Sample records for abdominal wall

  1. Congenital Abdominal Wall Defects

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


    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...

  2. Abdominal wall endometriosis.

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


    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.

  3. Economics of abdominal wall reconstruction.

    Bower, Curtis; Roth, J Scott


    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.

  4. Abdominal wall hernia and pregnancy

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


    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...

  5. Preoperative steroid in abdominal wall reconstruction

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


    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 ...

  6. Pulmonary complications of abdominal wall defects.

    Panitch, Howard B


    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.


    Vijaya; Sarbeshwar; Gogoi


    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: ...

  8. 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)


    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.

  9. Mesh repair of hernias of the abdominal wall

    W.W. Vrijland (Wietske)


    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

  10. Radiologic findings of abdominal wall endometriosis

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


    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. Mesh repair of hernias of the abdominal wall


    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...

  12. Abdominal Wall Endometrioma. Report of Two Cases

    Tahiluma Santana Pedraza


    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.

  13. Abdominal Wall Desmoid during Pregnancy: Diagnostic Challenges

    Johnny Awwad


    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.

  14. Connective tissue alteration in abdominal wall hernia

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


    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...

  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 Copyright Privacy Accessibility FOIA Viewers & Players U.S. ...

  16. 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)


    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

  17. 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


    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.

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

    Michael Walsh; Antony Pittathankal; Nnamdi Nwaejike


    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.

  19. [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


    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.

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

    Lou Xiaoli; Zhang Mingli; Cui Ying; Song Jianxing


    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.

  1. 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


    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

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

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


    -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...

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

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


    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.

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

    Osama S. Al Beteddini


    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.

  5. Abdominal Wall Endometrioma after Laparoscopic Operation of Uterine Endometriosis

    Tihomir Vukšić


    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.

  6. Bullhorn hernia: A rare traumatic abdominal wall hernia

    Bimaljot Singh


    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.

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

    Parag J Karkera


    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.

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

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


    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.

  9. Abdominal wall repair with human acellular dermal autograft

    Roel E. Genders


    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

  10. Reconstruction of complex abdominal wall defects

    Slater, N.J.


    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

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

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


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

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


    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.

  13. 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


    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.

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

    Textor Hans Jochen


    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.

  15. Mycobacterium fortuitum abdominal wall abscesses following liposuction

    Al Soub Hussam


    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.

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

    Agarwal Nitin


    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.

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

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


    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.

  18. 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


    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

  19. A New Rat Model for Orthotopic Abdominal Wall Allotransplantation

    William W. Lao, MD


    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.

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

    Abid, Shazia; El-Hayek, Kevin


    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).

  1. 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


    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

  2. 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.


    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,

  3. 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


    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...

  4. 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.


    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

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

    Mahir Gachabayov


    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.

  6. Clear Cell Adenocarcinoma Arising from Abdominal Wall Endometriosis

    Thouraya Achach


    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.

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

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


    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.

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

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


    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.

  9. 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)


    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.

  10. 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


    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.

  11. 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


    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.

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

    Christensen, Anders Mark; Christensen, Mads Mark


    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...

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

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


    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.

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

    Nahas Fábio Xerfan


    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.

  15. 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


    @@ 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).

  16. 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


    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.

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

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


    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.

  18. 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)


    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.)

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

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


    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.

  20. 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


    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.

  1. 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


    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.

  2. 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


    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.

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

    Alsaif H Saif


    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.

  4. 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


    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.

  5. [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


    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.

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

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


    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.

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

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


    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...

  8. Effects of aging on abdominal wall healing in rats

    Biondo-Simões Maria de Lourdes Pessole


    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.

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

    Kovačević Predrag


    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.

  10. 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)


    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.

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

    Maarten Philip Cornelissen


    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.

  12. 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)


    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.)

  13. [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


    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.

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

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


    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...

  15. 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)


    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.

  16. 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


    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.

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

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


    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....

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

    Kosuke Kobayashi


    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.

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

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


    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.


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


    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.

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

    Nelson Alfred Smith


    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.

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

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


    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.

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


    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...

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

    Oskay Kaya


    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.

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

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


    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...

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

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


    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.

  7. 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


    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.

  8. 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


    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.

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

    Ding-Hui Dong


    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.

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

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


    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.

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

    Satomi Jyunichiro


    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.

  12. 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)


    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

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

    Mohinder Kumar Malhotra


    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.

  14. 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)


    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.

  15. 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)


    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

  16. 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


    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.

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

    Hamed A. Al-Wadaani


    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.

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

    Veronskiĭ, G I; Zotov, V A


    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.

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

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


    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.

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

    Ajit Sawant


    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.

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

    Jayme Fortunato Athias


    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%.

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

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


    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.

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

    Yoshifumi Nakayama; Shinichi Kusuda; Naoki Nagata; Koji Yamaguchi


    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.

  4. 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


    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...

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

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


    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.

  6. Polymicrobial abdominal wall necrotizing fasciitis after cesarean section.

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


    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.


    A. Yaghoobi Notash


    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.

  8. 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


    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...

  9. 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


    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.

  10. [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


    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.




    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

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



    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.

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

    Hadjimarcou Andreas


    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.

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

    Boutros Cherif


    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

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

    Butany Jagdish


    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.

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

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


    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.

  17. 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


    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.

  18. [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


    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.

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

    H. Krentel


    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.

  20. 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:; 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))


    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

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

    Imtiaz Wani


    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.

  2. 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


    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.

  3. 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)


    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

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

    Ridwelski Karsten


    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.

  5. 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


    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.

  6. 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


    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.

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

    Stephan, Bradley; Ramshaw, Bruce; Forman, Brandie


    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.

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

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


    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.

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

    Polzer Stanislav


    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.

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

    Franchesca T Wotton; Jacob A Akoh


    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.


    李国庆; 单根法; 张辅贤; 钟竑


    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


    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


    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


    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. 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


    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.

  16. 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.

  17. 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


    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.

  18. 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)


    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.)

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

    Kim Si-Hyun


    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.

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

    Alexander Kreze


    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.

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

    K. D. Ojuka


    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.

  2. 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


    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.

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

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


    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...

  4. 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


    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.

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

    F.J. Gabilondo Zubizarreta


    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.

  6. 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.


    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.

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

    Fechner, R; Schwarz-Wings, D


    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.

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

    Brown, Stephen H M


    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.

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

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


    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.

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

    Jeffrey CY Chan


    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.

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

    M.L.L.S. Montenegro


    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.


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


    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...

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

    Sinan Carkman


    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.

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

    Souvagya Panigrahi


    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.

  15. 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


    [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

  16. 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


    [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.

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



    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.

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

    Daniel Lee John Bunker


    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.

  19. 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


    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.

  20. 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


    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.

  1. 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


    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.

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

    P M Kamble


    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.

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

    Ana Letícia Gomes Aramayo


    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.

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

    Yang, Ru, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Tang, Wei, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Xiao, Bo, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Feng, Zhi Song, E-mail: [Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)


    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.

  5. 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.

  6. 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.

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


    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...

  8. 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


    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

  9. 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


    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.




    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

  11. [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


    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.




    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

  13. 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


    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....

  14. 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


    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.

  15. Histochemical and immunohistochemical analysis of ruptured atherosclerotic abdominal aortic aneurysm wall

    Tanasković Irena


    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

  16. 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


    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.

  17. 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


    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.

  18. Giant desmoid tumor of the abdominal wall in a patient with Gardner Syndrome

    Daniel Paulino Santana


    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

  19. 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


    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.

  20. 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


    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.

  1. 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


    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

  2. Changing trend in congenital abdominal wall defects in Eastern region of Ireland.

    McDonnell, R


    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. 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


    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.

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

    Campanelli G


    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.

  5. 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


    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.

  6. 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


    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.

  7. 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


    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.

  8. 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)


    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.

  9. Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

    Sung Kyu Bae


    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


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

    Idit Melnik


    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.

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

    Fortunato Jayme Athias


    Full Text Available Os autores apresentam um estudo retrospectivo de 79 pacientes portadores de distrofias abdominais acompanhadas ou não de hérnias, operados no período compreendido entre 01/06/94 a 31/12/96. A idade média foi de 46 anos. A hérnia incisional isoladamente e o abdome distrófico (em avental foram o principal objetivo do estudo. Enfatizam a importância da dermolipectomia abdominal para a completa recuperação do paciente bem como demonstram facilitar o manuseio técnico das hérnias. A técnica da transposição peritônio-aponeurótica longitudinal bilateral (técnica de Lázaro da Silva foi utilizada para as grandes hérnias incisionais. É uma técnica já consagrada, que consta de três planos de suturas sem superposição dos mesmos. Sua recidiva em cinco anos de seguimento tem sido em tomo de 5% segundo estudos do próprio autor. A grande vantagem técnica é que, usando o saco herniário (quanto maior e mais espesso, melhor como fechamento e reforço do anel, evita-se o uso de prótese com todos os inconvenientes da mesma (fístulas, rejeições etc. Uma variante desta técnica, para as hérnias com anel herniário de até 10cm, é proposta pelos autores, e consiste no fechamento do anel e reforço da sutura com o saco herniário, em jaquetão. A vantagem seria a facilidade de execução e diminuição do tempo operatório, além de evitar dissecções extensas das camadas aponeuróticas. Quando o anel herniário alcançar 10cm e existir ligeira tensão, deve-se realizar incisão relaxadora na aponeurose anterior dos retos e recobrir a superfície cruenta com o próprio saco herniário que deverá estar íntegro. Esta técnica ainda requer maior observação clínica. É feita a revisão dos resultados dos procedimentos realizados isoladamente e acompanhados com dermolipectomia abdominal: 63 pacientes (81,66% evoluíram sem complicações, cinco recidivas (6,3%; um caso de hematoma extenso (1,26%; dois casos de abscesso de parede em

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

    Malkov I.I.


    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.

  14. Electromyographic activity of the anterolateral abdominal wall muscles during the vesical filling and evacuation

    Ahmed Shafik


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

    Chowbey Pradeep


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

  16. A case report of necrotizing fasciitis of the abdominal wall: A rare, life-threatening complication of a common disease process

    Anya Romanoff, MD


    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.

  17. 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)


    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)

  18. Haematogenous abdominal wall metastasis of differentiated, alpha-fetoprotein-negative hepatocellular carcinoma after previous antiandrogen therapy within a site of lipoma manifestation since childhood


    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...

  19. Abdominal wall metastasis in scar after open resection of an adrenocortical carcinoma

    Nikhil Gupta


    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.

  20. Uncommon presentation of actinomycosis mimicking colonic cancer: Colon actinomycosis with invasion of the abdominal wall

    Ilhan Bali


    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

  1. 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


    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

  2. 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


    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.

  3. 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


    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.

  4. Diagnostic value of susceptibility-weighted imaging of abdominal wall endometriomas during the cyclic menstrual changes: A preliminary study

    Solak, Aynur, E-mail: [Radiology Department of Sifa University Hospital, 35240, Fevzipasa Boulvard 172/2, Basmane, Izmir (Turkey); Şahin, Neslin, E-mail: [Radiology Department of Sifa University Hospital, 35240, Fevzipasa Boulvard 172/2, Basmane, Izmir (Turkey); Genç, Berhan, E-mail: [Radiology Department of Sifa University Hospital, 35240, Fevzipasa Boulvard 172/2, Basmane, Izmir (Turkey); Sever, Ali Rıza, E-mail: [Department of Radiology, Maidstone Hospital, Breast Unit, Maidstone, Kent (United Kingdom); Genç, Mine, E-mail: [Department of Gynecology and Obstetrics, Sifa University Hospital, 35240, Fevzipasa Boulvard 172/2, Basmane, Izmir (Turkey); Sivrikoz, Oya Nermin, E-mail: [Pathology Department of Sifa University Hospital, 35240, Bornova, Izmir (Turkey)


    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.

  5. 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.

  6. 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


    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.

  7. Blood Vessel Matrix Seeded with Cells: A Better Alternative for Abdominal Wall Reconstruction—A Long-Term Study

    Maciej Nowacki


    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.

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

    Liu Z


    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

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

    Suleiman, Nergis Nina


    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

  10. 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


    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.

  11. 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


    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

  12. [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


    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.

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

    Sofos SS


    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 

  14. 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


    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.

  15. 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


    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

  16. 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


    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.

  17. 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


    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

  18. 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.


    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

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

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


    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.

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

    René H Fortelny


    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

  1. 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


    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.

  2. Techniques for Abdominal Wall Closure after Damage Control Laparotomy: From Temporary Abdominal Closure to Early/Delayed Fascial Closure—A Review

    Qian Huang


    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.

  3. 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


    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.

  4. 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


    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

  5. 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)


    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

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

    Martin L van Niekerk


    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.

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

    van Niekerk, Martin L


    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.

  8. [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


    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.

  9. 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.


    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...

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

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


    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.

  11. 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. ...

  12. 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


    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.

  13. 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


    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.

  14. Abdominopelvic actinomycosis in three different locations with invasion of the abdominal wall and ureteric obstruction: An uncommon presentation

    Christian L. Galata


    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.

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

    Roje Zdravko


    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

  16. 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


    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

  17. 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


    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...

  18. 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


    .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.

  19. Avaliação fitoterápica da Jatropha gossypiifolia L. na cicatrização de suturas na parede abdominal ventral de ratos Phytotherapic evaluation of Jatropha gossypiifolia L. on rats ventral abdominal wall wound healing

    José Ulcijara Aquino


    L., which is used in popular medicine is considered to have good diuretic effect in hypertension and is also used as a laxative drug. It seems to have a healing effect, although not proved till now. PURPOSE: To evaluate the influence of intraperitoneum administration of Jatropha Gossypiifolia L., in suture healing of ventral abdominal wall of rats, through tensiometric measurement, macro and microscopic aspect of post-operative period. METHODS: Forty wistar male rates were allocated in two groups of 20 animals . After the incision and exposure of abdominal cavity 1 ml/kg/weight of 0,9% sodium chloride solution was injected in control group, and in the other one the injection was of 1 ml/kg/weight of a gross ethanol extract of Jatropha gossypiifolia L. The suture of the abdominal wall was than performed with polypropylene separated stitches. The animals were followed-up and killed in the third and seventh days. The ventral abdominal wall was macroscopically analyzed, the resistance strength to strain was measured and it was also studied the histological aspects. RESULTS: On macroscopic examination more intense adhesion was found on the group of Jatropha in both third and seventh post-operative days. The strain evaluation was meanly greater on Jatropha group also in third and seventh days. CONCLUSION: The histological comparative analysis between the different groups showed that the acute inflammatory process was meanly greater for the Jatropha group in third and seventh post-operative days. The vascular neoformation was significantly greater in third pos-operative day of Jathopha group; the other histological parameters were just alike. The intraperitoneum injection of Jatropha extract did not have any significant improvement for the wound healing on ventral abdominal wall on the evaluated animals in this study, no matter if analyzed at the third or seventh pos-operative days.

  20. Fine structural study of the innervation of muscle spindles in the internal oblique muscle of the abdominal wall in the adult mouse.

    Desaki, Junzo; Ezaki, Taichi; Nishida, Naoya


    We examined by electron microscopy the innervation of muscle spindles in the internal oblique muscle of the mouse abdominal wall. In the equatorial region, in addition to the sensory innervation on individual intrafusal muscle fibers, sensory cross terminals were often observed between nuclear chain fibers. In the area from the juxtaequatorial region to the polar region, nuclear bag fibers were supplied by trail and plate-type motor endings, while nuclear chain fibers were innervated by sensory endings, being probably secondary sensory endings. From these findings, it is clear that the innervation patterns differ between two types of intrafusal muscle fibers.

  1. Recombinant human bone morphogenetic protein 2-induced heterotopic ossification of the retroperitoneum, psoas muscle, pelvis and abdominal wall following lumbar spinal fusion

    Shah, Raj K. [The George Washington University School of Medicine, Washington, DC (United States); Moncayo, Valeria M.; Pierre-Jerome, Claude; Terk, Michael R. [Emory University School of Medicine, Radiology Department, Musculoskeletal Division, Atlanta, GA (United States); Smitson, Robert D. [Emory University School of Medicine, Atlanta, GA (United States)


    A 45-year-old man presented with vertebral collapse at L5 as an initial manifestation of multiple myeloma and underwent spinal fusion surgery using recombinant human bone morphogenetic protein-2 (rhBMP-2). Subsequent computed tomography (CT) scans and X-rays revealed heterotopic ossification of the left psoas muscle, pelvis, and anterior abdominal wall. While the occurrence of heterotopic ossification has previously been reported when rhBMP-2 has been used for spinal fusion surgery, this case demonstrates that it can occur to a much greater degree than previously seen. (orig.)

  2. Efeitos de duas técnicas de incentivo respiratório na mobilidade toracoabdominal após cirurgia abdominal alta Effects of two respiratory incentive techniques on chest wall mobility after upper abdominal surgery

    Maria Elaine Trevisan


    with the Voldyne device, and group 2 (n=6, submitted to a split-inspiration pattern training. Chest wall expansion was rated by measuring thorax circumferences before surgery and on the 1st, 3rd, and 5th post-operative (PO days. In both groups a significant decrease was found in circumference values on the 1st PO day, which gradually recovered, until on the 5th PO day no significant differences were found as compared to pre-operative measures. Group 1 showed significantly better thoracic-abdominal expansion rates than group 2's, as well as higher recovery time rates all through. Though both breathing techniques used were effective, inspiratory incentive using the Voldyne device showed better results in recovering chest mobility after upper abdominal surgery.

