and it is hoped that they will continue to improve outcomes. The availability of these outcomes data, along with the ongoing accumulation of clinical experience with a broad range of materials and techniques, will help surgeons to better identify the most appropriate prosthesis for the clinician and the patient. It appears that herniology will remain in the realm of the surgeon, since it is doubtful that any medical measures will replace the operative treatment for abdominal wall hernias. Although operative procedures are not yet ideal important advances have been made in herniorrhaphy resulting in improved outcomes: The use of local techniques has maximized the safety of anesthesia time needed for care has been minimized, with most procedures now being done

  16. Grandes hérnias incisionais Giant incisional hernias

    Manlio Basilio Speranzini

    2010-12-01

    Full Text Available INTRODUÇÃO: A correção de hérnias incisionais abdominais permanece como um dos procedimentos cirúrgicos mais comuns uma vez que ela ocorre em cerca de 11% das laparotomias. Vários são os fatores de risco. Surgem, em geral, nos primeiros cinco anos após a operação e seu manuseio ainda é controverso. OBJETIVO: Atualizar os meios e métodos empregados para a correção cirúrgica das hérnias abdominais gigantes. MÉTODO: Revisão da literatura com base no Pubmed, Scielo e Lilacs com cruzamento dos descritores "hérnia abdominal, próteses, complicações e técnicas cirúrgicas", e adicionando contribuição própria baseada na experiência dos autores no manuseio desta afecção. CONCLUSÃO: Mesmo as correções bem sucedidas, com a utilização ou não de grandes próteses, não são os procedimentos isentos de inconvenientes, pois a parede abdominal não retoma a sua elasticidade e complacência normais. Por este motivo, é importante que o paciente seja alertado da possibilidade da sua expectativa em relação ao resultado, tanto estético quanto funcional, não ser alcançada.BACKGROUND: The correction of abdominal hernias remains one of the most common surgical procedures since it occurs in about 11% of laparotomies. There are several risk factors. Arise, in general, the first five years after the operation and their management is controversial. AIM: Update the means and methods for surgical repair of giant abdominal hernias. METHOD: Literature review based on PubMed, Lilacs and Scielo with crossing the keywords "abdominal hernia, prostheses, surgical techniques and complications", and adding its own contribution based on the authors' experience in handling this condition. CONCLUSION: Even the successful correction with the use of large prostheses, may happen procedure inconvenient, because the abdominal wall does not resume its elasticity and compliance at the normal. For this reason, it is important that the patient be advised

  17. Delayed traumatic diaphragmatic hernia

    Lu, Jing; Wang, Bo; Che, Xiangming; Li, Xuqi; Qiu, Guanglin; He, Shicai; Fan, Lin

    2016-01-01

    Abstract Background: Traumatic diaphragmatic hernias (TDHs) are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with life-threatening outcomes. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias. Methods: Clinical data of patients who received treatment for delayed traumatic diaphragmatic hernias in registers of the First Affiliated Hospital of Xi’an Jiaotong University from 1998 to 2014 were analyzed retrospectively. Results: Six patients were included in this study. Left hemidiaphragm was affected in all of them. Most of the patients had a history of traffic accident and 1 a stab-penetrating injury. The interval from injury to developing symptoms ranged from 2 to 11 years (median 5 years). The hernial contents included the stomach, omentum, small intestine, and colon. Diaphragmatic injury was missed in all of them during the initial managements. All patients received operations once the diagnosis of delayed TDH was confirmed, and no postoperative mortality was detected. Conclusions: Delayed TDHs are not common, but can lead to serious consequences once occurred. Early detection of diaphragmatic injuries is crucial. Surgeons should maintain a high suspicion for injuries of the diaphragm in cases with abdominal or lower chest traumas, especially in the initial surgical explorations. We emphasize the need for radiographical follow-up to detect diaphragmatic injuries at an earlier stage. PMID:27512848

  18. Metastatic ovarian carcinoma presenting as an incarcerated femoral hernia

    Suzanne M. Beecher

    2015-01-01

    Conclusion: In cases, where there is a known intra-abdominal malignancy & the presence of an incarcerated hernia, there should be a high index of suspicion for the presence of tumour within the hernial contents.

  19. Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia

    Joseph Thomas; Natarajan Kumaresan; Sumanth Channapatna Suresh; Basant Mahadevappa

    2009-01-01

    Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera.  Case reports and series have been published with various organs and rare organs being part of the hernia.  Urinary bladder is a known content of sliding hernias.  This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation.

  20. Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia.

    Mahadevappa, Basant; Suresh, Sumanth Channapatna; Natarajan, K; Thomas, Joseph

    2009-01-01

    Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera. Case reports and series have been published with various organs and rare organs being part of the hernia. Urinary bladder is a known content of sliding hernias. This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation.

  1. 应用猪小肠黏膜下层与肌腱细胞构建组织工程支架修复大鼠腹壁缺损的实验研究%Repair of abdominal wall defect with engineered scaffold using tenocytes seeded porcine small intestinal submucosa in rats

    宋致成; 顾岩

    2012-01-01

    目的:应用猪小肠黏膜下层(small intestinal submucosa,SIS)与肌腱细胞构建组织工程支架,研究其在修复腹壁缺损时的生物力学特性.方法:制作SD大鼠腹壁缺损模型,应用所构建的组织工程支架修补缺损,术后4周取样进行大体观察,检测组织学及力学性能.结果:组织工程支架修补术后的SD大鼠无腹部裂开及疝发生,支架与腹腔内脏器有轻微粘连;HE及Masson染色发现支架与肌肉组织交界区有显著新生血管出现及肌肉组织长入.力学性能检测显示组织工程支架的力学强度显著大于SD大鼠腹壁肌肉强度.结论:构建组织工程支架可有效修补大鼠的腹壁缺损.%Objective To investigate the biomechanicai properties of the engineered scaffold using tenocytes seeded small intestinal submucosa (SIS) in abdominal wall defect. Methods Abdominal wall defect was repaired using engineered scaffold in rat modes. The rats were sacrificed after 4 weeks and the sample tissues were analyzed by gross observation, histological method and mechanical testing. Results All rats had no abdominal dehiscence or hernia. The engineered scaffold caused slight adhesion with organs. HE and Masson staining proved the junction between SIS and surrounding tissue had more new vessels. The muscle grew into the engineered scaffold. The mechanical strength of the engineered scaffold was much more than the abdominal wall muscles, which could provide sufficient mechanical strength. Conclusions Engineered scaffold repairing abdominal wall defect is a feasible and effective method.