  3. Finite Element Implementation of a Structurally-Motivated Constitutive Relation for the Human Abdominal Aortic Wall with and without Aneurysms

    Enevoldsen, Marie Sand; Henneberg, Kaj-Åge; Lönn, L


    The structural integrity of the abdominal aorta is maintained by elastin, collagen, and vascular smooth muscle cells. Changes with age in the structure can lead to develop-ment of aneurysms. This paper presents initial work to capture these changes in a finite element model (FEM) of a structural......-ly-motivated anisotropic constitutive relation for the “four fiber family” arterial model. First a 2D implementation is used for benchmarking the FEM implementation to fitted biaxial stress-strain data obtained experimentally from four different groups of persons; 19-29 years, 30-60 years, 61-79 years and abdominal aortic...

  4. 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


    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.

  5. Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls

    Lu YF


    Full Text Available Yueh-Feng Lu,1 Yu-Chin Lin,2 Kuo-Hsin Chen,3,4 Pei-Wei Shueng,1 Hsin-Pei Yeh,1 Chen-Hsi Hsieh1,5,6 1Division of Radiation Oncology, Department of Radiology, 2Division of Oncology and Hematology, Department of Medicine, 3Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, 4Department of Electrical Engineering, Yuan-Ze University, Taoyuan, 5Department of Medicine, 6Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Abstract: Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT; however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm3. The percent of lung volume receiving at least 20 Gy (V20 was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity

  6. The hypertrophy of the lateral abdominal wall and quadratus lumborum is sport-specific: an MRI segmental study in professional tennis and soccer players.

    Sanchis-Moysi, Joaquin; Idoate, Fernando; Izquierdo, Mikel; Calbet, Jose A; Dorado, Cecilia


    The aim was to determine the volume and degree of asymmetry of quadratus lumborum (QL), obliques, and transversus abdominis; the last two considered conjointly (OT), in tennis and soccer players. The volume of QL and OT was determined using magnetic resonance imaging in professional tennis and soccer players, and in non-active controls (n = 8, 14, and 6, respectively). In tennis players the hypertrophy of OT was limited to proximal segments (cephalic segments), while in soccer players it was similar along longitudinal axis. In tennis players the hypertrophy was asymmetric (18% greater volume in the non-dominant than in the dominant OT, p = 0.001), while in soccer players and controls both sides had similar volumes (p > 0.05). In controls, the non-dominant QL was 15% greater than that of the dominant (p = 0.049). Tennis and soccer players had similar volumes in both sides of QL. Tennis alters the dominant-to-non-dominant balance in the muscle volume of the lateral abdominal wall. In tennis the hypertrophy is limited to proximal segments and is greater in the non-dominant side. Soccer, however, is associated to a symmetric hypertrophy of the lateral abdominal wall. Tennis and soccer elicit an asymmetric hypertrophy of QL.

  7. Biliary peritonitis caused by a leaking T-tube fistula disconnected at the point of contact with the anterior abdominal wall: a case report

    Nikolić Marko


    Full Text Available Abstract Introduction Operations on the common bile duct may lead to potentially serious complications such as biliary peritonitis. T-tube insertion is performed to reduce the risk of this occurring postoperatively. Biliary leakage at the point of insertion into the common bile duct, or along the fistula, can sometimes occur after T-tube removal and this has been reported extensively in the literature. We report a case where the site at which the T-tube fistula leaked proved to be the point of contact between the fistula and the anterior abdominal wall, a previously unreported complication. Case presentation A 36-year-old sub-Saharan African woman presented with gallstone-induced pancreatitis and, once her symptoms settled, laparoscopic cholecystectomy was performed, common bile duct stones were removed and a T-tube was inserted. Three weeks later, T-tube removal led to biliary peritonitis due to the disconnection of the T-tube fistula which was recannulated laparoscopically using a Latex drain. Conclusion This case highlights a previously unreported mechanism for bile leak following T-tube removal caused by detachment of a fistula tract at its contact point with the anterior abdominal wall. Hepatobiliary surgeons should be aware of this mechanism of biliary leakage and the use of laparoscopy to recannulate the fistula.

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

    Vorovs'kyĭ, O O


    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.

  9. Abdominopelvic actinomycosis in three different locations with invasion of the abdominal wall and ureteric obstruction: An uncommon presentation


    Introduction: Actinomycosis is a rare chronic infectious disease caused by Gram-positive anaerobic bacteria that normally colonize the bronchial system and gastrointestinal tract in humans. The most common diseases associated with actinomycosis are orocervicofacial, thoracic and abdominal infections involving Actinomyces israelii. Due to its rarity, its various clinical presentations and often-infiltrative characteristics in radiological imaging, it can easily be mistaken for other clinical c...

  10. Reação histopatológica da parede da aorta abdominal ao stent não recoberto Histopathological reaction of the abdominal aorta wall to non-covered stents

    Rubio Bombonato


    Full Text Available OBJETIVO: Avaliar a reação histopatológica da parede aorta abdominal, em suínos, no nível das artérias renais, na presença de stent metálico não recoberto. MÉTODO: Foi estudada histopatologicamente a aorta abdominal de 10 suínos, com peso médio de 86,6 quilos e idade média de 6 meses, submetidos a implante de stent metálico posicionado na aorta, no nível das artérias renais, após 100 dias do implante. Os stents foram liberados por auto-expansão com laparotomia. Os cortes histológicos foram realizados nos seguintes locais: 1 transição entre a aorta normal e aorta contendo stent; 2 aorta contendo o stent; 3 porção contendo os óstios das artérias renais, 4 linfonodos periaórticos e, 5 parênquima renal. As lâminas foram coradas pela técnica da hematoxilina e eosina. RESULTADOS: Os achados macroscópicos revelaram: linfonodomegalia periaórtica; espessamento da parede aórtica; artérias lombares e renais pérvias; estrutura anatômica renal normal. Análises microscópicas, próximas aos stents, evidenciaram espessamento da parede vascular, secundário à fibrose intimal e camada média comprometida com fibrose intersticial. Medidas micrométricas da parede aórtica com o stent, comparada à aorta sem o stent, apresentaram aumento da espessura da parede (75,9% por hiperplasia da camada íntima secundária à proliferação de fibroblastos; depósitos de colágeno com infiltrado inflamatório e granulomas do tipo corpo estranho. CONCLUSÃO: O stent de aço inoxidável descoberto, implantado na aorta de suínos, produziu importante reação inflamatória, com fibrose nas camadas média e íntima, evidenciada pelas análises histopatológicas e a sua presença não comprometeu o estado pérvio da aorta e dos ramos lombares e renais.OBJECTIVE: To evaluate the histopathological reaction of the abdominal aorta wall in pigs' renal arteries to the presence of non-covered stainless steel stents. METHODS: The abdominal aorta of

  11. Application of a Silicone Sheet in Negative-Pressure Wound Therapy to Treat an Abdominal Wall Defect after Necrotizing Fasciitis

    Shin, Jin Su


    Necrotizing fasciitis (NF) is an aggressive soft-tissue infection involving the deep fascia and is characterized by extensive deterioration of the surrounding tissue. Immediate diagnosis and intensive treatment, including debridement and systemic antibiotics, represent the most important factors influencing the survival of NF patients. In this report, we present a case of NF in the abdomen due to an infection caused by a perforated small bowel after abdominal liposuction. It was successfully treated using negative-pressure wound therapy, in which a silicone sheet functioned as a barrier between the sponge and internal organs to protect the small bowel. PMID:28194352

  12. Morphological characteristics of tissues of anterior abdominal wall of rats after implantation of alloplastic material, processed with collagen, in the initially infected wounds

    Svisenko O. V.


    Full Text Available A research purpose was to investigate the tissue reactions on implantation of polypropylene mesh, processed with collagen, after the plastic of experimental defect at rats at underaponevrotic localization of prosthesis in the initially infected wounds. Research was performed in two experimental groups. Group 1 – at 27 rats in the conditions of the infected wound the monofilamentous polypropylene mesh of size 1×1,5 sm was fixed under aponevrosis. Group 2 – at 27 rats at analogous conditions with the previously infected wound the underaponevrotic fixation of polypropylene mesh, processed with collagen, was performed. From the data of morphological analysis, use of polypropylene mesh, processed with collagen, after the plastic of experimental defect at rats at underaponevrotic localization of prosthesis in the initially infected wounds accompanied with the acceleration of reparative processes and improvement of restructuring of connective tissue, muscular and vascular components of anterior abdominal wall during 4 weeks after intervention.

  13. A nicotina atua como fator deletério na reparação da parede abdominal The nicotine has a deleterious effect on the healing of abdominal wall

    Aldo da Cunha Medeiros


    Full Text Available OBJETIVO: Avaliar o efeito da nicotina na cicatrização da camada musculoaponeurótica da parede abdominal. MÉTODOS: Estudo experimental em que foram usados 16 ratos da raça Wistar pesando em média 210± 8g, separados aleatoriamente em 2 grupos de 8. Nos animais do grupo A foi implantado disco de nicotina (Nicotinel Ò na dose de 5mg/Kg de peso/dia no subcutâneo da região dorsal, trocado a cada dois dias, a partir do 5º dia antes da operação em que foi feita laparotomia mediana de 5 cm, até o 10º dia de observação. No grupo B (controle foram usados discos de celulose com o mesmo diâmetro. Tubo de silicone multiperfurado foi implantado no subcutâneo a 1cm da lesão da parede abdominal. A camada musculoaponeurótica e a pele foram suturadas com fio de nylon 5-0. No 10º dia pós-operatório foi colhido 1ml de líquido seroso do tubo de silicone por punção percutânea para dosagem de pO2 e os animais receberam dose letal de anestésico. Foi ressecado um segmento da camada musculoaponeurótica com 2cm de largura para tensiometria, em seguida processado e corado em HE e tricrômico de Masson para análise quantitativa dos dados histopatológicos em sistema digitalizado. A análise estatística foi feita pelo ANOVA e teste Newman-Keuls, com significância 0,05. RESULTADOS: No grupo A a pO2 do líquido tecidual atingiu o valor 17,75± 3,4 mmHg e no grupo B (controle a pO2 = 40,75± 6,4 mmHg (pOBJETIVE: An experimental study was done to evaluate the effect of nicotine on the healing of abdominal wall. METHODS: Sexteen Wistar rats weighing 210± 8g were randomly separated into two groups of eight rats each. In the group A Nicotine (Nicotinel Ò was implanted in the back subcutaneous 5mg/Kg each two days, begining at the fifth preoperative day. A 5cm median laparotomy was done, sutured with nylon 5-0 and the rats were observed in individual cages. The group B (control didn’t use nicotine. A multiperfurated silicone tube was implanted

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



    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。

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



    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.

  16. How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall? – A case report

    Watt John WH


    Full Text Available Abstract Background We present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma. Case presentation A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of Pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous. Results and Conclusion Percutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of Pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject.

  17. Distinct defects in collagen microarchitecture underlie vessel-wall failure in advanced abdominal aneurysms and aneurysms in Marfan syndrome

    Lindeman, J.H.N.; Ashcroft, B.A.; Beenakker, J.-W.M.; Es, M. van; Koekkoek, N.B.R.; Prins, F.A.; Tielemans, J.F.; Abdul-Hussien, H.; Bank, R.A.; Oosterkamp, T.H.


    An aneurysm of the aorta is a common pathology characterized by segmentalweakeningof the artery.Althoughit isgenerally accepted that the vessel-wall weakening is caused by an impaired collagen metabolism, a clear association has been demonstrated only for rare syndromes such as the vascular type Ehl

  18. CT对腹壁韧带样瘤的诊断价值%The diagnosis value of CT to abdominal wall ligament type lump

    严骏燕; 刘金有


    Objective To investigate the CT performance of abdominal wall desmoid tumor and improve the clinical diagnosis of the disease.Methods From October 2006 to March 201 3,Twenty-one pathologically confirmed cases of abdominal desmoid tumor CT data were retrospectively analyzed in Huangshan Shoukang Hospital.Results All the cases of patients with pathologically confirmed in all cases are single lesions in the rectus abdominis.The maxium mass of spindle-shaped or oval lumps was 3.8 cm × 7.4 cm with a mean of 2.1 cm ×3.9 cm with clear boundary,and unclear muscle tissue boundaries.Mass unenhanced density equaled to or was lower than the density of the muscle tissue.Densities in Sixteen tumors were even and 5 tumors with uneven images and enhanced.Conclusions The abdominal wall syndesmoma CT performance has the characteristic value which are important for disease diagnosis and distinction diagnosis.%目的:探讨腹壁韧带样瘤的CT表现,提高临床对该病的诊断率。方法回顾性分析2006年10月至2013年3月,黄山首康医院经过手术病理证实的腹壁韧带样瘤21例患者的CT资料。结果21例病理证实的患者中,均为单发,病变发生于腹直肌,肿块呈梭形或类圆形,肿块最大为3.8 cm ×7.4 cm,肿块边界清晰,与肌肉组织分界欠清。肿块平扫时的密度等于或低于肌肉组织的密度,16个肿块密度均匀,5个肿块密度欠均匀,增强后病灶呈明显强化。结论腹壁韧带瘤的CT表现具有特征性,对该病的诊断和鉴别诊断有重要价值。

  19. M型超声检测腹主动脉前后壁运动的初步研究%Primary studies of anteroposterior abdominal aortic wall motion with M-mode ultrasound

    辛群; 蔡珠虹; 包俊敏; 梅志军; 景在平


    Objective To find out the characteristics of anteroposterior abdominal aortic wall motion and to consider the potential implications of such variations. Methods M-mode ultrasound was used to measure abdominal aortic wall motion in human (n=20) and 2 animal species [dogs (n=8), and pigs (n=5)]. Anterior wall displacement (da),posterior wall displacement (dp), and diastolic diameter (Da) were measured. The ratio of displacement to the diameter was calculated (da/Dd. and dp/Dd). Results Aortic diameter varied from to (6.34±0.84) mm (dog) to (13.76±1.11) mm (human).Anterior wall displacement was about 3 times greater than the posterior among the species studied. The ratio of wall displacement to diastolic diameter were similar for the anterior and posterior walls. Wall displacement increased linearly with the diameter. Conclusions Abdominal aortic wall dynamics are similar in humans and animals regardless of the aortic size, with more anterior than posterior wall motion. These data suggest increased .dynamic strain of the anterior wall,which may help explain why human abdominal aortic aneurysms initially develop anteriorly. Haemodynamies plays an important role in the abdominal aortic aneurysm pathogenesis.%目的:应用M型超声观测正常腹主动脉前后壁运动的特征.方法:采集健康人组、健康犬组、健康猪组腹主动脉的M型超声图像,测量动脉前壁和后壁振幅(da和dP)、舒张期动脉直径(Dd),取其平均值;并分别计算各组数值:前壁振幅/舒张期动脉直径(da/Dd),后壁振幅/舒张期动脉直径(dp/Dd).结果:三组结果显示腹主动脉前壁振幅高于后壁振幅,差异有统计学意义(P<0.01).各组中管壁振幅与管径呈正相关.da/Dd和dp/Dd组间比较,差异无统计学意义.结论:正常腹主动脉前、后壁的运动差异与腹主动脉瘤的形成有一定关系,提示血液动力学因素在腹主动脉瘤发病机制中起着重要作用.

  20. Clinical analysis on 43 cases with abdominal wall and perineal endometriosis%43例腹壁会阴子宫内膜异位症的临床分析

    任黔川; 伍宗惠; 李晓斌


    目的:探讨腹壁、会阴子宫内膜异位症的诊断和治疗.方法:对1993~2008年收治的43例腹壁、会阴内异症病例进行同顾性分析.结果:根据临床表现和病理检查,43例均诊断正确.29例腹壁切口内异症均有剖宫产史,14例会阴内异症均有会阴撕裂或侧切史.腹壁内异症完整切除29例,会阴内异症完整切除13例,随访2~5年无复发.结论:根据典型的病史和体检,可以对腹壁、会阴内异症做出正确诊断;手术切除为主要治疗方法.%Objective; To explore the diagnosis and treatment of abdominal wall and perinea] endometriosis. Methods: 43 patients with abdominal wall and perineal endometriosis treated in the hospital from 1993 to 2008 were analyzed retrospectively. Results: 43 cases were diagnosed correctly according to clinical manifestations and pathological evidences. 29 cases with abdominal wall endometriosis had history of cesarean section, 14 cases with perineal endometriosis had history of perineal tear and episiotomy. 29 cases with abdominal wall endometriosis and 13 cases with perineal endometriosis were excised totally. All the cases were followed up for 2 ~5 years, no recurrence occurred. Conclusion; The patients with abdominal wall and perineal endometriosis can be diagnosed correctly according to typical medical history and physical examination. Surgical excision is the first choice for treatment

  1. 腹壁子宫内膜异位症的磁共振成像表现%Magnetic Resonance Imaging Features of Abdominal Wall Endometriosis

    梁文华; 陆菁菁


    目的:探讨腹壁子宫内膜异位症的磁共振成像( magnetic resonance imaging, MRI)表现特点。方法回顾性分析北京协和医院2008年1月至2013年1月经手术病理证实且行MRI检查的7例腹壁子宫内膜异位症患者的临床资料和MRI检查结果。结果7例腹壁子宫内膜异位症患者中5例单发,2例多发;7例患者共发现病灶10处,7处病灶位于左侧,2处位于正中,1处位于右侧;5处位于皮下及筋膜、未侵及腹壁肌层,4处侵及腹壁肌层,1处累及皮下、筋膜及腹壁肌层;2处病灶与盆腔内部脏器粘连。10处病灶中,9处病灶呈实性, T1WI及T2WI上以等信号或稍高信号为主;1处病灶呈囊性, T1WI呈高信号, T2WI可见“阴影”现象。7例患者有5例合并子宫疾病。结论对于腹壁子宫内膜异位症, MRI不但能准确定位,还能显示病变范围,是术前检查及术后随访的重要方法。%Objective To explore the characteristics of abdominal wall endometriosis (AWE) on magnetic resonance imaging (MRI).Methods The clinical and MRI data of 7 patients with pathologically confirmed AWE in Peking Union Medical College Hospital from January 2008 to January 2013 were retrospectively collected and ana-lyzed.Results Five of the AWE lesions were single and two were multifocal .Ten AWE lesions were found in 7 patients .Seven out of 10 lesions were located in the left , two in the middle , and one in the right .Five lesions were located in the subcutaneous tissue and fascia , the abdominal muscles were invaded in four lesions , and one was lo-cated in the subcutaneous tissue , fascia, and muscle.Endometrial invasion from the scar into the abdominal cavity was observed in two patients , with anterior wall and fundus of the uterus for one patient and anterior wall of bladder for another.Nine lesions were solid and mainly showed isointense or hyperintense signal on T 1WI and T2WI com-pared with muscle with foci of

  2. Linear abdominal trauma.

    Danto, L A; Wolfman, E F


    Three cases of blunt abdominal trauma are presented to exemplify the mechanism of trauma and the problems of diagnosis associated with any linear blow to the abdomen. The mechanisms of visceral injury are reviewed, and special attention is directed to the abdominal wall injury that can be present in these patients. This injury has special implications in directing the operative approach and repair. An unusual aortic occlusion is described which is peculiar to this type of injury.

  3. Electrospun biodegradable microfibers induce new collagen formation in a rat abdominal wall defect model - a possible treatment for pelvic floor repair?

    Tarpø, Cecilie Lærke Glindtvad; Chen, Menglin; Nygaard, Jens Vinge


    and effect on collagen and elastin production of a degradable mesh releasing basic fibroblast growth factor (bFGF). Implantation of biodegradable mesh with or without bFGF in their core has been conducted in 40 rats in an abdominal wall defect model. Samples were explanted after 4, 8, and 24 weeks......, and tested for mechanical properties and the composition of connective tissue. The study showed an increase in mRNA expression for collagen-I (p = 0.0060) and collagen-III (p = 0.0086) in the 4 weeks group with bFGF. The difference was equalized at 8 and 24 weeks. No difference was found at any time...... for protein amount for collagen-I, collagen-III, and fibronectin. The amount of collagen decreased from 4 to 24 weeks but the fraction of collagen increased. The maximal load of the newly formed tissue showed no effect of bFGF at any time. Exclusively, histology showed a limited ingrowth of collagen fibers...

  4. [Abdominal actinomycosis with IUD].

    Kamprath, S; Merker, A; Kühne-Heid, R; Schneider, A


    We report a case of abdominal actinomycosis in a 54 year old woman using an intrauterine device for a period of 8 years. The most important finding was a tuboovarialabscess at the left pelvic side with involvement of the serosa of the jejunum, ileum, sigma, and omentum majus. Intraoperative exploration showed a solid retroperitoneal infiltration between the pelvic side wall and sigma. Another infiltration was found on the left side of the abdominal wall. The diagnosis was confirmed by histopathological examination and the patient was treated by a combination of Aminopenicillin and Metronidazol. After a period of three months we observed a complete regression of the clinical and the MRI findings.

  5. Comparison of application of transthoracic abdominal wall vein and peripheral vein indwelling needleplacement%经胸腹壁静脉与外周静脉置入留置针的应用比较

    魏彬彬; 靳亚斌; 陈燕玲


    Objective To investigate the in peripheral venous puncture difficulties,through the comparison of thoracic and abdominal wall vein puncture effect. Methods 80 cases of neonatal routinely using the peripheral vein group ( scalp vein,limbs vein indwelling needle ) set,chest and abdominal wall vein group ( thoraco abdominal wall vein indwelling needle ) implantation,compared two groups of vein one-time success rate, incidence of complications, indwelling time. Results The chest and abdominal wall vein puncture success rate and retention time was significantly better than that of peripheral vein group two (Note:one time puncture success rate comparison,χ2=9.038,P<0.01). Conclusion the thoracic and abdominal wall vein puncture success rate high,vascular retention time is long, the peripheral group venous retention time of (2+1)days,thoracic and abdominal group venous retention time was(2.5+1.5) days,vascular complications and low. Ensure NICU in neonatal venous channels unblocked,the various drugs and nutrition can timely input.%目的:比较外周静脉穿刺与经胸腹壁静脉穿刺的应用效果。方法将80例新生儿按常规采用外周静脉组(头皮静脉、四肢静脉等)置留置针,胸腹壁静脉组(胸腹壁静脉)置入留置针,比较2组的一次性成功率、留置时间、并发症发生率。结果胸腹壁静脉穿刺成功率及保留时间显著优于外周静脉组(P<0.01),并发症少于外周静脉组(P<0.01)。结论经胸腹壁静脉穿刺成功率高,血管保留时间长,并发症发生率低,保证了新生儿重症监护室(NICU)新生儿静脉通道的畅通,使各种药物及营养成分能及时输入。

  6. 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


    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

  7. 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



    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

  8. Study on the strength of abdominal wall after TRAM flap for breast reconstruction%TRAM皮瓣乳房再造术后腹壁张力的研究

    顾建英; 亓发芝; 吴坤南; 徐剑炜; 施越冬; 张学军


    目的 研究TRAM皮瓣术后腹壁张力的情况。方法 采用调查表,运动测试和腹直肌形态CT扫描作手术前后对照。结果 手术初期(1~6周)腹壁张力下降,尤其以双蒂皮瓣者为甚,3个月后已无明显差异;运动测试显示术后运动不如术前;而CT扫描示腹直肌形态保持良好。结论 TRAM皮瓣乳房再造术后腹直肌肌力有下降,而腹壁张力无明显改变。%Objective To study the strength of abdominal wall after TRAM flap. Methods We made results by questionaire, examination test and CT scanning of rectus abdominis muscles. Results The strength of abdominal wall decreased in initial stage, especially in double-pedicle flap, but there was no significant difference after 3 months, examination tests show decreased strength after operation yet morphology of rectus abdominis muscle remained well. Conclusion The strength of abdominal wall shows no significant change after TRAM flap.

  9. Evaluation of inflammatory cells in abdominal aortic aneurysmal wall by tomography emission positron; Anevrisme de l aorte abdominale et inflammation vasculaire: place de la tomographie par emission de positons

    Sakalihasan, N. [Service de chirurgie cardiovasculaire et thoracique, CHU de liege, domaine universitaire du Sart Tilman, batimant B-35, 4000 liege 1, (Belgium); Hustinx, R. [Service de medecine nucleaire, CHU de Liege, (Belgium); Gomez, P.; Defraigne, J.O. [Departement de medecine nucleaire, CHU de Liege, (Belgium)


    The objective was to identify the methods of functional imaging and the molecular markers that could help to predict the imminence of a rupture in abdominal aortic aneurysm. The potential of the PET was studied to detect a hyper-metabolic state in the aneurysm wall and this information was connected with the evolution of the disease. An uptake of F.D.G. in the aneurysm wall reflects the presence of a great density of inflammatory cells (macrophages, lymphocytes, polymorphonuclear cells). It has been observed an accumulation of polymorphonuclear cells accompanying a dense infiltration of macrophages and lymphocytes only in the site of break. Our preliminary study and our most recent observations (not yet published) suggest a possible relationship between the F.G.D. captation by the aneurysm wall and the start of the activity of the matrix metallo-proteinases leading to the break. The PET scan could be useful for high risk patients because a positive PET imaging stigmatizes a greater risk of break. consequently, the positive PET imaging represents a diagnosis argument to proceed to a surgical operation, despite the age of the patient, the size of the abdominal aorta aneurysm and the higher operative risk. however, more data to better define the criteria of using the PET/T.D.M. in the evaluation of abdominal aorta aneurysm and to determine its exact contribution in the treatment determination. (N.C.)

  10. Effects of prokinetic drugs on the abdominal wall wound healing of rats submitted to segmental colectomy and colonic anastomosis Efeitos de drogas procinéticas na cicatrização da parede abdominal de ratos submetidos à colectomia segmentar e anastomose no cólon esquerdo

    Pedro Henrique Alves de Morais


    Full Text Available PURPOSE: To assess the effect of prokinetic agents on abdominal wall wound healing in rats submitted to segmental colectomy and colonic anastomosis. METHODS: Sixty rats were randomly allocated into three groups according to the agents they would receive in the postoperative period: M (metoclopramide; B (bromopride; and C (control, saline 0.9%. Surgical procedures were performed identically in all animals, and consisted of a midline laparotomy followed by resection of a 1-cm segment of large bowel with end-to-end anastomosis. The abdominal wall was closed in two layers with running stitches. Abdominal wall samples were collected on the 3rd or 7th postoperative day for measurement of breaking (tensile strength and histopathological assessment. RESULTS: There were no statistically significant differences in tensile strength of the abdominal wall scar between groups M, B, and C, nor between the three and seven days after surgery subgroups. On histopathological assessment, there were no statistically significant between-group differences in collagen deposition or number of fibroblasts at the wound site CONCLUSION: Use of the prokinetic drugs metoclopramide or bromopride had no effect on abdominal wall healing in rats submitted to segmental colectomy and colonic anastomosis.OBJETIVO: Avaliar os efeitos do uso de drogas prócinéticas na cicatrização da parede abdominal de ratos submetidos à colectomia segmentar e anastomose no cólon esquerdo. MÉTODOS: Foram utilizados 60 ratos, alocados aleatoriamente em três grupos para receberem as seguintes medicações no período pós-operatório: M (metoclopramida; B (bromoprida e C (solução salina a 0,9%. Os procedimentos cirúrgicos foram idênticos em todos os animais. Foi realizada laparotomia mediana, seguida de colectomia segmentar de 1-cm e anastomose colônica. O fechamento da parede abdominal foi feito em dois planos de sutura contínua. No 3° ou no 7° dia pós-operatório foram coletadas

  11. 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


    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

  12. 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


    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

  13. 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


    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.

  14. [Inflammatory abdominal aortic aneurysm].

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T


    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  15. A prospective, controlled evaluation of the abdominal reapproximation anchor abdominal wall closure system in combination with VAC therapy compared with VAC alone in the management of an open abdomen.

    Long, Kristin L; Hamilton, David A; Davenport, Daniel L; Bernard, Andrew C; Kearney, Paul A; Chang, Phillip K


    Dramatic increases in damage control and decompressive laparotomies and a significant increase in patients with open abdominal cavities have resulted in numerous techniques to facilitate fascial closure. We hypothesized addition of the abdominal reapproximation anchor system (ABRA) to the KCI Abdominal Wound Vac™ (VAC) or KCI ABThera™ would increase successful primary closure rates and reduce operative costs. Fourteen patients with open abdomens were prospectively randomized into a control group using VAC alone (control) or a study group using VAC plus ABRA (VAC-ABRA). All patients underwent regular VAC changes; patients receiving VAC-ABRA also underwent concomitant daily elastomer adjustment of the ABRA system. Primary end points included abdominal closure, number of operating room (OR) visits, and OR time use. Eight patients were included in the VAC-ABRA group and six patients in the control group. Primary closure rates between groups were not statistically different; however, the number of trips to the OR and OR time use were different. Despite higher Acute Physiology and Chronic Health Evaluation II scores, larger starting wound size, and higher rates of abdominal compartment syndrome, closure rates in the VAC-ABRA group were similar to VAC alone. Importantly, however, fewer OR trips and less OR time were required for the VAC-ABRA group.

  16. Laparoscopic abdominal wall components separation in a porcine model of intra-abdominai hypertension%腹腔镜腹壁结构分离治疗腹腔内高压的动物实验

    李世宽; 胡三元


    目的 通过动物实验,研究腹腔镜腹壁结构分离技术治疗腹腔内高压的效果.方法 8头巴马香猪于全麻下手术,通过腹腔灌注CO2建立腹腔高压(IAH)模型.于腹肌平面上方建立皮下隧道,在腹腔镜的监测下以超声刀切开腹外斜肌腱膜的止点,记录术前、单侧减压和双侧减压后的腹腔内压(IAP)、腰围(WL)、中心静脉压(CVP)、平均动脉压(MAP)和心率(HR)的变化.结果 建立IAH(25 mm Hg)后,WL为(65.3±2.5)cm,MAP为(88±14)mm Hg,HR为(115±9)次/min,CVP为(10.8±2.2)cm H2O.实施腹腔镜腹壁结构分离后,IAP降至(16.0±1.5)mm Hg(P<0.01),WL升至(83.1±1.9)cm(P<0.01),MAP升至(100±12)mm Hg(P<0.01),HR降至(97±7)次/min(P<0.01),CVP降至(7.3±1.8)cmH2O(P<0.01).结论 IAP的变化可引起巴马香猪的血液动力学改变,腹腔镜腹壁结构分离技术可显著降低其IAH,从而改善血液动力学.%Objective To determine the effect of laparoscopic abdominal wall components separation procedure on a porcine model of intra-abdominal hypertension (IAH). Methods IAH to 25 nun Hg was created by insufllating carbon dioxide into abdominal cavity of eight anesthetized pigs. Bilateral subcutaneous tunnels above the plane of the abdominal musculature were developed. Dissection of the external oblique insertion and development of the plane between external and internal oblique muscles was performed using ultrasonic scalpel monitored by laparoscopy. Changes in intra-abdominal pressure (IAP), waistline (WL), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) were recorded. Results Following intra-abdominal hypertension, WL, MAP, HR and CVP changed significantly. After laparoscopic abdominal wall components separation, there was a significant decrease in IAP from 25 mm Hg to ( 16. 0 ± 1.5 ) mm Hg ( P < 0. 01 ). Also, this procedure increased WL by (5.6 ± 2. 0) cm [ from (65.3 ± 2. 5 ) cm to (88 ± 14) cm; P < 0. 01 ]. Due to abdominal depression, the MAP

  17. [Differential diagnosis of abdominal pain].

    Frei, Pascal


    Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain.

  18. The characteristics of abdominal wall endometriosis: meta-analysis and literature review%腹壁子宫内膜异位症疾病特征Meta分析

    吴珍珍; 郭钰珍


    目的 探讨腹壁子宫内膜异位症(abdominal wall endometriosis,AWE)患者的疾病特征.方法 通过PubMed 检索,检索词为:abdominal wall endometriosis,extrapelvic endometriosis,scar endometriosis,incisional endometriosis,inguinal endometriosis,umbilical endometriosis,ectopic endometriosis,cutaneous endometriosis,关系为“or”.限定检索词在title/abstract中,发表期限为1980年至2012年间,依据纳入及排除标准,筛选出文献共31篇,病例数共441例.用STATA10.0统计软件处理.结果 研究对象中,剖宫产术后病例278例,占63.04%(278/441);经腹子宫全切术后病例44例,占9.98%(44/441);其他手术或操作后病例33例,占7.48%(33/441);自发性病例63例,占14.29%(63/441).平均年龄为32.17岁(95%CI 29.59~34.97岁),Q=4.811,df=10,P=0.903,I2=0.平均无症状期(症状出现与前次手术、操作的间隔时间)为3.95年(95%CI 2,43~6.43年),Q=1.687,df=5,P=0.890,I2=0.平均病灶最大直径为3.30cm(95%CI 2.58~4.22cm),Q=7.791,df=5,P=-0.168,I2=35.82%.主要就诊症状:包块占(93.22±2.11)%(95%CI 88.88%~97.56%),Q=15.446,df=26,P=0.949,I2=0;疼痛占(85.73±2.74)%(95%CI 80.07%~91.39%),Q=19.119,df=25,P=0.791,I2=0;症状具有月经周期相关性者占(58.59±5.55)%(95%CI 47.19%~70.00%),Q=68.584,df=26,P=0.000,I2=62.09%.结论 AWE最常继发于剖宫产手术后,也可发生与经腹金子宫切除术后、羊膜腔穿刺术后、阑尾切除术后,甚至在没有任何腹部手术、操作史的患者也可发病.前次手术、操作后出现症状有时间间隔.主要症状为腹壁痛性包块,93%的患者有腹壁包块,86%的患者主诉疼痛,只有约1%的患者无上述症状,近40%的患者症状与月经周期不相关,月经周期相关性症状不能作为鉴别诊断的依据.