  2. Ambulatory hernia surgery under local anesthesia is feasible and safe in obese patients.

    Acevedo, A; León, J

    2010-02-01

    Ambulatory hernia surgery under local anesthesia is becoming more widely used worldwide. Although many reports include obese patients, there are no studies that report specifically on the feasibility and safety of ambulatory hernia surgery in this category of patients. This paper documents our experience in this respect. The present investigation is an observational study performed at the CRS Hernia Center, Santiago, Chile, on 510 obese and 1,521 non-obese patients with all kinds of hernias susceptible to ambulatory hernia repair under local anesthesia. Both tissue and mesh repairs were performed. Obesity was defined as a body mass index (BMI) greater than 30. Patients with a BMI greater than 45 were excluded from this study. Operative time and pain experienced during the intervention were recorded. During the controls performed by a staff member at the 7th postoperative day, a questionnaire was answered by each patient regarding satisfaction, complaints, and postoperative pain. A second questionnaire was completed on the 30th postoperative day. Satisfaction and pain were both measured by means of a 10-point visual analog scale (VAS). The mean age was similar in both groups (51 years for non-obese and 52 years for obese patients). Obesity was present in 38.3% of women and in 17.5% of men (P ambulatory abdominal wall hernia repair under local anesthesia is feasible in obese patients. Because of the increased length of surgery in these patients, monitored sedation and prophylactic antibiotic cover should be used. The slight decrease in patient satisfaction is balanced by the lower risks and higher costs associated with full general anesthetic.

  3. Laparoscopic mesh repair of a Morgagni hernia using the double-crown technique: A case study.

    Kaida, Takeshi; Ikeda, Atsushi; Shimoda, Hirofumi; Sako, Hiroyuki; Uchida, Hiroshi; Wada, Masahiro; Ikeda, Ken; Okusawa, Seijiro; Watanabe, Masahiko

    2014-11-01

    We report a case of Morgagni hernia in which the patient underwent laparoscopic mesh repair. A 65-year-old woman presented with an abnormal shadow in the right lower lung field on a routine medical checkup. CT showed that the transverse colon passed between the liver and abdominal wall, and herniated into the thoracic cavity. Simple closure was precluded by the large hernial orifice. We therefore performed laparoscopic repair using a Parietex Optimized Composite Mesh. The double-crown technique was used to fix the margin of the mesh to the region around the hernial orifice. Our procedure for repair of a Morgagni hernia with a large hernial orifice is safe and minimally invasive, and it may effectively prevent recurrence.

  4. Umbilical hernia--a potential donor-site complication of fat injection laryngoplasty.

    Chiu, Feng-Shiang; Lin, Yaoh-Shiang; Chang, Ying-Nan; Lee, Jih-Chin

    2012-11-01

    Injection laryngoplasty with autologous fat appears to be an effective and simple technique for the treatment of patients with glottic insufficiency in comparison with other surgical techniques. Despite of its advantages, associated complications have also been reported, including immediate donor-site morbidity (eg, hematoma and abscess), fat extrusion of the injection site, and delayed manifestation of vocal granuloma or overinjected vocal folds. In this article, a patient suffering from accidental injury to the deep abdominal fascia without peritoneal penetration in the fat harvest procedure is presented. Three months after the fat injection laryngoplasty, an umbilical hernia was proved to occur via the clinical imaging. Several etiologies are supposed to induce the herniation of intraabdominal structures, including surgeon's incaution, abdominal obesity, intense wound inflammation and fibrosis, and the native weak point of the abdominal wall around the umbilicus. This case provides information that overdepth and negligence in fat harvest may injure the deep abdominal fascia, then possibly causing the umbilical hernia as a delayed donor-site complication.

  5. Intermuscular lipoma in a 4-year-old child presenting like Spigelian hernia

    Manoj Saha

    2015-01-01

    Full Text Available Lipomas are commonest benign tumor and can occur at any part of the body, but intermuscular lipomas are very rare and usually occur at middle age or later. Intermuscular lipomas remain hidden till they attain a large size. They commonly appear on anterior abdominal wall. We treated a case of intermuscular lipoma in a 4-year-old girl. It presented as a bulge at right iliac fossa during straining; its location and symptoms were similar to that of Spigelian hernia. Actual diagnosis was made under general anesthesia and complete surgical excision was done. This is a rare mode of presentation of an intermuscular lipoma. Intermuscular lipoma of the abdominal wall at this young age was not reported earlier.

  6. Intermuscular lipoma in a 4-year-old child presenting like Spigelian hernia.

    Saha, Manoj

    2015-01-01

    Lipomas are commonest benign tumor and can occur at any part of the body, but intermuscular lipomas are very rare and usually occur at middle age or later. Intermuscular lipomas remain hidden till they attain a large size. They commonly appear on anterior abdominal wall. We treated a case of intermuscular lipoma in a 4-year-old girl. It presented as a bulge at right iliac fossa during straining; its location and symptoms were similar to that of Spigelian hernia. Actual diagnosis was made under general anesthesia and complete surgical excision was done. This is a rare mode of presentation of an intermuscular lipoma. Intermuscular lipoma of the abdominal wall at this young age was not reported earlier.

  7. Intermuscular lipoma in a 4-year-old child presenting like Spigelian hernia

    2015-01-01

    Lipomas are commonest benign tumor and can occur at any part of the body, but intermuscular lipomas are very rare and usually occur at middle age or later. Intermuscular lipomas remain hidden till they attain a large size. They commonly appear on anterior abdominal wall. We treated a case of intermuscular lipoma in a 4-year-old girl. It presented as a bulge at right iliac fossa during straining; its location and symptoms were similar to that of Spigelian hernia. Actual diagnosis was made unde...

  8. Feasibility and outcome after laparoscopic ventral hernia repair using Proceed mesh

    Rosenberg, J.; Burcharth, J.

    2008-01-01

    BACKGROUND: There are many different meshes available for laparoscopic repair of ventral hernias. A relatively new product is the Proceed mesh with a bioresorbable layer against the bowels and a polypropylene layer against the abdominal wall. There are, however, no human data available. The aim...... study included 49 patients with a median age of 64 years (range 30-89) and body mass index of 27.8 (19.4-50.5). The dimensions of the mesh varied from 4 x 4 cm to 30 x 40 cm (median 15 x 15 cm). One patient developed an uncomplicated wound infection and none of the 49 patients developed mesh infections...