  19. Effects of bromopride on abdominal wall healing with induced peritoneal sepsis after segmental colectomy and colonic anastomosis in rats Efeitos da bromoprida na cicatrização da parede abdominal com sepse peritoneal induzida e submetidos à ressecção segmentar e anastomose do cólon esquerdo em ratos

    Marcos Vinícius Melo de Oliveira


    Full Text Available PURPOSE: Evaluate the effects of bromopride on abdominal wall healing of rats with induced peritoneal sepsis after segmental colectomy and colonic anastomosis. METHODS: Forty rats underwent sectioning of the left colon and end-to-end anastomosis and were divided into two groups of 20 animals for the administration of bromopride (bromopride group - B or saline solution (control group - C. Each group was divided into subgroups of 10 animals each to be killed on the third (GB3 and GC3 or seventh postoperative day (GB7 and GC7. It was analyzed the following characteristics: breaking strength of the abdominal wall's wound; surgical and histopathological features of the abdominal wall; and clinical features of the rats. RESULTS: There was no difference between the groups in relation to the weight of the rats and the breaking strength of the abdominal wall's wound. The GB7 group presented less edema and less quantity of fibrin during histopathological evaluation compared to the GC7 group. CONCLUSION: Bromopride did not have harmful effects on the healing of abdominal wall in rats.OBJETIVO: Avaliar o efeito da bromoprida, na cicatrização da ferida operatória da parede abdominal de ratos com sepse peritoneal experimentalmente induzida e submetidos a ressecção segmentar e anastomose de cólon esquerdo. MÉTODOS: 40 ratos distribuídos em dois grupos contendo 20 animais, para administração de bromoprida (grupo bromoprida- B ou solução de NaCl 0,9% (grupo controle - C. Cada grupo foi dividido em subgrupos contendo 10 animais, para eutanásia no terceiro (GB3 e GC3 ou sétimo dia (GB7 e GE7 de pós-operatório. Os ratos foram submetidos à secção do cólon esquerdo e anastomose término-terminal. No dia da eutanásia foram avaliadas as características cirúrgicas da cavidade abdominal e clínicas dos ratos. Foram coletados segmentos da parede para a avaliação histopatológica e de resistência tênsil da ferida operatória. RESULTADOS: N

  20. Evidence-based medical research of abdominal wall endometriosis from cesarean section%剖宫产腹壁切口子宫内膜异位症的循证医学研究



    目的:探讨腹壁子宫内膜异位症的发生与剖宫产腹壁切口的关系。方法通过计算机检索中国期刊全文数据库、万方数据库、重庆维普期刊数据库、EBSCO、PubMed,按照纳入和排除标准收集研究两种剖宫产腹壁切口类型的腹壁子宫内膜异位症的病例对照研究8篇,检索时间为1997~2013年,采用RevMan 5.2软件进行Meta分析。结果横切口组与纵切口组腹壁子宫内膜异位症发生率的比较,差异有统计学意义[OR合并=1.42,95%CI为(1.10,1.85),Z=2.65,P=0.008],本研究纳入文献的发表性偏倚的漏斗图分析,基本呈对称倒漏斗状。结论剖宫产术后腹壁子宫内膜异位症的发生与腹壁切口的选择关系密切,横切口易发生腹壁子宫内膜异位症。%Objective To discuss the relationship between abdominal wall endometriosis and cesarean abdominal inci-sion. Methods Chinese Journal Full-text database,WanFang DATA,Chongqing VIP periodical database,EBSCO,PubMed from 1997 through 2013 was retrievaled to identify case-control studies about the abdominal wall endometriosis from two kinds of cesarean incisions.The quality of the included studies was assessed and the RevMan 5.2 software was used for Meta-analysis. Results There were significant differences between transverse incision group and vertical incision group of the incidence rate of abdominal wall endometriosis [combined odds ratio (OR) was 1.42 with 95%CI was (1.10,1.85),Z=2.65,P=0.008].Funnel plot analysis was used to the publication bias of the including studies,basic sym-metrical inverted funnel. Conclusion There is a close relationship between the occurrence of abdominal wall en-dometriosis and the choice of incision of abdominal wall,in which are mostly transverse incision.

  1. Comparação entre pericárdio bovino preservado em glicerina e malha de poliéster no reparo de falhas da parede abdominal em ratos Comparison of glycerin preserved bovine pericardium and a polyester mesh for the repair of abdominal wall defects in rats

    Juliany Gomes Quitzan


    Full Text Available OBJETIVO: Comparar uma malha comercial de poliéster com o pericárdio bovino preservado em glicerina na reconstituição de defeitos da parede abdominal. MÉTODOS: Foram utilizados 30 ratos, divididos em dois grupos eqüitativos. Efetuou-se uma excisão retangular de 2,5 x 2 cm, incluindo toda a musculatura abdominal e peritônio. No grupo I a parede abdominal foi reparada com malha de poliéster e no grupo II com pericárdio bovino conservado em glicerina. Os animais foram sacrificados aos 15, 60 e 90 dias de pós-operatório, sendo o local cirúrgico avaliado macroscópica e histologicamente. RESULTADOS: Os animais do grupo I apresentaram aderências mais severas e em maior número quando comparados aos do grupo II; porém, sem comprometimento funcional. A análise histológica revelou incorporação dos tecidos aos implantes, com maior resposta fibroblástica nos animais do grupo I. CONCLUSÃO: A malha de poliéster oferece maior resistência estrutural e resposta fibroblástica mais intensa; contudo, promove grande quantidade de aderências às vísceras abdominais, quando comparada ao pericárdio bovino.PURPOSE: The aim of the study was to compare polyester mesh and glycerin preserved bovine pericardium for the repair of abdominal wall defects. METHODS: Thirty rats divided into two equal experimental groups were used. A 2.5 x 2 cm rectangular defect including all abdominal muscles and peritoneum was performed. The defect was reconstructed using polyester mesh in group I and glycerin preserved bovine pericardium in group II. The animals were submitted to euthanasia at 15, 60 and 90 days postoperatively, and the surgical area was evaluated by macroscopic and microscopic examination. RESULTS: The animals of the Group I had more abdominal adhesions and those were more severe than the animals of the Group II. The microscopic examination showed incorporation of the tissues in the implants with accentuated fibroblastic reaction in the animals of

  2. 腹壁内异症151例临床分析%Clinicopathological features of 151 cases with abdominal wall endometriosis

    袁蕾; 张金花; 刘惜时


    目的 探讨腹壁内异症(AWE)的临床特点.方法 回顾性分析复旦大学附属妇产科医院2003年1月至2010年12月间收治的166例AWE患者的临床资料,其中151例完成随访,随访时间16 ~97个月.结果(1)发病情况:AWE占同期内异症的1.96%(166/8469).随访资料完整的151例AWE患者均有剖宫产史,术后发病距前次手术时间为24个月(3~192个月),其长短与前次剖宫产相关因素(剖宫产时年龄、切口位置、分娩孕周、产后哺乳时间、产后月经恢复时间和产后是否避孕)均无相关性(P>0.05),与AWE病灶大小也无相关性(P>0.05).AWE患者的病程为26个月(2~ 168个月),病程长短与术后发病至前次手术时间呈负相关(r=-0.267,P<0.05),与AWE病灶大小呈正相关[病灶最大直径≥3 cm者(101例),病程明显长于病灶最大直径<3 cm者(50例),r=0.326,P<0.05].(2)辅助检查:术前超声检查确诊AWE 147例(97.4%,147/151),超声检查病灶中位最大直径为20 mm,明显小于术中探查的病灶中位最大直径35 mm,差异有统计学意义(P<0.05),仅有26.5%(40/151)的患者术前超声可提示病灶侵犯的深度.(3)疗效及其影响因素:所有患者均手术切除AWE病灶,其中34例(22.5%,34/151)患者术前药物治疗3~9个月,57例患者(37.7%,57/151)术后药物治疗.AWE病灶最大直径≥3 cm者的复发率为3.1%(3/96)显著低于AWE病灶最大直径<3 cm者的17.8%(8/45),差异也有统计学意义(P<0.05).术后药物治疗者的复发率(3.8%,2/53)显著低于未用药物者(10.2%,9/88),差异也有统计学意义(P<0.05).(4)症状缓解及复发情况:术后症状缓解率为93.4%(141/151),复发率为7.8%(11/141),平均复发时间为(20±16)个月.结论 手术是治疗AWE的主要方法,AWE病灶大小及术后用药与否是影响复发的主要因素.%Objective To investigate clinicopathological features of abdominal wall endometriosis(AWE).Methods A retrospective study

  3. Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm doxycycline selectively depletes aortic wall neutrophils and cytotoxic t cells

    Lindeman, J.H.N.; Abdul-Hussien, H.; Bockel, J.H. van; Wolterbeek, R.; Kleemann, R.


    Background-Doxycycline has been shown to effectively inhibit aneurysm formation in animal models of abdominal aortic aneurysm. Although this effect is ascribed to matrix metalloproteinase-9 inhibition, such an effect is unclear in human studies. We reevaluated the effect of doxycycline on aortic wal

  4. 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


    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 .

  5. Comparative study of the microvascular blood flow in the intestinal wall, wound contraction and fluid evacuation during negative pressure wound therapy in laparostomy using the V.A.C. abdominal dressing and the ABThera open abdomen negative pressure therapy system.

    Lindstedt, Sandra; Malmsjö, Malin; Hlebowicz, Joanna; Ingemansson, Richard


    This study aimed to compare the changes in microvascular blood flow in the small intestinal wall, wound contraction and fluid evacuation, using the established V.A.C. abdominal dressing (VAC dressing) and a new abdominal dressing, the ABThera open abdomen negative pressure therapy system (ABThera dressing), in negative pressure wound therapy (NPWT). Midline incisions were made in 12 pigs that were subjected to treatment with NPWT using the VAC or ABThera dressing. The microvascular blood flow in the intestinal wall was measured before and after the application of topical negative pressures of −50, −75 and −125mmHg using laser Doppler velocimetry. Wound contraction and fluid evacuation were also measured. Baseline blood flow was defined as 100% in all settings. The blood flow was significantly reduced to 64·6±6·7% (P blood flow was significantly reduced to 39·6±6·7% (P blood flow could be observed between the two groups. The ABThera system afforded significantly better fluid evacuation from the wound, better drainage of the abdomen and better wound contraction than the VAC dressing.

  6. 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


    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.

  7. 皮下注射子宫内膜法建立Lewis大鼠腹壁子宫内膜异位症模型%Establishment of endometriosis model by abdominal wall subcutaneous injection of endometrium in Lewis rats

    周玲; 钱志红; 任琼珍


    Objective To establish a endometriosis model by abdominal subcutaneous injection of endometrium in Lewis rats. Methods Endometrium of Lewis rats was subcutaneously injected into abdominal wall in 28 Lewis rats. On the 7th day and 21st day after surgery, the heterotopic nodules were taken out for HE staining and pathological observation. Results All 28 rats were survived with the ectopic endometrium growing in abdominal wall The ectopic endometrium nodules grew like a small cystic mass and with the basic organizational structures of normal endometrium under microscope. Conclusion The endometriosis model of Lewis rats has been successfully established, which is beneficial to the study of endometriosis.%目的 建立Lewis大鼠皮下子宫内膜异位症(EM)模型.方法 以同系大鼠作为供体,取子宫内膜,采用皮下注射法对28只大鼠行皮下造模手术,术后第7天及第21天取异位子宫内膜结节行HE染色和病理组织学观察.结果 实验大鼠均成活,腹壁子宫内膜异位种植成功率100%.子宫内膜在腹壁内生长,呈隆起囊状小包块,具有正常子宫内膜基本组织结构.结论 以同系大鼠子宫内膜皮下注射法成功地建立了Lewis大鼠腹壁EM模型,可用于EM研究.

  8. Comparative study between polypropylene and polypropylene/poliglecaprone meshes used in the correction of abdominal wall defect in rats Estudo comparativo entre as telas de polipropileno e polipropileno/poliglecaprone utilizadas na correção de defeito na parede abdominal ventral de ratos

    Carlos Alberto Lima Utrabo


    Full Text Available PURPOSE: To evaluate the healing process of a defect in the ventral abdominal wall of rats, comparing the polypropylene and polypropylene/poliglecaprone meshes on the 30th and 60th postoperative day. METHODS: Thirty two Wistar rats were submitted to a ventral abdominal wall defect, with integrity of the parietal peritoneum. In the repair, were used polypropylene (group A and polypropylene/poliglecaprone (group B meshes. The groups were subdivided into four subgroups of eight animals euthanized on the 30th (A30 and B30 and 60th postoperative day (A60 and B60. Fragments of the abdominal wall of the animals were submitted to macroscopic, tensiometric and histological evaluations. RESULTS: The tensiometry on subgroup A30 showed a mean average break point of 0.78 MPa and in A60, 0.66 Mpa. In subgroup B30 it was 0.84 MPa and in B60, 1.27 Mpa. The score of the inflammatory process showed subacute phase on A30 and B30 sub-groups and chronic inflammatory process in subgroups A30 and 60B. CONCLUSIONS: The tensile strength was higher on the wall repaired by polypropylene/poliglecaprone mesh in the 60th post-operative day. Histology showed higher concentration of fibrosis on the surface of the polypropylene mesh with a tendency to encapsulation. In polypropylene/poliglecaprone subgroups the histology showed higher concentration of fibrosis on the surface of mesh filaments.OBJETIVO: Avaliar a cicatrização de um defeito, na parede abdominal ventral de ratos, comparando-se as telas de polipropileno e polipropileno/poliglecaprone no 30º e 60º dia do pós-operatório. MÉTODOS: Trinta e dois ratos Wistar foram submetidos à produção de defeito na parede abdominal ventral, com integridade do peritônio parietal. Na correção foram utilizadas as telas de polipropileno (grupo A e polipropileno/poliglecaprone (grupo B. Houve subdivisão em quatro subgrupos (A30, A60, B30 e B60 de oito animais que foram submetidos à eutanásia no 30º e 60º dia do p

  9. Abdominal pain

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is does not always reflect the seriousness ...

  10. Abdominal actinomycosis.

    Wagenlehner, F M E; Mohren, B; Naber, K G; Männl, H F K


    Intra-abdominal and extraperitoneal actinomycosis are rare infections, caused by different Actinomyces species. However, they have been diagnosed more frequently in the last ten years. We report three cases of abdominal actinomycosis and a literature review of the last eight years. All three patients were diagnosed by means of histopathologic examination only. In one case, an intrauterine device (IUD) was associated with the infection. Therapy consisted of surgical resection of the inflammatory, infected tissue, and long-term antibiotic therapy. All patients are free of recurrence. Abdominal actinomycosis should be included in the differential diagnosis of an abdominal pathology of insidious onset, especially when an IUD is in place. Even when infection had spread extensively, combined operative and antibiotic therapy cured most of the cases.

  11. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    Carney, John


    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  12. Estudo biomecânico e morfológico da cicatrização da parede abdominal sob ação de meloxicam Biomechanical and morphological study in rats’ abdominal wall healing under meloxicam action

    João Ricardo F. Tognini


    Full Text Available Foi realizado um estudo biomecânico e morfológico da cicatrização da parede abdominal de ratos sob ação do meloxicam. Os 60 ratos do grupo controle receberam meloxicam na dose única diária de 0, ou 0,3 ml de solução salina de cloreto de sódio a 0,9% via intramuscular por 4 dias consecutivos. Os 60 ratos do grupo experimento foram submetidos a laparotomia e posterior síntese por técnica padronizada. Os animais desse grupo também receberam meloxicam ou solução salina da mesma maneira do grupo controle. No 5° ,10° ou 15° dias de observação os animais foram avaliados quanto a curva ponderal e os segmentos contendo cicatrizes de laparotomias foram submetidos a análise de força de rotura por meio de um tensiômetro e análise histológica (quantificação de colágeno e macrófagos com auxílio de um programa informatizado. Os resultados foram submetidos a testes estatísticos (alfa#0,05. A curva ponderal mostrou menor perda de peso nos animais que receberam meloxicam no 5° dia de observação, provavelmente devido a menor dor pós-operatória. O teste de rotura e a análise histológica não mostraram diferenças significantes entre os grupos, demonstrando que o meloxicam não interfere na cicatrização. Conclui-se que o meloxicam não induz a alterações biomecânicas e morfológicas na cicatrização da ferida operatória da parede abdominal de ratos.A biomechanical / morphological study in rats’ abdominal wall healing and Meloxicam was performed in 120 male wistar rats. The 60 animals in the control group were injected Meloxicam IM (0, or saline soluction (NaCl 0,9% in the initial four consecutive days. The 60 animals in the experimental group carried out standart laparotomie and closure. Each animal in the initial four days was injected meloxicam or saline soluction in the same way of the control group. About the 5th, 10th or 15th post-operative day the animals weith-body were measured and segments of

  13. Verificação da viabilidade do transplante autógeno de testículo no omento e na parede abdominal em ratos Verification of the feasibility of autogenous testis implant in omentum and abdominal wall in mice

    Sergio Ibañez Nunes


    Full Text Available OBJETIVO: verificar a viabilidade do transplante autógeno de testículos na parede abdominal e omento, em ratos, sem anastomose vascular, analisando a estrutura histológica das células testiculares após o implante. MÉTODOS: foram utilizados 60 ratos Wistar, machos, de 10-12 semanas de idade, distribuídos em três grupos: grupo controle: 20 ratos sem orquiectomia, com operação simulada; grupo 2: 20 ratos com orquiectomia bilateral sendo um testículo implantado no omento maior; grupo 3: 20 ratos com orquiectomia bilateral, sendo um testículo implantado na parede abdominal. Após dois meses eles foram mortos e os testículos avaliados pelo exame anatomopatológico. RESULTADO: o peso dos implantes teve perda de 0,62g no grupo 2, de 0,73g no grupo 3 e no grupo controle houve aumento de 0,1g. Ao estudo anatomopatológico, no grupo controle a estrutura testicular foi preservada; no grupo 2 encontrou-se 80% de inflamação e necrose, não foram visualizadas células de Sertoli ou de Leydig, em dois animais encontraram-se túbulos seminíferos; no grupo 3 encontrou-se 75% de inflamação e 60% de necrose, somente em um conseguiu-se visualizar células de Sertoli e em três células de Leydig. CONCLUSÃO: não é viável o transplante autógeno de testículo sem anastomose vascular em ratos no omento maior e na parede abdominal.OBJECTIVE: To verify the feasibility of autologous transplantation of testes to the abdominal wall and omentum of rats without vascular anastomosis, analyzing the histological structure of the testicular cells after implantation. METHODS: We used 60 male Wistar rats, 10-12 weeks of age, which were divided into three groups: control group: 20 rats without orchiectomy with sham operation; group 2: 20 rats undergoing bilateral orchiectomy, with one of the testicles being implanted into the greater omentum; and group 3: 20 rats submitted to bilateral orchiectomy, with one testicle implanted in the abdominal wall. After two

  14. Evaluation of peritoneal adhesions formation and tissue response to polypropylene - poli (2-hydroxyethyl methacrylate-(polyHEMA implant on rats' abdominal wall Avaliação da formação de aderências peritoneais e da resposta tecidual ao implante de poli (2-hidroxietil dimetacrilato-(poliHEMA na parede abdominal de ratos

    Neusa Margarida Paulo


    Full Text Available PURPOSE: To verify if the composit poli (2-hydroxyethyl methacrylate-PolyHEMA/polypropylene mesh implanted in the female rat's abdominal wall could be suitable for the prevention of peritoneal adhesions, and for the evaluation of the tecidual response produced by this biomaterial. METHODS: Polypropylene meshes (Group PP, n=20 and polypropylene meshes coated with a layer of poli (2-hydroxyethyl methacrylate-PolyHEMA (Group PH, n=20 were implanted on the abdominal wall of Wistar female rats. Ten animals from each group were submitted to euthanasia at 15 and 30 days of the postoperative period. RESULTS: The animals from the group PP presented visceral adhesions on the mesh surface, which was not observed in the ones from group PH. At the histopathological examination foreign body response was observed in both groups, whilst there was a greater intensity of inflammatory response in group PH on both moments. CONCLUSION: The poli (2-hydroxyethyl methacrylate polyHEMA hydrogel associated to polypropylene mesh reduces visceral adhesion formation in rats, although it may be associated to greater inflammatory reaction.OBJETIVO: Verificar se compósito poli 2-hidroxietil dimetacrilato (PoliHEMA / tela de polipropileno implantado na parede abdominal de ratas seria adequado para prevenção de aderências peritoneais e avaliar a resposta tecidual desencadeada por este biomaterial. MÉTODOS: Foram implantadas telas de polipropileno - Grupo PP (n=20 e telas de polipropileno revestidas por uma camada de poli 2 (hidroxietil dimetacrilato-PolyHEMA - Grupo PH (n=20 na parede abdominal de ratas da linhagem Wistar. Dez animais de cada grupo foram submetidos à eutanásia aos 15 e 30 dias de pós-operatório. RESULTADOS: Os animais do grupo PP apresentaram aderências viscerais na superfície da tela, o que não foi observado nos do grupo PH. Observou-se no exame histopatológico resposta tipo corpo estranho nos dois grupos sendo que no grupo PH houve maior

  15. Adult abdominal hernias.

    Murphy, Kevin P


    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.

  16. Abdominal Sepsis.

    De Waele, Jan J


    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy.

  17. Childhood abdominal cystic lymphangioma

    Konen, Osnat; Rathaus, Valeria; Shapiro, Myra [Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba (Israel); Dlugy, Elena [Department of Paediatric Surgery, Schneider Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Freud, Enrique [Department of Paediatric Surgery, Sapir Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Kessler, Ada [Department of Diagnostic Imaging, Sourasky Medical Centre, Tel-Aviv (Israel); Horev, Gadi [Department of Diagnostic Imaging, Schneider Medical Centre, Tel-Aviv (Israel)


    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two

  18. Clinical study of computerized tomography for diagnosis of endometriosis of abdominal wall%CT对腹壁子宫内膜异位症诊断的临床研究

    杜全兴; 张振全; 鲍瑞新


    目的:探讨CT对腹壁子宫内膜异位症的临床诊断价值。方法回顾性分析2011年6月至2013年12月,河北省玉田县医院收治的腹壁子宫内膜异位患者23例。通过术前的CT检查,辅助手术切除治疗。结果 CT扫描发现,本组23例患者,单个肿块14例,多个肿块9例。肿块最小0.9 cm ×1.6 cm,最大5.1 cm ×3.0 cm。肿块均位于腹壁切口瘢痕下方,位于皮下脂肪层12例,腹壁切口肌层内7例,肌层与壁层腹膜4例。实块型肿块3个,囊肿型肿块14个,囊实混合性6个。手术后23例患者症状基本消失。手术时间35~70 min,平均住院时间(6±2)d,预后较好,切口均甲级愈合。结论 CT对子宫内膜异位症的准确位置以及对周围组织的浸润情况具有较高的临床诊断价值,有助于子宫内膜异位症手术的顺利进行,值得临床推广。%Objective To investigate clinical diagnostic value of computerized tomography (CT) examination for endometriosis of abdominal wall.Methods A total of 23 patients with endometriosis of abdominal wall who were admitted to Hebei Yutian Hospital from June 201 1 to December 201 3,were enrolled into the retrospective analysis.All patients received perioperative CT scan,and then surgical resections were performed.Results The results of CT scan revealed that there were 1 4 cases of single mass and 9 cases of multiple masses in whole group (23 patients).The size of mass ranged from minimum of 0.9 cm ×1 .6 cm,to maximum of 5.1 cm ×3.0 cm.All masses were located below the abdominal wall wound scar,including 1 2 cases in the subcutaneous fat layer,7 cases in muscle layer of abdominal wall wound,and 7 cases between muscle and parietal peritoneum.Solid mass was observed in 3 cases,cystic mass in 1 4 cases,and mixed mass in 6 cases.The symptoms of all 23 patients almost disappeared after operation.The operation time was 35 to 70 minutes,and the average length of stay was (6 ±2


    B. S. Sukovatykh


    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.

  20. Nursing care of abdominal wall wounds in 28 patients with open abdomen after skin transplantation%28例腹腔开放创面植皮患者的护理

    李晓婷; 刘云; 任建安; 赵允召; 吴莉莉; 韩刚; 王革非; 顾国胜; 赵日升


    总结了28例腹腔开放患者自体皮肤移植后的创面护理.分阶段评估植皮后第3天、第7天、第21天的创面恢复情况,采用不同的创面护理措施.对创面合并肠瘘的患者,保持引流的有效性,并采取主动引流,避免肠液侵蚀.同时,做好头部供皮区的护理,加强功能锻炼和心理支持.本组27例患者腹壁创面植皮后第21天,皮片覆盖面积超过90%,只有1例未达90%,经过积极的创面护理,最终创面得到修复.%This paper summarizes the nursing care of abdominal wall wounds for 28 patients with open abdomen after autologous skin transplantation. Targeted wound care was provided for the patients based on the wound assessment at 3 days, 7 days and 21 days after skin transplantation. For patients complicated by intestinal fistula, active drainage was important to avoid corrosion from intestinal fluid. Moreover,nursing care focused on proper nursing of head skin donor site,functional exercises and psychological support. As a result,the covered size of the abdominal wall wounds by blade of thick skin was over 90% in 27 cases at 21 days after skin transplantation. Only one case was under 90%,but healed ultimately after active wound care.

  1. 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


    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。

  2. Analysis of the tensile strength on the healing of the abdominal wall of rats treated with infliximab Análise da força tênsil na cicatrização da parede abdominal de ratos tratados com infliximabe

    João Vieira Lopes


    Full Text Available PURPOSE: To evaluate the effects of infliximab, a murine/human chimeric monoclonal antibody, on the tensile strength of abdominal wall surgical wounds. METHODS: Sixty Wistar healthy male rats with initial body weight between 215 and 390 g and 60 and 90 days of age were randomly assigned into two groups, E (Experimental and C (Control with 30 animals each. Group E animals received a single subcutaneous dose of 5mg/Kg of infliximab, and Group C animals received equivalent subcutaneous volume of a solution of 0.9% NaCl. After 48h, animals from both groups were submitted to a 4 cm median incision in the abdominal wall, including all layers that had been reconstituted with continuous suture of the aponeurotic muscle and skin, with 5.0 nylon thread. Then, Group E animals were separated by simple allotment into three subgroups named E3, E7 and E14 with ten animals each, and those from group C into C3, C7, C14 and were submitted, respectively, the reoperation and euthanasia at the third, seventh and fourteenth postoperative day. The anterior abdominal wall, which was resected during reoperation, was cut with No 15 scalpel lamina perpendicularly to the surgical wound. Each specimen, in the form of a 6 cm x 2 cm strip, was fixed by the extremity so that the suture line was equidistant from the fixation points of the dynamometer, in order to undergo the tensile strength test. The dynamometer, which was gauged for each series of measures, was calibrated to apply velocity to the 25 mm/min rupture test; the rupture value was expressed in N (Newton. Prior to euthanasia, the abdominal vena cava was identified and punctured in order to collect blood for TNF-α dosage. RESULTS: The mean tensile strength found for animals from subgroups E3, E7, E14, C3, C7, C14 were, respectively, 16.03, 18.69, 27.01, 28.40, 27.22, 29.15 and 24.30 N. In the results of the multiple comparisons tests, significant differences (pOBJETIVO: Avaliar os efeitos do infliximabe, anticorpo

  3. 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


    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.

  4. Abdominal Aortic Aneurysm (AAA)

    ... News Physician Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... an abdominal aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  5. Hérnia traumática da parede abdominal Traumatic abdominal hernia

    Alexandre Cruz Henriques


    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.

  6. Biomechanical evaluation of microbial cellulose (Zoogloea sp. and expanded polytetrafluoroethylene membranes as implants in repair of produced abdominal wall defects in rats Avaliação biomecânica de membranas de celulose microbiana (Zoogloea sp. e de politetrafluoretileno expandido como implantes no reparo de defeitos produzidos na parede abdominal em ratos

    Suyiene Cordeiro Falcão


    Full Text Available PURPOSE: To evaluate the Load of Rupture of implants of membranes of microbial cellulose (Zoogloea sp. and extended polytetrafuoroethylene in sharp defects of abdominal wall of rats. METHODS: Sixty Wistar male rats, with a mean weight of 437,7g ± 40,9, anesthetized by a mixture of ketamine (5mg/100g and xylazine (2mg/100g, were submitted to a rectangular (2x3cm excision of the abdominal wall, including fascia, muscle and peritoneum, and treated with membranes of microbial cellulose (MC (MC Group- 30 animals or extended polytetrafluoroethylene (ePTFE (ePTFE Group- 30 animals. Each group was subdivided in 14th POD, 28th POD and 60th POD Subgroups. Under anesthesia, animals were submitted to euthanasia at 14th POD, 28th POD and 60th POD for evaluation of Load of Rupture. RESULTS: Load of Rupture levels were significantly elevated (pOBJETIVO: Avaliar a Carga de Ruptura de implantes de membranas de celulose microbiana (Zoogloea sp. e de politetrafluoretileno expandido em defeitos agudos produzidos na parede abdominal de ratos. MÉTODOS: Sessenta ratos machos Wistar, com média de peso de 437,7g ± 40,9, anestesiados com uma mistura de cetamina (5mg/100g e xilazina (2mg/100g, foram submetidos à excisão retangular (2x3cm na parede ventral do abdômen, incluindo fáscia, músculo e peritônio. Subseqüentemente, foram tratados com implante de membranas de celulose microbiana (CM (Grupo CM - 30 animais ou de politetrafluoretileno expandido (PTFEe (Grupo PTFEe - 30 animais. Cada grupo foi ainda subdividido nos Subgrupos 14º DPO, 28º DPO e 60º DPO. Os animais foram submetidos à eutanásia com doses letais de tiopental no 14º DPO, 28º DPO e 60º DPO, para avaliação da Carga de Ruptura na área do implante. RESULTADOS: Os níveis da Carga de Ruptura foram significativamente elevados (p<0,05 entre os Subgrupos 14º DPO, 28º DPO e 60º DPO de cada grupo estudado. Quando comparados entre Grupos, os valores da Carga de Ruptura foram

  7. 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


    Full Text Available RACIONAL: O uso de telas cirúrgicas para a correção de defeitos da parede abdominal vem ocupando cada vez mais espaço nas operações no mundo todo. OBJETIVO: Estudar duas telas cirúrgicas distintas (Proceed® e Ultrapro® na cicatrização de defeito produzido em parede abdominal de ratos avaliando-se macroscopia, tensiometria e microscopia. MÉTODO: A amostra foi constituída por 32 ratos Wistar, divididos em dois grupos de 16 animais e quatro subgrupos de oito, submetidos à eutanásia com 15 dias e 30 dias para avaliação. As variáveis macroscópicas foram: presença de hematoma nos bordos da sutura da tela cirúrgica na parede abdominal, união entre a tela e a borda da ferida, presença de infecção no sítio cirúrgico, presença de fístulas de vísceras com a tela cirúrgica, presença de aderências dentro da cavidade abdominal e presença de hérnia incisional. Na microscopia avaliaram-se as fases do processo inflamatório da cicatrização, e na tensiometria a força tênsil necessária para ruptura do material. RESULTADOS: A união entre a tela cirúrgica e a borda da ferida foi melhor no subgrupo Ultrapro 15 dias que no Proceed 15 dias; com 30 dias foi igual nos dois subgrupos. Não houve diferença significativa quanto às demais variáveis da macroscopia. Os dois grupos nos dois momentos tiveram a mesma proporção de casos com processo inflamatório crônico, mas houve maior escore de inflamação do Ultrapro 15 dias que do Ultrapro 30 dias. O subgrupo Ultrapro 15 dias mostrou força de ruptura maior que o subgrupo Proceed 15 dias, mas em 30 dias não houve diferença. Ultrapro mostrou força de ruptura igual para os dois momentos, mas Proceed 30 dias mostrou força de ruptura maior que Proceed 15 dias. CONCLUSÃO: As telas são semelhantes nas variáveis analisadas.BACKGROUND: The use of surgical meshes for the repair of abdominal wall defects has been increasing its share in surgeries worldwide. AIM: To study two

  8. Membrana de látex da seringueira (Hevea brasiliensis, com e sem polilisina a 0,1% e tela de marlex na reconstrução de defeitos iatrogênicos da parede abdominal de ratos Seringueira's latex membrane (Hevea brasiliensis with and without polylysine 0,1% and marlex mesh for the reconstruction of iatrogenics abdominal wall defects in rats

    Neusa Margarida Paulo


    Full Text Available OBJETIVO: Comparar o implante de membrana de látex da seringueira sem e com polilisina 0,1% e tela de marlex na reparação de defeitos abdominais iatrogênicos em ratos. MÉTODOS: Ressectou-se em bloco um segmento circular de aproximadamente três centímetros de diâmetro da parede muscular abdominal ventral de 31 ratos Wistar, preservando-se a pele. Os animais foram divididos em 3 grupos: grupo látex sem polilisina, grupo látex com polilisina 0,1% e grupo marlex. Os animais foram sacrificados aos cinco e aos 120 dias após o procedimento cirúrgico. Fragmentos da parede abdominal foram coletados e submetidos à avaliação histopatológica. RESULTADOS: As principais alterações observadas nos grupos tratados com as membranas de látex sem e com polilisina 0,1% foram deiscência (21 animais e evisceração (dois animais. A eliminação dos implantes nos grupos tratados com látex ocorreu, em média, aos 13,8 dias. Nestes animais ocorreu a formação de tecido conjuntivo fibroso, similar ao observado no grupo que recebeu o marlex. Outras alterações notadas foram aderências viscero-parietais em todos os grupos avaliados. CONCLUSÃO: A membrana de látex da seringueira com e sem polilisina a 0,1%, quando utilizada para reconstrução de defeitos abdominais em ratos é eliminada, em média, aos 13,8 dias após a sua implantação, deixando uma base fibrosa de reparação, similar à observada após a implantação da tela de marlex.PURPOSE: To compare seringueira latex membrane implant, with and without polilysine at 0.1% and marlex mesh on the repair of iatrogenic abdominal defects in rats. METHODS: A circular segment block of approximate three centimeters of diameter was sectioned out of the ventral adominal muscle wall of 31 Wistar rats. The skin was preserved. The animals were divided into three experimental groups: only latex, latex and polilysine at 0.1%, and marlex mesh. Some rats underwent eutranasia at five and some at 120 days