  9. Free-breathing black-blood CINE fast-spin echo imaging for measuring abdominal aortic wall distensibility: A feasibility study.

    Lin, Jyh-Miin; Patterson, Andrew; Chao, Tzu-Cheng; Zhu, Chengcheng; Chang, Hing-Chiu; Mendes, Jason; Chung, Hsiao-Wen; Gillard, Jonathan; Graves, Martin

    2017-03-22

    The paper reports a free-breathing black-blood CINE fast-spin echo (FSE) technique for measuring abdominal aortic wall motion. The free-breathing CINE FSE includes the following MR techniques: 1) variable-density sampling with fast iterative reconstruction; 2) inner-volume imaging; and 3) a blood-suppression preparation pulse. The proposed technique was evaluated in eight healthy subjects. The inner-volume imaging significantly reduced the intraluminal artifacts of respiratory motion (p = 0.015). The quantitative measurements were a diameter of 16.3 ± 2.8 mm and wall distensibility of 2.0 ± 0.4 mm (12.5 ± 3.4%) and 0.7 ± 0.3 mm (4.1 ± 1.0%) for the anterior and posterior walls, respectively. The cyclic cross-sectional distensibility was 35 ± 15% greater in the systolic phase than in the diastolic phase. In conclusion, we developed a feasible CINE FSE method to measure the motion of the abdominal aortic wall, which will enable clinical scientists to study the elasticity of the abdominal aorta.

  10. Bilateral Morgagni Hernia: A Unique Presentation of a Rare Pathology

    Michael Leshen

    2016-01-01

    Full Text Available Morgagni hernia is an unusual congenital herniation of abdominal content through the triangular parasternal gaps of the anterior diaphragm. They are commonly asymptomatic and right-sided. We present a case of a bilateral Morgagni hernia resulting in delayed growth in a 10-month-old boy. The presentation was unique due to its bilateral nature and its symptomatic compression of the mediastinum. Diagnosis was made by 3D reconstructed CT angiogram. The patient underwent medical optimization until he was safely able to tolerate laparoscopic surgical repair of his hernia. Upon laparoscopy, the CT findings were confirmed and the hernia was repaired.

  11. Bilateral Morgagni Hernia: A Unique Presentation of a Rare Pathology.

    Leshen, Michael; Richardson, Randy

    2016-01-01

    Morgagni hernia is an unusual congenital herniation of abdominal content through the triangular parasternal gaps of the anterior diaphragm. They are commonly asymptomatic and right-sided. We present a case of a bilateral Morgagni hernia resulting in delayed growth in a 10-month-old boy. The presentation was unique due to its bilateral nature and its symptomatic compression of the mediastinum. Diagnosis was made by 3D reconstructed CT angiogram. The patient underwent medical optimization until he was safely able to tolerate laparoscopic surgical repair of his hernia. Upon laparoscopy, the CT findings were confirmed and the hernia was repaired.

  12. Clinical study of preperitoneal tension-free hernia repair and totally extra peritoneal hernia repair via Lower abdominal median incision%下腹部正中切口腹膜前无张力疝修补术与完全腹膜外疝修补术临床对比研究

    潘平东; 钟强文; 池宇明

    2015-01-01

    目的:探讨经下腹正中切口腹膜前无张力疝修补术(后入路组)和完全腹膜外疝修补术(TEP 组)在成人腹股沟疝治疗中的临床效果。方法回顾性分析2012年1月至2013年12月,嘉应学院医学院附属医院85例腹股沟疝患者的临床资料,根据手术方式分为二组,后入路组43例, TEP 组42例。比较二组患者手术时间、住院时间、术后疼痛评分、住院费用、围手术期并发症(切口感染、阴囊血肿、尿潴留等)发生情况及复发情况。结果二组手术均顺利完成,TEP 组患者的住院时间、术后疼痛评分均低于后入路组,差异有统计学意义(t =3.070、6.006,P =0.007、0.000),而手术时间和住院费用高于后入路组,差异有统计学意义(t =6.730、7.890,P =0.003、0.000)。二组患者并发症发生率比较差异无统计学意义(χ2=0.079,P =0.778)。随访6~24个月,平均(19±4)个月,TEP 组分别于术后1年和15个月各复发1例,后入路组术后3个月复发1例,均再次手术后治愈。结论TEP 患者术后疼痛轻,下床活动早,住院时间短。经下腹部正中切口腹膜前无张力疝修补术费用低、技术易掌握,对双侧腹股沟疝、常规前进路的开放术后复发疝更为适合,值得基层医院推广。%Objective To investigate the clinical outcome of the open preperitoneal tension-free hernia repair via lower abdominal median incision (posterior approach group)and totally extraperitoneal hernia repair (TEP group)in treatment of adult inguinal hernia.Methods The clinical data of 85 patients from January 201 2 to December 201 3 in Affiliated Hospital of Medicine College of Jiaying University were retrospectively analyzed,including 42 cases in TEP group and 43 cases in posterior group.The two groups were compared with operation time,hospitalization time,postoperative pain score,hospital cost and

  13. Techniques for Abdominal Wall Closure after Damage Control Laparotomy: From Temporary Abdominal Closure to Early/Delayed Fascial Closure—A Review

    Qian Huang

    2016-01-01

    Full Text Available Open abdomen (OA has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient’s physiological condition allows.

  14. Human acellular dermal matrix for repair of abdominal wall defects: review of clinical experience and experimental data.

    Holton, Luther H; Kim, Daniel; Silverman, Ronald P; Rodriguez, Eduardo D; Singh, Navin; Goldberg, Nelson H

    2005-01-01

    The use of prosthetic mesh for the tension-free repair of incisional hernias has been shown to be more effective than primary suture repair. Unfortunately, prosthetic materials can be a suboptimal choice in a variety of clinical scenarios. In general, prosthetic materials should not be implanted into sites with known contamination or infection because they lack an endogenous vascular network and are thus incapable of clearing bacteria. This is of particular relevance to the repair of recurrent hernias, which are often refractory to repair because of indolent bacterial colonization that weakens the site and retards appropriate healing. Although fascia lata grafts and muscle flaps can be employed for tension-free hernia repairs, they carry the potential for significant donor site morbidity. Recently, a growing number of clinicians have used human acellular dermal matrix as a graft material for the tension-free repair of ventral hernias. This material has been shown to become revascularized in both animal and human subjects. Once repopulated with a vascular network, this graft material is theoretically capable of clearing bacteria, a property not found in prosthetic graft materials. Unlike autologous materials such as fascial grafts and muscle flaps, acellular dermal matrix can be used without subjecting the patient to additional morbidity in the form of donor site complications. This article presents a thorough review of the current literature, describing the properties of human acellular dermal matrix and discussing both animal and human studies of its clinical performance. In addition to the review of previously published clinical experiences, we discuss our own preliminary results with the use of acellular dermal matrix for ventral hernia repair in 46 patients.