  9. Tensile strength study of the abdominal wall following laparotomy synthesis using three types of surgical wires in Wistar rats Estudo da resistência tênsil da parede abdominal após síntese de laparotomia usando três tipos de fios cirúrgicos em ratos Wistar

    Lucas Félix Rossi


    Full Text Available PURPOSE: To study the tensile strength of the abdominal wall following laparotomy synthesis utilizing three types of surgical wires. METHODS: Thirty Wistar rats were randomized into three groups of ten rats each. Each group underwent a 3cm-laparotomy which was closed with 3-0 polyglactin 910, polyglecrapone and catgut wires. After 63 days, euthanasia was performed and part of the abdominal wall was removed with which a strip was produced measuring 2.0 cm in length by 6.0 cm in width comprising the abdominal muscles with the implanted mesh. The sample was fixed in a mechanical test machine in which constant force was applied contrary to the tissue strips. Maximum force was considered, expressed in Newton, until full rupture of the tissue occurred. The non-parametrical Kruskal - Wallis test was used for the statistical analysis, admitting pOBJETIVO: Estudar a resistência tênsil da parede abdominal após síntese de laparotomia utilizando três tipos de fios cirúrgicos. MÉTODOS: Trinta ratos da linhagem Wistar randomizados em três grupos de dez exemplares cada um. Em cada grupo fez-se uma laparotomia de dois centímetros que foi fechada com fios 3-0 de poliglactina 910, poliglecaprone e categute. Após 63 dias, foi feita a eutanásia e retirou-se uma área da parede abdominal com a qual fez-se uma tira medindo 2,0 cm de comprimento por 6,0 cm de largura englobando os músculos abdominais com a tela implantada. A amostra foi fixada em máquina de ensaios mecânicos na qual se aplicou força constante contrária às tiras de tecido. Foi considerada a força máxima expressa em Newton até ocorrer a ruptura total da amostra. Para a análise estatística, utilizou-se teste não paramétrico de Kruskal - Wallis admitindo-se p<0,05. RESULTADOS: A média de resistência do grupo categute foi ligeiramente menor (33.50 N ao da poliglactina (34.23 N, sendo essa diferença não estatisticamente significativa (p=0,733. O grupo poliglecaprone foi o que

  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


    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. Retrospective analysis of a VACM (vacuum-assisted closure and mesh-mediated fascial traction treatment manual for temporary abdominal wall closure – results of 58 consecutive patients

    Beltzer, Christian


    Full Text Available Introduction: The optimal treatment concept for temporary abdominal closure (TAC in critically ill visceral surgery patients with open abdomen (OA continues to be unclear. The VACM (vacuum-assisted closure and mesh-mediated fascial traction therapy seems to permit higher delayed primary fascial closure rates (FCR than other TAC procedures. Material and methods: Patients of our clinic (n=58 who were treated by application of a VAC/VACM treatment manual in the period from 2005 to 2008 were retrospectively analysed. Results: The overall FCR of all patients was 48.3% (95% confidence interval: 34.95–61.78. An FCR of 61.3% was achieved in patients who had a vicryl mesh implanted at the fascial level (VACM therapy in the course of treatment. Mortality among patients treated with VACM therapy was 45.2% (95% CI: 27.32–63.97.Conclusions: The results of our own study confirm the results of previous studies which showed an acceptable FCR among non-trauma patients who were treated with VACM therapy. VACM therapy currently appears to be the treatment regime of choice for patients with OA requiring TAC.

  12. Abdominal aspergillosis: CT findings

    Yeom, Suk Keu, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Hye Jin, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Byun, Jae Ho, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Ah Young, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Lee, Moon-Gyu, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Ha, Hyun Kwon, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of)


    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  13. 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


    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

  14. 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



    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.

  15. Uso del Fingerprinting de ADN para asignar paternidad en un rebaño con casos de malformación congénita de la pared abdominal Application of DNA Fingerprinting to determine paternity in cattle with large congenital abdominal wall defect progeny

    N. GORLA


    Full Text Available Se evaluó la efectividad del fingerprinting de ADN para determinarla paternidad en un rebaño bovino con casos de malformacióncongénita de la pared abdominal. La técnica elegida fue elfingerprinting multilocus con la sonda (CAC5. Las muestrasde ADN fueron obtenidas de sangre periférica por los métodoshabituales, digeridas con la enzima de restricción Hae III, transferidasa membranas de nylon e hibridadas. Se analizaron en forma visual los patronesde banda obtenidos y los datos fueron procesados por el programa "PATER".A pesar de la alta consanguinidad de las razas estudiadas, la probabilidadde paternidad (W obtenida fue en un caso W = 0.80 y en el otro W = 0.93,lo que demostró la efectividad de la sonda (CAC5 paradeterminar la paternidad de un mismo toro sobre los dos terneros afectadosThe efficiency of DNA fingerprinting to solve a paternity dispute wasevaluated in four Hereford bulls of a Cebú/Hereford cattle herdwith two calves affected by a congenital abdominal wall malformation. Thetest was carried out using multi-locus probe (CAC5. 8 DNA samples ?twofrom the affected calves, two from their corresponding mothers and 4 frombulls (supposed sires? were processed. These samples were digested withrestriction enzyme Hae III, blotted onto nylon membranes and hybridisedwith (CAC5. The bands obtained were visually analysed and data was processedby the computer program "PATER" (with the "PATER" computer program. Theprobability of paternity (W was W = 0.80 in one case and W = 0.93 in theother. Despite the known inbreeding of the bovine breed tested, it waspossible to ascertain the paternity with multilocus DNA fingerprinting(CAC5

  16. Traumatic abdominal hernia complicated by necrotizing fasciitis.

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


    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.

  17. Abdominal actinomycosis mimicking acute appendicitis.

    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis


    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.

  18. 腹壁造口病人出院后造口管理模式的研究现状%Research status quo of post discharge stoma management model for patients with abdominal wall stoma

    周花仙; 瞿春华; 瞿海红


    It expounded the survival status quo of patients with abdominal wall stoma after discharge,intro-duced stoma management model from the four aspects of status quo stoma care,continuity of care,team cooper-ation and information application.It put forward that hospital community family integration management model could provide continuous,systematic and standardized nursing services for stoma patients and make them back to society as soon as possible.%阐述了腹壁造口病人出院后的生存现状,从造口护理现状、延续护理、团队合作、信息化应用4方面介绍了造口的管理模式,提出医院—社区—家庭一体化管理模式可为造口病人提供连续、系统、规范的护理服务,使造口病人尽早回归社会。

  19. Efeito da suplementação oral de l-glutamina na parede colônica de ratos submetidos à irradiação abdominal Effect of oral supplement of l-glutamine in colonic wall of rats subjected to abdominal irradiation

    Cristina Fajardo Diestel


    Full Text Available OBJETIVO: Avaliar as alterações estruturais na parede do cólon irradiado, em ratos, verificando se a suplementação de L-glutamina pode prevení-las. MÉTODOS: Foram empregados 30 ratos Wistar, machos, adultos, divididos em três grupos: I - controle, II- irradiado e III - irradiado, com suplementação de L-glutamina durante os 14 dias do estudo. O Grupo Controle foi mantido em condições-padrão de laboratório, enquanto os grupos II e III foram submetidos à irradiação abdominal, com dose única de 1000 cGy, no 8°. dia da experimentação. Todos os animais foram operados no 15°. dia, para ressecção de segmento colônico para análise estereológica. RESULTADOS: O grupo II apresentou volume total da parede colônica significativamente menor que o Grupo Controle, sem alterar os volumes parciais de cada camada histológica. No grupo III, houve manutenção do volume total da parede do cólon, próxima ao Grupo Controle, com aumento significativo da camada mucosa, quando comparada aos grupos I e II. Na camada mucosa do grupo III, houve a manutenção do volume parcial do epitélio, comparado ao Grupo Controle, sem melhora significativa da superfície epitelial. CONCLUSÃO: Sugere-se que a suplementação de L-glutamina seja benéfica na parede do cólon irradiado, em ratos.PURPOSE: To evaluate the structural alterations of the irradiated colonic wall in rats, verifying if L-glutamine supplementation is able to prevent them. METHODS: We used 30 male adult Wistar rats, divided into three groups: I - control, II - irradiated, and III - irradiated with L-glutamine supplementation during the 14 days of the study. Control group was maintained in laboratory standard conditions while groups II and three were submitted to abdominal radiation with an only dose of 1000 cGy in the 8th day of experimentation. All the animals were submitted to laparotomy in the 15th day for resection of the colonic segment for stereological analysis. RESULTS: Group

  20. A comparative study of the performance of catgut and polyglecaprone 25 sutures in rat abdominal walls, contaminated or not Estudo comparativo entre o fio de categute e o poliglecaprone 25 em paredes abdominais, contaminadas ou não, de ratos

    Maria de Lourdes Pessole Biondo-Simões


    Full Text Available Forty Wistar-Tecpar rats were used to determine the performance of polyglecaprone 25 sutures in the abdominal wall, contaminated or not. The animals were anesthetized and polyglecaprone 25 was implanted into the ventral abdominal wall on the left side and compared to the use of plain catgut implanted on the right. The subcutaneous tissue of 20 animals was contaminated with a standardized Staphylococcus aureus solution and the remaining 20 animals were not contaminated. The animals were checked on the third and seventh day after implant and the tissue reaction caused by polyglecaprone 25 in the presence or absence of contamination was found to be significantly less intense.Comparou-se as suturas realizadas com poliglecaprone e categute na parede abdominal, contaminada ou não, de ratos. Foram utilizados 40 ratos Wistar Tecpar divididos em dois grupos de 20 designados A e B. Implantavam-se os fios na parede abdominal ventral, com o poliglecaprone à esquerda e o categute à direita. No grupo B inoculava-se na tela subcutânea 1,0ml de solução padronizada de Staphylococcus aureus no trajeto de cada um dos fios. Praticava-se a eutanásia, em 10 animais de cada grupo, no terceiro e no sétimo dia. A parede abdominal ventral, repartida em duas metades, direita e esquerda, era fixada em formalina e encaminhada para estudo histopatológico. O fio de poliglecaprone 25, na presença ou ausência de contaminação da parede abdominal de ratos, apresentou reação tecidual significantemente menos intensa do que o fio de categute, em ratos.

  1. A new understanding of the anatomic structure of posterior abdominal wall in retroperitoneal laparoscopic renal surgery%后腹腔镜下肾脏手术解剖标志的应用研究

    蔡伟; 李宏召; 张旭; 孙圣坤; 董隽; 史立新; 宋勇; 祝强


    目的 复习和再认识后腹腔镜下后腹壁解剖结构的形态和位置关系,建立和确认后腹腔镜下肾脏手术的解剖标志,提高后腹腔镜手术操作水平. 方法 2010年1-8月,对35例后腹腔镜下肾脏手术进入后腹腔和控制肾动脉之前的操作过程进行分步解剖技术研究,记录后腹壁解剖标志的形态和位置毗邻关系,分析验证各解剖标志与肾、肾门和肾动脉的关系. 结果 后腹腔镜下可见后腹壁由膈肌的腰部、腰方肌和腰大肌以及外侧弓状韧带、内侧弓状韧带和膈肌脚构成,这些肌肉和韧带在肾门背侧附近交界移行.内侧弓状韧带横行向脊柱方向指向肾门附近,膈肌脚的弧形部分与肾动脉走行成镜像状态.35例术中均可以观察到这些解剖结构,按此标志定位肾和肾门,35例均可直接到达肾门解剖分离肾动脉和静脉. 结论 后腹壁肌肉和韧带的位置和形态相对固定,在腹腔镜下清晰可见,可以作为后腹腔镜下肾脏手术的解剖标志.参考后腹壁的肌肉和韧带解剖标志定位肾脏,解剖分离肾门和肾动脉是有效的实用操作技术.%Objective To provide reliable technical method by identifying referential anatomic landmarks for retroperitoneal laparoscopic renal surgery,with respect to the renal hilum and renal artery.Methods The regional anatomy of the posterior abdominal wall was studied in 35 cases of retroperitoneal laparoscopic renal surgery from January to August 2010.These included 27 cases of renal cancer,6 cases of renal pelvis cancer and 2 cases of renal tuberculosis.Distended the retroperitoneal space using balloon dilation along with sharp and dull dissection.We recorded the forms and positions of the posterior abdominal cavity's anatomical landmarks and evaluated the relationship between each anatomical landmark with respect to the renal hilum and renal artery.Results The perirenal fascia posterior layer and perinephric fat on the renal


    马绍英; 王旭昇; 董丽; 李幼忱; 周沫; 赵亚平; 李宝兴


    matrix in the reconstruction of abdominal wall defects in rabbits, and to investigate the application feasibility of xeno-transplantation of acellular dermal matrix. Methods The porcine acellular dermal matrix was prepared from a health white pig. Twenty-six Japanese white rabbits (weighing 2.2-2.3 kg, female or male) were randomly assigned to 2 groups: the control group (n=6) and the experimental group (?=20). In the control group, the full-thickness abdominal wall defect of 5.0 cm × 0.5 cm was made, and the defect was sutured directly, in the experimental group, the full-thickness abdominal wall defect of 5.0 cm × 2.5 cm was made, and the defect was repaired with porcine acellular dermal matrix patch at the same size as the defect. At 5 weeks after surgery, the incidence of hernia and the intra-abdominal adhesions were observed and the wound breaking strength was compared between the patch-fascia interface and the fascia-fascia interface. The graft vascularization was evaluated through histological analysis at 6 months after surgery in the experimental group. Results No hernia occurred in all rabbits of 2 groups. At 5 weeks after surgery, healing was observed between patch and the muscularfascia; the vascularization was seen in the porcine acellular dermal matrix patch. There was no significant difference in the adhesion grade (Z= -0.798, P=0.425) between the experimental group (grade 2 in 1 rabbit, grade 1 in 5, and grade 0 in 12) and the control group (grade 1 in 1 and grade 0 in 5). No significant difference was found (t= -0.410, P=0.683) in the breaking strength between the patch-fascia interface in the experimental group [(13.0 ± 5.5) N] and the fascia-fascia interface in control group [(13.6 ± 4.0) N]. In the experimental group, the small vessels and the infiltration of inflammatory cells were observed in the porcine acellular dermal matrix patch after 5 weeks through histological observations. The junctions of the patch-fascia interface healed with fibrous

  3. Abdominal aortic aneurysms

    Lindholt, Jes Sanddal


    Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective....... The acceptance rate was 77%, and 95% accept control scans. Furthermore, persons at the highest risk of having an AAA attend screening more frequently. We found that 97% of the interval cases developed from aortas that initially measured 2.5-2.9 cm - i.e. approx. only 5% attenders need re-screening at 5-year...... methods for measuring the degree of wall calcification must be developed and validated....

  4. 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


    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

  5. A case report of abdominal distention caused by herpes zoster

    Su-Rong Zhou; Chuan-Yu Liu


    Gastrointestinal complications caused by herpes zoster are extremely rare.Here,we described a case of abdominal distention caused by herpes zoster.The patient was a 59-year-old female who suffered from unexplained paroxysmal and a burning pain on the right part of her waist and abdomen,accompanied by abdominal distention.Intestinal pseudo-obstruction was diagnosed by abdominal radiography.Distention of the right abdominal wall was still apparent after one month.In this report,we found that recovery from abdominal distention caused by herpes zoster is difficult and may require surgical intervention.

  6. 彩色多普勒超声产前诊断胎儿前腹壁畸形%Prenatal diagnosis of fetal anterior abdominal wall defects with color Doppler ultrasonography

    赵新美; 吴春燕; 陈雷


    目的 探讨彩色多普勒超声(CDU)在产前诊断胎儿前腹壁畸形(AAWDs)中的价值.方法 回顾性分析21胎经引产或随访证实的胎儿AAWDs声像图特征.结果 21胎AAWDs中,8胎为腹裂,10胎为脐膨出,3胎为体蒂异常.CDU确诊19胎,误诊2胎,诊断准确率90.48%.结论 CDU通过辨认胎儿脐带与AAWDs的关系,能较准确地显示AAWDs的病理特征,在胎儿AAWDs的诊断与鉴别诊断中起重要作用.%Objective To investigate the value of color Doppler ultrasonography (CDU) in diagnosis of prenatal fetal anterior abdominal wall defects (AAWDs).Methods The sonographic features of 21 fetuses with AAWDs confirmed with induced labor or follow-up were analyzed retrospectively.Results There were 21 AAWDs fetuses, included 8 gastroschisis, 10 omphalocele and 3 body stalk anomaly.Nineteen in 21 fetuses were diagnosed with CDU, while 2 were misdiagnosed.The ultrasonographic diagnostic accuracy was 90.48%.Conclusion CDU can identify the relationship between the defects and the umbilical cord, and thus accurately demonstrate the pathologic features of AAWDs, playing an important role in diagnosis and differential diagnosis of AAWDs.