  15. 螺旋CT对腹壁膨出的临床诊断价值%Clinical Application of Abdominal Wall Bulge with CT Scan

    刘飞德; 邢新博; 李基业; 王世斌; 朱瑛梅; 姚胜

    2012-01-01

    目的 探讨螺旋CT对腹壁膨出的临床诊断价值.方法 收集本科就诊并行螺旋CT检查的腹壁膨出32例,观察腹壁膨出的部位及大小,行手术治疗者术后行螺旋CT复查手术效果.结果 32例腹壁膨出患者中,14例接受外科手术治疗,18例未行手术治疗.腹壁膨出在螺旋CT中表现为膨出区域的腹壁三层肌肉菲薄或消失,无明显疝囊或腹腔内容物疝出.术后螺旋CT复查可见膨出区域的侧腹壁三层肌肉及肌肉间隙出现,部分可见补片影.结论 螺旋CT对腹壁膨出的诊断和鉴别诊断具有确定性作用,同时可以为综合评估患者病情、选择手术方法及判断术后效果提供重要依据.%Objective To evaluate the clinical application of CT examination in abdominal wall bulge. Methods Retrospective study were carried out to 32 cases of abdominal wall bulge of which patients were accepted CT examination. The site and size of the bulge were evaluated, and postoperative CT examination was performed to evaluate the effect of the operation. Results Out of the 32 cases, 14 accepted surgical repair using synthetic mesh while the rest didn' t. CT scan demonstrated no facial defect or herniation of any intra-abdominal content in the bulge area, but the lateral abdominal wall musculature (external oblique, internal oblique, and transversus abdominal muscles) and/or rectus muscle on the bulge side appeared attenuated compared with the corresponding structures on the opposite side. The following CT scan check-up showed that the three layers of abdominal muscles on the bulge side appeared to be thicker compared with preoperative structures and the spaces between the three muscular layers emerged. And the mesh could be seen in some cases in CT scan. Conclusion CT scan is perfect in the diagnosis of the abdominal wall bulge and plays an important role in the evaluation of the patient situation, surgical technique and effectiveness of surgical repair.

  16. Hérnias incisionais no pós-operatório de correção de aneurisma de aorta abdominal Postoperative incisional hernias after open abdominal aortic aneurysm repair

    2012-01-01

    CONTEXTO: A incidência de hérnia incisional no pós-operatório da correção aberta de aneurisma de aorta abdominal é alta, variando de 10 a 37% e mais de três vezes mais comum do que em pacientes submetidos à correção para doença obstrutiva aorto-ilíaca. OBJETIVO: Apresentar a incidência de hérnia incisional em um grupo de pacientes acompanhados no pós-operatório da correção aberta de aneurisma de aorta abdominal. MÉTODOS: Série de casos em uma população de 144 pacientes operados por aneurisma ...

  17. Nonwoven polypropylene prosthesis in large abdominal wall defects in rats Tela de polipropileno sem tecelagem na correção de grandes defeitos da parede abdominal em ratos

    Patrick dos Santos Barros dos Reis

    2012-10-01

    Full Text Available PURPOSE: To evaluate, in large abdominal wall defects surgically shaped in rats, if a synthetic polypropylene nonwoven prosthesis could be used as a therapeutic option to conventional polypropylene mesh. METHODS: Twenty four (24 Wistar rats were enrolled into three groups. Group 1 (Simulation group with an abdominal wall defect of 3 X 3 left untreated and Groups 2 and 3, respectively treated with a conventional polypropylene mesh and a polypropylene nonwoven (NWV prosthesis to cover the breach. At the 45th postoperatively day, adhesion (area and strength and vascularization of Groups 2 and 3 were evaluated. The histological preparations with Hematoxylin-Eosin, Tricromium of Masson, Pricrosirius red and polarization with birefringence, and also the structural analysis of the prostheses carried on by Thermogravimetry and Differential Scanning Calorimetry were also assessed. RESULTS: There were no significant differences between the Groups 2 and 3. CONCLUSION: In rats, the polypropylene nonwoven prosthesis showed to be safe and has to be considered as an alternative to conventional mesh manufactured by weaving in the treatment of great defects of the abdominal wall.OBJETIVO: Avaliar, em grandes defeitos da parede abdominal produzidos cirurgicamente em ratos, se uma prótese sintética de polipropileno sem tecelagem poderia ser utilizada como alternativa terapêutica às telas convencionais de polipropileno. MÉTODOS: Vinte e quatro ratos foram distribuídos em três grupos numericamente iguais. Grupo 1 (Simulação, no qual um defeito de 3 x 3 cm foi constituído na parede abdominal sem tratamento. Uma tela convencional de polipropileno e uma tela de polipropileno sem tecelagem foram colocadas para cobrir o defeito, nos grupos 2 e 3 , respectivamente. No 45º dia de pós-operatório foram avaliadas a área e a força das aderências, além da vascularização. Também foram analisados os preparados histológicos com Hematoxilina-eosina, Tricr

  18. Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with {sup 99m}Tc-MAA accumulation in the anterior abdominal wall?