  7. Malignant fibrous histiocytoma of the abdominal wall

    Arif Aslaner; Burhan Mayir; Tuğrul Çakır; Umut Rıza Gündüz; Nurullah Bülbüller


    Malignant fibrous histiocytoma (MFH) or undifferentiated pleomorphic sarcoma is a type of malignt neoplasm that arises from any soft tissue and bone involving extremities, abdomen and retroperitoneum. MFH of the external oblique abdominis muscle is rare. Surgical resection of the mass is the treatment of choice depending on the stage of the disease and the invasion depth of the tumor. Radiotherapy, chemotherapy and immunotherapy are the other treatment methods. We present a case of a 71-year ...

  8. Malignant fibrous histiocytoma of the abdominal wall

    Arif Aslaner


    Full Text Available Malignant fibrous histiocytoma (MFH or undifferentiated pleomorphic sarcoma is a type of malignt neoplasm that arises from any soft tissue and bone involving extremities, abdomen and retroperitoneum. MFH of the external oblique abdominis muscle is rare. Surgical resection of the mass is the treatment of choice depending on the stage of the disease and the invasion depth of the tumor. Radiotherapy, chemotherapy and immunotherapy are the other treatment methods. We present a case of a 71-year old man with the diagnosis of MFH on external oblique muscle which was completely resected. We believe that adjuvant chemoradiotherapy following surgical resection of the tumor was the most appropriate treatment for this disease.

  9. 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


    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.

  10. The comparison of abdominal-wall-lift gasless and convention laparoscopy in myomectomy for gigantic hysteromyoma in posterior wall%无气腹悬吊式腹腔镜与传统气腹腹腔镜对后壁巨大子宫肌瘤剜除术的临床疗效比较

    吴继蓉; 彭晓梅; 陈霞


    目的 探讨无气腹悬吊式腹腔镜在困难子宫肌瘤剜除术中的应用价值.方法 对比分析2009年1月~2011年12月在妇产科同期施行无气腹腹腔镜与气腹腹腔镜后壁巨大子宫肌瘤剜除情况,比较两者手术时间、术中出血量、术后排气时间、住院日、住院费用等情况.结果 两组患者术中无并发症发生,无气腹组手术时间(67.6±24.7)min,术中出血量(80.0±50.1)ml,术后排气时间(1.1±0.5)d,平均住院日(7.2±1.8)d,平均住院费用(6274.5±500.4)元;气腹组手术时间(108.1±25.3)min,术中出血量(184.9±56.3)ml,术后排气时间(2.6±0.4)d,住院日(10.2±2.9)d,住院费用(7510.8±624.7)元.组间比较,差异有显著性(均P<0.05).结论 无气腹悬吊式腹腔镜后壁巨大子宫肌瘤剜除术优于传统气腹腹腔镜,可能会成为子宫肌瘤剜除术的标准术式.%Objective To discuss the value of abdominal lift gasless laparoscopy in g myomectomy for gigantic hysteromyoma in posterior wall. Methods Operation time, blood loss, anus exhaust time, the hospital day,and the cost of hospitalization were compared between 30 cases with gigantic hysteromyoma in the uterus back wall undergone laparoscopy without pneumoperitoneum and 30 cases undergone conventional laparoscopy. Results The general conditions (number and size of myoma) of 2 groups were not significantly different. There were no complications in both group. The average operating time (67. 6±24. 7)min, the amount of bleeding (80. 0±50.1)ml, anus exhaust timed. l±0. 5)d, the hospital day(7. 2±1. 8)d,and the cost of hospitalization(6274. 5±500. 4)RMB of Abdominal-wall-lift gasless laparoscopy group were significantly shorter and cheaper than those of convential laparoscopy group (108. 1±25. 3)min, (184. 9± 56.3)ml, (2.6±0.4)d, (10. 2±2. 9)d, (7510. 8±624. 7)RMB (P<0. 05). Conclusion Gasless laparoscopy exhibits more advantages than conventional laparoscopy in myomectomy for gigantic hysteromyoma

  11. 老年腹壁巨大切口疝修补方式的改进策略%Improvement strategy of the repair mode on huge incisional fernia of abdominal wall in elderly patients

    周小平; 谢清; 何培生; 邹中辉; 李冠华


    ObjectiveTo investigate the effects of tension-free hernioplasty and general strengthen suture in operation. Methods Collected 104 elderly patients with operation in our general surgery department from 2013 June to 2014 April, di-vided into observation group received tension-free hernioplasty strengthening the visceral sac amd control group received gen-eral strengthen suture with 52 cases per subgroup randomly. To compare the clinical effects of two groups.Results The deletion occurrence of hernial sac in control group was higher than that of observation group during and after operation. The operation time, TTE and treatment cost of observation group were better than those of control group. There was not difference of superficial infection in two groups, the hematoma occurrence and abdominal wal stiffness occurrence of observation group were better than those of control group.Conclusion Tension-free hernioplasty strengthening the visceral sac on huge incisional fernia of ab-dominal wall in elderly patients can improve security, reduce complication and operation time and be worthy of application.%目的:集中探讨采用无张力平片修补术较常规加强缝合术在对老年患者腹壁巨大切口疝手术过程中的疗效对比。方法:选取2013年6月~2014年4月因疝气于我院普外科进行手术治疗的老年患者104例,按照随机分配的原则,采用无张力平片加强内脏囊进行修复治疗的52例患者为观察组,另52例采用常规加强缝合治疗的为对照组,比较两组患者的临床效果。结果:将两组患者治疗后疝囊内缺损发生率进行比较,对照组在术后疝囊内1个缺损发生率明显高于观察组患者,并且在疝囊手术中缺损发生的机率明显高于观察组患者,以上差异较大,具有明显的统计学意义;同时,观察组在治疗过程中较对照组术程更短、拔管时间更短、治疗更加经济有效;将两组患者治疗后术后并

  12. Abdominal aortic aneurysms : clinical insights and outcome after endovascular repair

    Zandvoort, H.J.A.


    Abdominal aortic aneurysm (AAA) is a focal dilatation of the abdominal aorta. The pathophysiology of AAA is a complex multifactorial process and much is still unknown. Histologic and biochemical analysis of AAA wall characteristics can contribute to a better insight in AAA pathophysiology. To make t

  13. Lateral abdominal muscle size at rest and during abdominal drawing-in manoeuvre in healthy adolescents.

    Linek, Pawel; Saulicz, Edward; Wolny, Tomasz; Myśliwiec, Andrzej; Kokosz, Mirosław


    Lateral abdominal wall muscles in children and adolescents have not been characterised to date. In the present report, we examined the reliability of the ultrasound measurement and thickness of the oblique external muscle (OE), oblique internal muscle (OI) and transverse abdominal muscle (TrA) at rest and during abdominal drawing-in manoeuvre (ADIM) on both sides of the body in healthy adolescents. We also determined possible differences between boys and girls and defined any factors-such as body mass, height and BMI-that may affect the thickness of the abdominal muscles. B-mode ultrasound was used to assess OE, OI and TrA on both sides of the body in the supine position. Ultrasound measurements at rest and during ADIM were reliable in this age group (ICC3,3 > 0.92). OI was always the thickest and TrA the thinnest muscle on both sides of the body. In this group, an identical pattern of the contribution of the individual muscles to the structure of the lateral abdominal wall (OI > OE > TrA) was observed. At rest and during ADIM, no statistically significant side-to-side differences were demonstrated in either gender. The body mass constitutes between 30% and muscles under examination at rest and during ADIM. The structure of lateral abdominal wall in adolescents is similar to that of adults. During ADIM, the abdominal muscles in adolescents react similarly to those in adults. This study provided extensive information regarding the structure of the lateral abdominal wall in healthy adolescents.

  14. Evaluation of the abdominal wall cicatrization of rabbits exposed to nicotine and undergone abdominoplasty using nylon thread or cyanoacrylate Avaliação da cicatrização da parede abdominal de coelhos expostos à nicotina e submetidos à abdominoplastia, utilizando-se nylon ou cianocrilato

    Luciano Assis Costa


    Full Text Available PURPOSE: To compare the wound healing of the abdominal wall of rabbits exposed to nicotine and submitted to abdominoplasty using 2-octyl cyanoacrylate or nylon thread for the surgery suture. METHODS: Thirty two rabbits were used. They were divided in subgroups: A1, A2, B1 e B2. Group A received saline 0.9%; group B received nicotine, both groups for 14 days before surgery. We performed an abdominoplasty with a nylon suture into the A1 and B1 subgroups; as for A2 and B2 groups the suture was performed with cyanoacrylate. The euthanasia happened in the 14th post-operative day. After, we evaluated: swollen process, fibroblast proliferation, collagen, neovascularization, and macroscope and microscope epithelization of the scars. RESULTS: We observed the presence of eosinophils in all scars exposed to the cyanoacrylate, and a significant increase of neovascularization in the subgroup B2 comparing to the A2 one (p=0.037. The other variables haven't showed any statistical difference. CONCLUSIONS: Nicotine hasn't influenced the swollen process, the fibroblast proliferation, the presence of collagen, neither the epithelialization. The neovascularization showed cicatricial immaturity when comparing group A2 to group B2. The eosinophils in the scars repaired with glue showed that the substance has acted as an allergen.OBJETIVO: Comparar a cicatrização da parede abdominal de coelhos expostos à nicotina e submetidos à abdominoplastia utilizando 2-octil cianoacrilato ou nylon na síntese cirúrgica. MÉTODOS: Utilizou-se 32 coelhos. Estes foram distribuídos em subgrupos: A1, A2, B1 e B2. O grupo A recebeu solução de NaCl 0,9%; o B recebeu nicotina, ambos durante 14 dias do pré-operatório. Nos subgrupos A1 e B1 foi realizada abdominoplastia e sutura com "nylon"; enquanto A2 e B2 a síntese ocorreu com cianoacrilato. A eutanásia ocorreu no 14º dia do pós-operatório. Na pesquisa avaliou-se: processo inflamatório, proliferação fibroblástica, col

  15. Abdominal radiation - discharge

    Radiation - abdomen - discharge; Cancer - abdominal radiation; Lymphoma - abdominal radiation ... When you have radiation treatment for cancer, your body goes through changes. About 2 weeks after radiation treatment starts, you might notice changes ...

  16. Abdominal aortic aneurysm

    ... this page: // Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  17. Abdominal and Pelvic CT

    Full Text Available ... accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives. ... kidney and bladder stones. abdominal aortic aneurysms (AAA), injuries to abdominal organs such as the spleen, liver, ...

  18. [Inflammatory aneurysms of the abdominal aorta].

    Tovar Martín, E; Acea Nebril, B


    Approximately 10 per cent of abdominal aneurysms have an excessively thick wall that sometimes involve duodenum, cava or colon by an inflammatory process. Between February 1986 and December 1992, 147 patients with abdominal aortic aneurysm (AAA) were treated surgically and in 13 (8.8%) the aneurysms were found to be inflammatory. Their mean age was 67.3 years (70.1 years in non inflammatory group) and all were symptomatics initially (abdominal pain in 53%, rupture in 23%, mass in 15%). The operative mortality for elective resection was 37% in patients with inflammatory abdominal aortic aneurysms (IAAA) decreasing to 9% in the AAA group without inflammatory involvement. We conclude that surgery is indicated in these patients to prevent rupture and to hasten the subsidense of inflammatory process ever with postoperative morbi-mortality increased.

  19. [Pathogenetic aspects of intra-abdominal hypertension in patients with abdominal sepsis].

    Veliev, N A; Gasanova, D N


    The authors had offered the original estimated system with the points calculation, basing on analysis of the examination and treatment results in 150 patients, suffering abdominal sepsis. The system, alike others, includes not only determination of the inflammation factors and indices of endotoxicosis, but as well as those, concerning intraabdominal pressure, the anterior abdominal wall rigidity and the tissues elasticity. Among the important indices, needed to determine, were considered those, which categorize the syndrome of intraabdominal, intrathoracic and microregional hypertension as well as the mechanisms of endotoxicosis pathogenesis. The authors recommend to use the indices of pathological consequences of this two factors while doing assessment of the abdominal sepsis severity.

  20. Post trauma abdominal cocoon.

    Kaur, Supreet; Doley, Rudra Prasad; Chabbhra, Mohinish; Kapoor, Rajeev; Wig, Jaidev


    Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  1. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu


    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  2. Abdominal wound closure: current perspectives

    Williams ZF


    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 

  3. Advancements in identifying biomechanical determinants for abdominal aortic aneurysm rupture.

    Kontopodis, Nikolaos; Metaxa, Eleni; Papaharilaou, Yannis; Tavlas, Emmanouil; Tsetis, Dimitrios; Ioannou, Christos


    Abdominal aortic aneurysms are a common health problem and currently the need for surgical intervention is determined based on maximum diameter and growth rate criteria. Since these universal variables often fail to predict accurately every abdominal aortic aneurysms evolution, there is a considerable effort in the literature for other markers to be identified towards individualized rupture risk estimations and growth rate predictions. To this effort, biomechanical tools have been extensively used since abdominal aortic aneurysm rupture is in fact a material failure of the diseased arterial wall to compensate the stress acting on it. The peak wall stress, the role of the unique geometry of every individual abdominal aortic aneurysm as well as the mechanical properties and the local strength of the degenerated aneurysmal wall, all confer to rupture risk. In this review article, the assessment of these variables through mechanical testing, advanced imaging and computational modeling is reviewed and the clinical perspective is discussed.

  4. Management of abdominal wall defects (gastroschisis and omphalocele at Hospital Universitario San Vicente de Paúl, in Medellín, Colombia, 1998-2006 Tratamiento de los defectos de la pared abdominal (gastrosquisis y onfalocele en el Hospital Universitario San Vicente de Paúl, Medellín, 1998-2006

    Mirian Natalia Herrera Toro


    Full Text Available

    Introduction: Gastroschisis and omphalocele are neonatal malformations of the abdominal wall. Despite their great differences, both are severe diseases characterized by herniation of viscera through the defect in the abdominal wall. Children with these defects present as surgical emergencies that pose a difficult challenge to the attending surgeon. Even with appropriate management, the mortality rate is between 20-40%. Omphalocele and, to a lesser degree gastroschisis, are associated with a wide range of malformations.

    Objective: The aim of this retrospective review was to describe the management of children with gastroschisis or omphalocele, and the results obtained with it, at the

    Pediatric Surgery Section, Hospital Universitario San Vicente de Paúl, in Medellin, Colombia.

    Abdominal epilepsy in chronic recurrent abdominal pain

    V Y Kshirsagar


    Full Text Available Background: Abdominal epilepsy (AE is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG abnormalities and favorable response to the introduction of anti-epileptic drugs (AED. We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74% children with an abnormal EEG and 39 (26% children with normal EEG. All children were subjected to AED (Oxcarbazepine and 139 (92% children responded to AED out of which 111 (74% children had an abnormal EEG and 27 (18% had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74% of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56% were females and 36 (32.43% were male, majority of children were in the age of group of 9

  5. Abdominal Decompression in Children

    J. Chiaka Ejike


    Full Text Available Abdominal compartment syndrome (ACS increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH by intra-abdominal pressure (IAP monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children.

  6. Abdominal Compartment Syndrome

    Ovchinnikov V.А.; Sokolov V.А.


    We considered one of the most complicated problems of surgery and intensive care — abdominal compartment syndrome. It is a severe, and in some cases lethal complication developing in major injuries and pathology of abdominal cavity and retroperitoneal space, as well as in extra-abdominal pathology. In addition, compartment syndrome can be the complication of a number of surgical procedures accompanied primarily by laparotomy wound closure with tissue tension. We demonstrated the classificatio...

  7. Abdominal Compartment Syndrome

    Pınar Zeyneloğlu


    Full Text Available Intraabdominal hypertension and Abdominal compartment syndrome are causes of morbidity and mortality in critical care patients. Timely diagnosis and treatment may improve organ functions. Intra-abdominal pressure monitoring is vital during evaluation of the patients and in the management algorithms. The incidence, definition and risk factors, clinical presentation, diagnosis and management of intraabdominal hypertension and Abdominal compartment syndrome were reviewed here.