    Ahmadzadehfar, Hojjat; Sabet, Amir; Muckle, Marianne; Haslerud, Torjan; Biersack, Hans Juergen; Ezziddin, Samer [University Hospital Bonn, Department of Nuclear Medicine, Bonn (Germany); Moehlenbruch, Markus; Meyer, Carsten; Wilhelm, Kai; Schild, Hans Heinz [University Hospital Bonn, Department of Radiology, Bonn (Germany)

    2011-08-15

    While influx of chemoembolic agents into the hepatic falciform artery (HFA) from the hepatic artery can cause supraumbilical skin rash, epigastric pain and even skin necrosis, the significance of a patent HFA in patients undergoing radioembolization is not completely clear. Furthermore, the presence of tracer in the anterior abdominal wall seen in {sup 99m}Tc-macroaggregated albumin ({sup 99m}Tc-MAA) images, which is generally performed prior to radioembolization, has been described as a sign of a patent HFA. The aim of this retrospective study was to evaluate the incidence and consequences of {sup 99m}Tc-MAA accumulation in the anterior abdominal wall, indicating a patent HFA, in patients undergoing radioembolization of liver tumours. A total of 224 diagnostic hepatic angiograms combined with {sup 99m}Tc-MAA SPECT/CT were acquired in 192 patients with different types of cancer, of whom 142 were treated with a total of 214 radioembolization procedures. All patients received a whole-body scan, and planar and SPECT/CT scans of the abdomen. Only patients with extrahepatic {sup 99m}Tc-MAA accumulation in the anterior abdominal wall were included in this study. Posttreatment bremsstrahlung SPECT/CT and follow-up results for at least 3 months served as reference standards. Tracer accumulation in the anterior abdominal wall was present in pretreatment {sup 99m}Tc-MAA SPECT/CT images of 18 patients (9.3%). The HFA was found and embolized by radiologists before treatment in one patient. In the remaining patients radioembolization was performed without any modification in the treatment plan despite the previously mentioned extrahepatic accumulation. Only one patient experienced abdominal muscle pain above the navel, which started 24 h after treatment and lasted for 48 h without any skin changes. The remaining patients did not experience any relevant side effects during the follow-up period. Side effects after radioembolization in patients with tracer accumulation in the

  19. [Influence of mydocalm on the degree of intra-abdominal hypertension and local blood circulation in the intestinal wall in experiment].

    Sapegin, V I; Sapegin, I D; Il'chenko, F N

    2014-01-01

    The effect of mydocalm (tolperison, 5 mg/kg single dose) on the dynamics of intra-abdominal hypertension (IAH), blood circulation regulation, and oxygen balance in the tissues of intestinal wall were studied in acute experiments on rabbits. Using a special stand of original design, the initial IAH level was modeled at 200 mm H2O with the subsequent stopping of further receipt of liquid during 3 hours in an elastic container in the abdominal cavity. During 3-h observation without drug administration, no changes in IAH due to the tone of muscles of the frontal abdominal wall takes place, but there is progressive deceleration of local blood flow (-35.33 + 0.99%, p < 0.01), suppressed dilation (-20.02 + 0.54%, p < 0.01) and constriction (-60.45 + 1.17%, p < 0.01) reactivity of vessels, and decreased oxygen tension (-47.18 + 0.75%, p < 0.01) in the intestinal wall at the end of experiment. The introduction of mydocalm reduces the tone of muscles of the frontal abdominal wall, which leads to a decrease in IAH (maximum effect after 1.5 hours, -20.81 + 0.84%, p < 0.01) and prevents decrease in the local blood flow (-26.77 + 0.41%, p < 0.01), suppression of dilation (-16.51 + 0.34%, p < 0.01) and constriction (-37.85 + 0.61%, p < 0.01) reactivity of vessels, and reduction in oxygen tension (-36.60 + 1.18%, p < 0.01) at the end of experiment. The administration of mydocalm can extend the limits of application of a conservative therapy for patients with IAH and to improve the results.

  20. Laparoscopic transabdominal extraperitoneal repair of lumbar hernia

    Sharma A

    2005-01-01

    Full Text Available Lumbar hernias need to be repaired due to the risk of incarceration and strangulation. A laparoscopic intraperitoneal approach in the modified flank position causes the intraperitoneal viscera to be displaced medially away from the hernia. The creation of a wide peritoneal flap around the hernial defect helps in mobilization of the colon, increased length of margin is available for coverage of mesh and more importantly for secure fixation of the mesh under vision to the underlying fascia. Laparoscopic lumbar hernia repair by this technique is a tensionless repair that diffuses total intra-abdominal pressure on each square inch of implanted mesh. The technique follows current principles of hernia repair and appears to confer all benefits of a minimal access approach.

  1. Diagnosis and treatment of obturator hernia

    Nakayama, Takamori; Kobayashi, Seiji; Shiraishi, Kou; Nishiumi, Takao; Mori, Syunji; Isobe, Kiyoshi; Furuta, Yoshiaki [Shizuoka Red Cross Hospital (Japan)

    2002-09-01

    Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n=7) or an inguinal approach (n=5). The hernial orifice was closed using the uterine fundus (n=6), a patch (n=5), and direct suture (n=1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery. (author)

  2. Hérnia de Spiegel bilateral: relato de caso e revisão de literatura Bilateral spiegelian hernia: case report and literature review

    José Marcos Parreira

    2007-09-01

    Full Text Available RACIONAL: As hérnias spigelianas são raros defeitos da parede abdominal. Apresentam quadro clínico pouco esclarecedor e com risco real de estrangulamento. RELATO DO CASO: Mulher de 55 anos, apresentava-se com massa endurecida e irredutível em fossa ilíaca esquerda além de aumento localizado da parede abdominal à direita e uma volumosa hérnia umbilical. A tomografia computadorizada de abdome mostrou duas hérnias spigelianas direita e esquerda, com conteúdo encarcerado. O tratamento foi herniorrafia seguida de colocação de tela. CONCLUSÃO: As hérnias de Spiegel caracterizam-se por serem raras e com diagnóstico muitas vezes de exclusão. Necessitam de tratamento cirúrgico pelo importante risco de estrangulamento do seu conteúdo.BACKGROUND: Spiegelian hernias are rare defects of the abdominal wall, which present a not much clarifying medical profile as well as the risk of strangulation. CASE REPORT: A fifty-five year old women presented herself with a hardened and irreducible mass in the left iliac foss, as well as local increase of the right abdominal wall and a voluminous umbilical hernia. Computerized tomography of the abdomen showed two spiegelian hernias, a right and a left, with incarcerated content. The treatment was herniorrhaphy followed by mesh placement. CONCLUSION: Spiegelian hernias are rare conditions, which are many times diagnosed using exclusion. These patients need surgical treatment due to the risk of content strangulation.

  3. Estudo das telas cirúrgicas de polipropileno/poliglecaprone e de polipropileno/polidioxanona/celulose oxidada regenerada na cicatrização de defeito produzido na parede abdominal de ratos Study of surgical meshes of polypropylene/polyglecaprone and polypropylene/polydioxanone/oxidized regenerated cellulose on the healing of defects produced in abdominal wall of rats

    Marcia Regina Zanello Pundek

    2010-06-01

    different surgical meshes (Proceed® and Ultrapro® on the healing of defects produced in abdominal wall of rats evaluating the macroscopic, microscopic and tensiometric parameters. METHOD: Thirty two Wistar rats were divided into two groups of 16 animals and four groups of eight animals euthanized within 15 and 30 days for evaluation. The macroscopic variables were: the presence of hematoma at the edges of the sutures of the surgical mesh in the abdominal wall; the knitting of the surgical mesh and the edge of the wound; presence of infection at the surgical site; presence of viscera fistulas on the surgical mesh; presence of adhesions in the abdominal cavity; presence of incisional hernia. During microscopy the stages of the inflammatory process of healing where evaluated, and tensiometry evaluated the tensile force required to rupture the material. RESULTS: The knitting of the mesh and the edge of the surgical wound was better in the 15 days Ultrapro subgroup than in the 15 days Proceed subgroup; within 30 days the knitting was similar in both subgroups. There was no significant difference for the variable of macroscopy. Both groups in both periods had the same proportion of cases with chronic inflammation, but there were higher scores of inflammation in the 15 days Ultrapro subgroup than the 30 days Ultrapro subgroup. The subgroup 15 days Ultrapro showed greater rupture strength than the subgroup 15 days Proceed, but in 30 days there were no difference. Ultrapro showed equal rupture strength in both periods, but 30 days Proceed showed greater rupture strength than 15 days Proceed. CONCLUSION: The meshes are similar in variables.

  4. Atypical right diaphragmatic hernia (hernia of Morgagni, spigelian hernia and epigastric hernia in a patient with Williams syndrome: a case report

    Rashid Farhan

    2009-01-01

    Full Text Available Abstract Introduction Williams syndrome is rare genetic disorder resulting in neurodevelopmental problems. Hernias of the foramen of Morgagni are rare diaphragmatic hernias and they mostly present on the right side, in the anterior mediastinum. They are usually asymptomatic and are difficult to diagnose, especially in patients with learning disabilities. Case presentation This 49-year-old woman with Williams syndrome, cognitive impairment and aortic stenosis presented to physicians with right-sided chest pain. She had previously undergone repair of her right spigelian and epigastric hernia. Her abdominal examination was unremarkable. Chest X-ray suggested right-sided diaphragmatic hernia and pleural effusion for which she received treatment. The computed tomography scan showed a diaphragmatic hernia with some collapse/consolidation of the adjacent lung. Furthermore, the patient had aortic stenosis and was high risk for anaesthesia (ASA grade 3. She underwent successful laparoscopic repair of her congenital diaphragmatic hernia leading to a quick and uneventful postoperative recovery. Conclusion These multiple hernias suggest that patients with Williams syndrome may have some connective tissue disorder which makes them prone to develop hernias especially associated with those parts of the body which may have intracavity pressure variations like the abdomen. Diaphragmatic hernia may be the cause of chest pain in these patients. A computed tomography scan helps in early diagnosis, and laparoscopic repair helps in prevention of further complications, and leads to quick recovery especially in patients with learning disabilities. In the presence of significant comorbidities, a less invasive operative procedure with quick recovery becomes advisable.

  5. Congenital Diaphragmatic Hernia

    2012-01-01

    Congenital Diaphragmatic Hernia (CDH) is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is < 5 in 10,000 live-births. The etiology is unknown although clinical, genetic and experimental evidence points to disturbances in the retinoid-signaling pathway during organogenesis. Antenatal diagnosis is often made and this allows prenatal management (open correction of the hernia in the past and reversible fetoscopic tracheal obstruction nowadays) that may be indicated in cases with severe lung hypoplasia and grim prognosis. Treatment after birth requires all the refinements of critical care including extracorporeal membrane oxygenation prior to surgical correction. The best hospital series report 80% survival but it remains around 50% in population-based studies. Chronic respiratory tract disease, neurodevelopmental problems, neurosensorial hearing loss and gastroesophageal reflux are common problems in survivors. Much more research on several aspects of this severe condition is warranted. PMID:22214468

  6. Abdominal wall surgery

    ... pregnancy. Skin and muscle cannot regain its normal tone. This can be a problem for very overweight people who lost a lot of weight. Tummy tuck is major surgery. It is important to read about the procedure before having it. ...

  7. Endoscopic inguinal hernia repair

    M.T.T. Knook

    2002-01-01

    textabstractInguinal hernias are among the oldest surgical challenges, having been recognized by the Egyptians in 1500 BC and Hippocrates in 400 BC. Celsus in 40 AD described Roman surgical practice, including manual hernia reduction for strangulated hernia, truss for reducible hernia and surgery on

  8. Strangulated obturator hernia - an unusual presentation of intestinal obstruction.

    Zeeshan, Saqib

    2012-01-31

    An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved.

  9. Spigelian hernia: surgical anatomy, embryology, and technique of repair.

    Skandalakis, Panagiotis N; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

    2006-01-01

    Spigelian hernia (1-2% of all hernias) is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the spigelian aponeurosis (i.e., the aponeurosis of the transverse abdominal muscle limited by the linea semilunaris laterally and the lateral edge of the rectus muscle medially). Mostly, these hernias lie in the "spigelian hernia belt," a transverse 6-cm-wide zone above the interspinal plane; lower hernias are rare and should be differentiated from direct inguinal or supravescical hernias. Although named after Adriaan van der Spieghel, he only described the semilunar line (linea Spigeli) in 1645. Josef Klinkosch in 1764 first defined the spigelian hernia as a defect in the semilunar line. Defects in the aponeurosis of transverse abdominal muscle (mainly under the arcuate line and more often in obese individuals) have been considered as the principal etiologic factor. Pediatric cases, especially neonates and infants, are mostly congenital. Embryologically, spigelian hernias may represent the clinical outcome of weak areas in the continuation of aponeuroses of layered abdominal muscles as they develop separately in the mesenchyme of the somatopleura, originating from the invading and fusing myotomes. Traditionally, repair consists of open anterior herniorraphy, using direct muscle approximation, mesh, and prostheses. Laparoscopy, preferably a totally extraperitoneal procedure, or intraperitoneal when other surgical repairs are planned within the same procedure, is currently employed as an adjunct to diagnosis and treatment of spigelian hernias. Care must be taken not to create iatrogenic spigelian hernias when using laparoscopy trocars or classic drains in the spigelian aponeurosis.

  10. Mini-laparotomy with abdominal wall lifting for partial gastrectomy in patients with early gastric mucosal cancer at lesser curvature of the middle stomach.

    Tomita, Ryouichi; Fujisak, Shigeru; Park, Yeong Ji

    2009-01-01

    Partial gastrectomy (PG) is the most frequently adopted minimally invasive procedure for early gastric cancer (EGC), especially mucosal cancer (MC). The aim of this study was to introduce a minimally invasive procedure, i.e., minilaparotomy with abdominal wall lifting for PG in patients with early mucosal gastric cancer at the lesser curvature of the middle stomach. Well differentiated adenocarcionoma in MC at the lesser curvature of the middle stomach was selected, where no lymph node metastasis (NO) was confirmed using ultrasonic endoscopy, CT, and MRI during the preoperative examinations. PG was also chosen for patients with a tumor size of 2cm or less and non-depressive type in whom endoscopic mucosal resection (EMR) or endoscopic submucosal resection (ESD) was not possible. Five MC patients (3 men and 2 women, aged 44-62 years, mean age 53.3 years) underwent mini-laparotomy with abdominal wall lifting for PG. Our procedure involved a 6 cm upper abdominal median incision made at the beginning of the operation. The upper abdominal wall was lifted by a subcutaneous Kirshner wire. The small wound was also pulled upward and/or laterally by Kent retractors and conventional surgical instruments were used through the wound. The middle stomach could be detected through the small wound and partially resected, approximately 1 cm from the tumor edge under the guide of the endoscope. The resected stomach margin was stitched layer-to-layer. In this way, PG was easily completed. The total surgical time was 71.8 +/- 12.9 min and the mean estimated blood loss was 30.8 +/- 20.5 ml. Day of starting diet was 3 +/- 0.7 days after operation. Post-operative hospitalization was 8.2 +/- 1.3 days. There was no surgical mortality. All subjects were satisfied with this procedure. Mini-laparotomy with abdominal wall lifting is a safe and efficient technique in the treatment of PG for MC with NO at the lesser curvature of the middle stomach when EMR or ESD is impossible.

  11. Foreign body granuloma in the anterior abdominal wall mimicking an acute appendicular lump and induced by a translocated copper-T intrauterine contraceptive device: a case report

    Ansari Maulana Mohammed

    2009-04-01

    Full Text Available Abstract Introduction Intrauterine contraceptive devices may at times perforate and migrate to adjacent organs. Such uterine perforation usually passes unnoticed with development of potentially serious complications. Case presentation A 25-year-old woman of North Indian origin presented with an acute tender lump in the right iliac fossa. The lump was initially thought to be an appendicular lump and treated conservatively. Resolution of the lump was incomplete. On exploratory laparotomy, a hard suspicious mass was found in the anterior abdominal wall of the right iliac fossa. Wide excision and bisection of the mass revealed a copper-T embedded inside. Examination of the uterus did not show any evidence of perforation. The next day, the patient gave a history of past copper-T Intrauterine contraceptive device insertion. Conclusions Copper-T insertion is one of the simplest contraceptive methods but its neglect with inadequate follow-up may lead to uterine perforation and extra-uterine migration. Regular self-examination for the "threads" supplemented with abdominal X-ray and/or ultrasound in the follow-up may detect copper-T migration early. To the best of our knowledge, this is the first report of intrauterine contraceptive device migration to the anterior abdominal wall of the right iliac fossa.

  12. A CLINICAL STUDY ON SLIDING INGUINAL HERNIAS

    Sobha Rani

    2015-09-01

    Full Text Available INTRODUCTION: A sliding hernia is a type of hernia in which posterior wall of the sac is not only formed by the parietal peritoneum, but also by sigmoid colon with its mesentery on its left side; caecum on right side and often with portion of bladder in both sides. During surgery care is taken not t o separate the content from the sac as the posterior wall of the sac is formed by the sliding component itself and attempts to dissect it from wall results in vascular injury to the structure and end in ischemic insult of the sliding component. Thus slidin g hernia is important for the special surgical technique and care during intraoperative period which decreases the morbidity. AIMS AND OBJECTIVE S : To study the incidence of sliding hernia in S.V.R.R.G. General Hospital Tirupati . To know the presentation, o rgan involved in the sliding, post - operative complications in the management of sliding hernias. METHODOLOGY : STUDY DESIGN: Prospective Clinical Study , STUDY AREA: Sri Venka teswara Medical College Tirupat i . SOURCE OF DATA: This study is an observational study in which 600 patients with hernia were studied and 40 patients with sliding component during intra operative period were studied in a period of 12 months. S AMPLE SIZE: 40 patients fulfilling the inclusion criteria . METHOD OF COLLECTION OF DATA: Detai led history taking , Complete clinical examination , Appropriate Investigations Blood & Urine Examination, USG , Surgery is performed & Operative findings were recorded. INCLUSION CRITERIA: Patients more than 13 years, with inguinal hernia giving written inform ed consent. EXCLUSION C RITERIA: Patients less than 13 yrs. Patients with comorbid conditions like heart diseases, liver and renal diseases. SOFTWARE: Statistical software mainly SPSS 11.0 and Systat 8.00 was used for the analysis of the data and Microsoft word and excel have been used to generate graphs tables etc. CONCLUSION: In the observational study done on 40 ca ses of

  13. Laparoscopic Repair and Percutaneous Endoscopic Gastrostomy to Treat Giant Esophageal Hiatal Hernia with Gastric Obstruction: A Case Report.

    Hamai, Yoichi; Hihara, Jun; Tanabe, Kazuaki; Furukawa, Takaoki; Yamakita, Ichiko; Ibuki, Yuta; Okada, Morihito

    2015-06-01

    We describe a 74-year-old man with repeated aspiration pneumonia who developed gastric obstruction due to giant esophageal hiatal hernia (EHH). We repaired the giant EHH by laparoscopic surgery and subsequently anchored the stomach to the abdominal wall by percutaneous endoscopic gastrostomy (PEG) using gastrofiberscopy. Thereafter, the patient resumed oral intake and was discharged on postoperative day 21. At two years after these procedures, the patient has adequate oral intake and lives at home. Because this condition occurs more frequently in the elderly with comorbidities, laparoscopic surgery contributes to minimally invasive treatment. Furthermore, the procedure combined with concurrent gastropexy via PEG is useful for treating patients who have difficulty swallowing and for preventing recurrent hernia.

  14. Incarcerated amyand hernia

    Fatih Ciftci; Ibrahim Abdulrahman

    2015-01-01

    Amyand's hernia is a rare condition defined by theinclusion of the appendix vermiformis within the herniasac. Its incidence among cases of groin hernia is lessthan 1%. The clinical manifestation of incarceratedinguinal hernia generally masks the symptoms andsigns of acute appendicitis, which renders preoperativediagnosis difficult. In this study, we present two casesof Amyand's hernia that were diagnosed preoperatively.The patients were taken for operation withthe prediagnosis of incarcerated inguinal hernia. Weevaluated these cases along with data from priorstudies.

  15. Basic principle and standard procedure of hernia surgery%疝外科的基本原则和手术规范流程

    陈革; 唐健雄

    2015-01-01

    The basic principle of the hernia surgery is to find the hernia sac, reduce the contents, find the hernia ring and repair the abdominal wall defect.In recent years, the field of hernia surgery has a rapid development and the basic principle of hernia surgery has an obvious change in specific details.The standard procedure of hernia surgery is the guide of our work in practice to determine whether patients need surgical treatment.If operation is available, suitable method should be chosen and surgeons should pay attention to the special problems of hernia surgery in the perioperative period.According to the standard operation procedure in practice, the lowest morbidity of intraoperative complication may occur and patients will have the maximal gain.%疝外科的基本原则是找到疝囊、回纳疝内容物、发现疝环及腹壁缺损并进行修补.近年来,疝外科领域取得了飞速的发展,其基本原则在具体细节方面有了巨大的变化.疝外科手术的规范流程是指导我们在实践工作中判断患者是否需要手术治疗,如果可以手术治疗应采用何种方法,围手术期需要注意的疝外科特有的问题.按照手术规范流程来进行实际工作,可以使患者在术中发生并发症的可能降到最低,术后得到最大的收益.

  16. Abdominopelvic actinomycosis in three different locations with invasion of the abdominal wall and ureteric obstruction: An uncommon presentation

    Christian L. Galata

    2015-01-01

    Conclusion: A rare actinomyceal infection should be considered in patients with a non-specific pelvic mass and atypical abdominal presentations, especially if a previous history of IUD usage is known.

  17. Amyand's hernia: A case report

    Sofia Anagnostopoulou; Dimitrios Dimitroulis; Theodore G Troupis; Maria Allamani; Alexandros Paraschos; Antonios Mazarakis; Nikolaos I Nikiteas; Alkiviadis Kostakis

    2006-01-01

    The presence of vermiform appendix in inguinal hernia is rare and is known as Amyand's hernia. We report an Amyand's hernia, where the appendix was found in a right inguinal hernia in one male cadaver aged ninety two years.

  18. Fatores de risco associados à deiscência aponeurótica no fechamento da parede abdominal Risk factors associated to aponeurotic dehiscence in abdominal wall closure

    Olival Cirilo Lucena da Fonseca-Neto; Rômulo Vasconcelos; Antônio Lopes de Mirian

    2008-01-01

    RACIONAL: A deiscência aponeurótica do abdômen após intervenções cirúrgicas responde por índices de morbi-mortalidade em torno de 9% a 49% e apresenta incidência aproximada de 0,5% a 3%. OBJETIVO: Identificar os fatores de risco mais prevalentes e elaborar aspecto epidemiológico do perfil dos pacientes susceptíveis à esta complicação. MÉTODOS: Foram estudados no período de março a agosto de 2005 15 pacientes que estiveram internados e que apresentaram deiscência aponeurótica abdominal, proven...

  19. Radiographic observation of congenital diaphragmatic hernia

    Rhee, Chung Sik [Ewha Women' s University College of Medicine, Seoul (Korea, Republic of)

    1973-12-15

    Five cases of congenital diaphragmatic hernia. Case 1: A female infant, birth weight 2.25 kg, Apgar score 10, normal delivery at 11:33 P.M. on Feb.8, 1972. Lt side congenital diaphragmatic hernia. Case 2: A female infant, birth weight 1.48 kg, Apgar score 5, normal delivery at 11:20 A.M. on Oct.14, 1972. Lt. side congenital diaphragmatic hernia. This infant was twin. this infant's mother was toxemia. Case 3; A 33 years old women was admitted to the our hospital because of Lt.hip joint pain without other symptoms. Date of admission: Jan. 8, 1973. Rt side congenital diaphragmentic hernia. Case 4: A 4 month infant male was admitted to the our hospital because of vomiting, dyspnea and abdominal pain. He had cyanosis intermittently after one month ago. This infant was normal delivered. The family history was not contributory. Date of admission: This infant was normal delivered. The family history was not contributory. Date of admission: Aug. 30, 1971. Rt side congenital diaphragmatic hernia. Case 5: A 13 years old girl was admitted to our hospital because of general weakness without other symptoms. This patient was normal delivered. The family history was not contributory. Date of admission: March. 15, 1973. Lt. side congenital diaphragmentic hernia.

  20. Perineal hernia: surgical anatomy, embryology, and technique of repair.

    Stamatiou, Dimitrios; Skandalakis, John E; Skandalakis, Lee J; Mirilas, Petros

    2010-05-01

    Perineal hernia is the protrusion into the perineum of intraperitoneal or extraperitoneal contents through a congenital or acquired defect of the pelvic diaphragm. The first case was reported by de Garangeot in 1743. Perineal hernias may occur anteriorly or posteriorly to the superficial transverse perineal muscles. Congenital perineal hernia is a rare entity. Failure of regression of the peritoneal cul de sac of the embryo is considered a predisposing factor for hernia formation. Acquired perineal hernias are primary or secondary. Primarily acquired perineal hernias are caused by factors associated with increased intra-abdominal pressure. They are more common in females as a result of the broader female pelvis and the attenuation of the pelvic floor during pregnancy and childbirth. Secondarily acquired perineal hernias are incisional hernias associated with extensive pelvic operations such as abdominoperineal resection of the anorectum and pelvic exenteration. Pain in the perineal area, intestinal obstruction, topical skin erosion, and difficulty with urination necessitate the surgical repair of a perineal hernia. This can be accomplished through transabdominal, perineal, or combined abdominoperineal approaches. The defect in the muscles of the pelvic diaphragm may be closed either with direct suturing or by using autogenous tissues or synthetic mesh.