  8. Post trauma abdominal cocoon

    Supreet Kaur


    Full Text Available Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  9. Pathways of peritoneal tumour recurrence after abdominal surgical trauma

    M.E.E. van Rossen (Marie Elma)


    textabstractThe peritoneum is the largest and the most complex arranged serous membrane in the body that lines both the intra-abdominal wall and the viscera contained within the peritoneal cavity. It is capable of walling off infections and has several functions such as the ability to synthesise, se

  10. Transverse abdominal plane neurostimulation for chronic abdominal pain: a novel technique.

    Gupta, Mayank; Goodson, Robert


    Management of chronic abdominal pain can be challenging. Sometimes patients fail to get adequate response from multiple medications and nerve blocks. We present a patient case report of chronic abdominal pain with a history of multiple surgeries managed successfully by neuromodulation of the transverse abdominis plane (TAP). The TAP block is a procedure in which local anesthetic is injected into the abdominal fascial plane that carries sensory nerves to the abdominal wall in order to block pain sensation. It has been shown to reduce postoperative pain and analgesic dependence after abdominal and gynecological surgeries. A 60-year-old woman presented to us for chronic abdominal pain for which medications provided little relief. She had an extensive history of abdominal surgeries and was also treated for lower back pain with surgery and less invasive procedures in the past. Under our care, she underwent 2 TAP blocks with almost complete resolution of her abdominal pain. Her pain, however, came back within a few of weeks of the procedures. Since our patient found pain relief from the TAP blocks, we proceeded with neurostimulation of the TAP for long-term pain relief. We placed a dorsal column stimulator 16 contact lead for lower back and leg pain and 8 contact leads placed in the TAP under ultrasound guidance. She has had multiple follow-ups since her TAP lead placement procedure with continued and near complete resolution of her abdominal pain. The TAP lead stimulation was helping her abdominal pain and the dorsal column lead stimulation was helping her back and leg pain.

  11. Comparative Study of Acellular Small Intestinal Submucosa and Acellular Pericardium for Repairing Abdominal Wall Defects in Rats%脱细胞小肠黏膜下层与脱细胞心包修复大鼠腹壁缺损的对比研究

    肖毅频; 王冠宇; 王强; 张剑


    Objective: To investigate the effects of small intestinal submucosa (SIS)and acellular pericardium (PC)on repairing wall defeats in rats, to compare compatibility of the two biological materials. Methods: A full-thickness 3cm × 2cm abdominal wall defeat was created in 40 rats weight from 200 to 250g, then they were repaired with an interpositional implant( SIS,n=20; PC,n=20). And the rats were harvested at week 1, week 2, week 4,and week 8 after operation. Animal general state of health, intra-abdominal adhesions and tensile strength were investigated. Results:All rats survived and the defeats were completely repaired by the materials without fistula or hernia. There were leas adhesion in SIS group than that in PC group 4、8 weeks after operation, the tensile strength of abdominal wall in SIS group is stronger than that in PC group (p <0.05). No obvious immunoreaction was observed in two groups by histology.Remodeling and regeneration and vascularization of the abdominal wall were better in SIS group compared with PC group. There was not difference of inflammatory reaction of the two groups. Conlusion:Both SIS and PC were feasible to repair full-thickness abdominal wall defeat and SIS is superior to PC in regards to tissue compatibility.%目的:观察小肠黏膜下层(small intestinal submucosa,SIS)和脱细胞心包(pericardium,PC)修复大鼠腹壁缺损的效果,比较两种生物材料相容性.方法:SD大鼠40只,体重200~250g,手术造成3cmx2cm全层腹壁缺损,随机分为二组(n=20),分别采用相同面积的小肠黏膜下层(small intestinal submucosa,SIS)和脱细胞真皮基质(acellular dermal matr,ADM)补片进行修补.术后1、2、4和8周分批取出腹壁修复材料,行动物一般情况观察、腹腔内粘连情况评价、力学强度测定及组织学观察.结果:术后动物都成活,两种材料术后8周均无疝瘘发生,缺损得到完整修复.术后各期SIS组的腹腔粘连评分明显低于PC组.术后4、8周,SIS组

  12. Abdominal neurenteric cyst

    Radoje (C)olovi(c); MarJan Micev; Miodrag Jovanovi(c); Slavko Mati(c); Nikica Grubor; Henry Dushan E Atkinson


    Neurenteric cysts are extremely rare congenital anomalies, often presenting in the first 5 years of life, and are caused by an incomplete separation of the notochord from the foregut during the third week of embryogenesis. They are frequently accompanied with spinal or gastrointestinal abnormalities, but the latter may be absent in adults. Although usually located in the thorax, neurenteric cysts may be found along the entire spine. We present a 24-year-old woman admitted for epigastric pain, nausea, vomiting, low grade fever and leucocytosis. She underwent cystgastrostomy for a loculated cyst of the distal pancreas at the age of 4 years, which recurred when she was at the age of 11 years. Ultrasound and computer tomograghy (CT) scan revealed a 16cm×15cm cystic mass in the body and tail of pancreas, with a 6-7 mm thickened wall. Laboratory data and chest X-ray were normal and spinal radiographs did not show any structural abnormalities. The patient underwent a complete cyst excision, and after an uneventful recovery, remained symptom-free without recurrence during the 5-year follow-up. The cyst was found to contain 1200mL of pale viscous fluid. It was covered by a primitive singlelayered cuboidal epithelium, along with specialized antral glandular parenchyma and hypoplastic primitive gastric mucosa. Focal glandular groups resembling those of the body of the stomach were also seen. In addition, ciliary respiratory epithelium, foci of squamous metaplasia and mucinous glands were present. The wall of the cyst contained a muscular layer, neuroglial tissue with plexogenic nerve fascicles, Paccini corpuscle-like structures, hyperplastic neuroganglionar elements and occasional psammomatous bodies, as well as fibroblast-like areas of surrounding stroma. Cartilagenous tissue was not found in any part of the cyst. Immunohistochemistry confirmed the presence of neurogenic elements marked by S-100, GFAP, NF and NSE. The gastric epithelium showed mostly CK7 and EMA

  13. Recurrent Abdominal Pain

    Banez, Gerard A.; Gallagher, Heather M.


    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

  14. [Abdominal pregnancy, institutional experience].

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q


    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy.

  15. Gastrointestinal causes of abdominal pain.

    Marsicano, Elizabeth; Vuong, Giao Michael; Prather, Charlene M


    Gastrointestinal causes of abdominal pain are numerous. These causes are reviewed in brief here, divided into 2 categories: acute abdominal pain and chronic abdominal pain. They are further subcategorized by location of pain as it pertains to the abdomen.

  16. Functional Abdominal Pain in Children

    ... functional abdominal pain. Functional abdominal pain can be intermittent (recurrent abdominal pain or RAP) or continuous. Although ... tests are needed or whether a trial of diet changes, stress management or medication may be started. ...

  17. Evaluation of healing prosthetic materials polyester mesh resorbable film and collagen elastin matrix /polypropylene used in rabbits abdominal wall defects Avaliação da cicatrização da tela de poliéster com lâmina absorvível e a tela de colágeno-elastina/polipropileno utilizadas no reparo de lesões da parede abdominal de coelhos

    Danielle Duck Schulz


    Full Text Available PURPOSE: To compare polyester with absorbable layer prosthesis with collagen-elastin/polypropylene prosthesis in the repair of abdominal wall defects. METHODS: The 16 studied rabbits were divided in groups A and B (euthanized on the 30th and 60th days, after the implant of the mesh. The animals underwent laparotomy and received a 2cm wall "defect" on each side of the Alba linea. The repair was made with the suture of a polyester mesh with absorbable film on the left side of the Alba Linea and with collagen-elastin/polypropylene mesh on the right side. Adherences were classified according to Nair Score and microscopic evaluation observing types I and III collagen formation and other immunohistochemical analyses. RESULTS: There were no significant differences in adhesion formation. The collagen type I showed higher deposition in polyester with absorbable layer. In group B, the difference between the meshes was significant, with higher collagen III deposition in polyester with absorbable layer (60º P.O.. About the metalloproteinases, the presence of MMP -1 and MMP-8 were about the same; the expression of MMP-13 increased near to the 60th day. CONCLUSIONS: There is no significant difference between the two meshes in adhesion formation and immunohystochemical evaluation. The polyester mesh resorbable film presented a higher deposition of collagen.OBJETIVO: Comparar a tela poliéster com lâmina absorvível e a confeccionada pela aposição da tela de colágeno-elastina/polipropileno no reparo de lesões da parede abdominal. MÉTODOS: Foram avaliados 16 coelhos, divididos aleatoriamente em dois grupos e submetidos a eutanásia no 30º e no 60º dia P.O. Os animais foram submetidos à laparotomia e confecção de dois defeitos triangulares de 2 cm, de espessura total, na parede abdominal ventral. A correção foi realizada através de fixação, na metade esquerda da linha alba, da tela de poliéster com lâmina absorvível e na direita, tela composta

  18. Comparative study of the healing process of the aponeurosis of the anterior abdominal wall of rats after wound closure using 3-0 nylon suture and N-butil-2-cyanoacrylate tissue adhesive Estudo comparativo da cicatrização da aponeurose da parede abdominal anterior com a utilização do fio de poliamida monofilamentar 3-0 e o adesivo N-Butil-2-Cianoacrilato em ratos

    Carlos Augusto Marques Batista


    Full Text Available PURPOSE: To investigate the healing process of the aponeurosis of the anterior abdominal wall of rats, comparing two different materials for wound closure: 3-0 nylon suture and tissue adhesive N-butyl-2-cyanoacrylate. METHODS: Forty-four Wistar rats were randomly divided into four groups according to the type of material used (suture or adhesive and the number of days until reoperation (seven or 14 days. After a 4 cm incision in the aponeurosis, 22 rats underwent wound closure using 3-0 nylon suture and the other 22, the tissue adhesive. After seven days, 11 rats from each group were weighed again, submitted to reoperation and then euthanized. The same procedure was carried out after 14 days with the remaining rats. The surgical wound was macroscopically examined, the tensile strength was measured and the tissue edges were histologically examined. The statistical analysis was performed using analysis of variance and Cox's proportional hazards model. Significance level was set at p OBJETIVO: Investigar o processo de cicatrização da aponeurose da parede abdominal anterior em ratos, comparando dois diferentes materiais de sutura: fio de poliamida monofilamentar 3-0 e adesivo N-butil-2-cianoacrilato. MÉTODOS: Quarenta e quatro ratos Wistar, foram divididos aleatoriamente em quatro grupos, de acordo com o material de síntese (fio e adesivo cirúrgico e o tempo de reoperação (7 e 14 dias. Após uma incisão de 4 cm na aponeurose, 22 animais foram submetidos à síntese com o fio de poliamida e os outros 22 animais com o adesivo proposto. Após o procedimento, aguardou-se um período de 7 e 14 dias, quando os animais, 11 de cada grupo, foram novamente pesados e submetidos à eutanásia, sendo realizada a avaliação macroscópica da ferida operatória, mensuração da força de ruptura da parede abdominal e estudo histológico das bordas da incisão. A análise estatística foi realizada através de um modelo de análise de variância e de riscos

  19. [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


    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.

  1. Abdominal tuberculosis: Imaging features

    Pereira, Jose M. [Department of Radiology, Hospital de S. Joao, Porto (Portugal)]. E-mail:; Madureira, Antonio J. [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Vieira, Alberto [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Ramos, Isabel [Department of Radiology, Hospital de S. Joao, Porto (Portugal)


    Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:1.To review the relevant pathophysiology of abdominal tuberculosis. 2.Illustrate CT findings that can help in the diagnosis.

  2. Abdominal and Pelvic CT

    Full Text Available ... is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. ... GI) contrast exams and ultrasound are preferred for evaluation of acute abdominal conditions in babies, such as ...

  3. [The abdominal catastrophe].

    Seiler, Christian A


    Patients with an abdominal catastrophe are in urgent need of early, interdisciplinary medical help. The treatment plan should be based on medical priorities and clear leadership. First priority should be given to achieve optimal oxygenation of blood and stabilization of circulation during all treatment-phases. The sicker the patient, the less invasive the (surgical) treatment should to be, which means "damage control only". This short article describes 7 important, pragmatic rules that will help to increase the survival of a patient with an abdominal catastrophe. Preexisting morbidity and risk factors must be included in the overall risk-evaluation for every therapeutic intervention. The challenge in patients with an abdominal catastrophe is to carefully balance the therapeutic stress and the existing resistance of the individual patient. The best way to avoid abdominal disaster, however, is its prevention.

  4. Abdominal ultrasound (image)

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  5. Abdominal x-ray

    ... are, or may be, pregnant. Alternative Names Abdominal film; X-ray - abdomen; Flat plate; KUB x-ray ... Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also ...

  6. New composite patches and biologic patches for repair of contaminated abdominal wall defect in dogs: A comparative study%污染环境下新型复合补片和生物补片修补犬腹壁缺损的比较研究

    郑亚杰; 田文; 丁国飞; 姚京; 马冰


    Objective To compare the characteristics of two compound patches made of collagen and polypropylene(PP) and the feasibility of their application in repair of contaminated wounds. Methods Twenty-four adult male dogs, weighing 16-20kg, were included in this study. A dog model with 3 contaminated defects at the upper, left and right abdominal wall was established. The 3 abdominal wall defects were repaired by implanting 3 kinds of patches into them. The patches were divided into PP and collagen compound patch group(group A), porcine cross-linked biologic patch group(group B), and cattle cross-linked biologic patch group(group C). A dog abdominal hernia model was established. A segment of small intestine was removed, into which 10ml 0.9% sodium chloride solution was injected and then aspirated to contaminate the abdominal cavity, abdominal wall and patches. The abdominal wall defects were closed with 5cm × 5cm patches. The dogs were killed on day 90 after operation to observe the adhesion of organs in abdominal cavity. The patches and their adjacent tissue were cut into sections for histological study. Results No death occurred while patch and omentum adhesion was observed in different groups 90 days after operation. Histological study showed that the scores of proliferating fibroblasts, inflammatory reaction and formation of new blood vessels were higher in group A than in groups B and C. Conclusion The effect of PP and collagen compound patch and biological patch is similar in preventing adhesion under contaminated environment. However, it leads to severer proliferation of fibroblasts, inflammatory reaction and formation of new blood vessels than biologic patch.%目的 比较胶原蛋白与聚丙烯(polypropylene,PP) 制作的复合补片和两种生物补片的特点及其应用于污染伤口一期修补的可行性.方法 成年雄性普通犬24 只,体质量16-20kg,在同一只动物上、左、右腹部建立三个污染缺损模型,将3 种补

  7. Previous Multiple Abdominal Surgeries: A Valid Contraindication to Abdominal Free Flap Breast Reconstruction?

    Di Candia, Michele; Asfoor, Ahmed Al; Jessop, Zita M.; Kumiponjera, Devor; Hsieh, Frank; Malata, Charles M.


    Presented in part at the following Academic Meetings: 57th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery, September 24-27, 2008, Naples, Italy.45th Congress of the European Society for Surgical Research (ESSR), June 9-12, 2010, Geneva, Switzerland.British Association of Plastic Reconstructive and Aesthetic Surgeons Summer Scientific Meeting, June 30-July 2, 2010, Sheffield Hallam University, Sheffield, UK. Background: Patients with previous multiple abdominal surgeries are often denied abdominal free flap breast reconstruction because of concerns about flap viability and abdominal wall integrity. We therefore studied their flap and donor site outcomes and compared them to patients with no previous abdominal surgery to find out whether this is a valid contraindication to the use of abdominal tissue. Patients and Methods: Twenty patients with multiple previous abdominal operations who underwent abdominal free flap breast reconstruction by a single surgeon (C.M.M., 2000-2009) were identified and retrospectively compared with a cohort of similar patients without previous abdominal surgery (sequential allocation control group, n = 20). Results: The index and control groups were comparable in age, body mass index, comorbidities, previous chemotherapy, and RT exposure. The index patients had a mean age of 54 years (r, 42-63) and an average body mass index of 27.5 kg/m2 (r, 22-38). The main previous surgeries were Caesarean sections (19), hysterectomies (8), and cholecystectomies (6). They underwent immediate (n = 9) or delayed (n = 11) reconstructions either unilaterally (n = 18) or bilaterally (n = 2) and comprising 9 muscle-sparing free transverse rectus abdominis muscle and 13 deep inferior epigastric perforator flaps. All flaps were successful, and there were no significant differences in flap and donor site outcomes between the 2 groups after an average follow up of 26 months (r, 10-36). Conclusion: Multiple previous abdominal

  8. Abdominal emergencies in pediatrics.

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E


    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  9. Abdominal paracentesis and thoracocentesis.

    Lee, Ser Yee; Pormento, James G; Koong, Heng Nung


    Abdominal paracentesis and thoracocentesis are common bedside procedures with diagnostic, therapeutic and palliative roles. We describe a useful and familiar a useful and familiar technique with the use of a multiple lumen catheter commonly used for central venous line insertion for drainage of ascites or moderate to large pleural effusions. The use of a multiple lumen catheter allows easier and more rapid aspiration of fluid with a smaller probability of the side holes being blocked as compared to the standard needle or single catheter methods. This is particularly useful in situations where the dedicated commercial kits for thoracocentesis and abdominal paracentesis are not readily available.

  10. Mouse bladder wall injection.

    Fu, Chi-Ling; Apelo, Charity A; Torres, Baldemar; Thai, Kim H; Hsieh, Michael H


    Mouse bladder wall injection is a useful technique to orthotopically study bladder phenomena, including stem cell, smooth muscle, and cancer biology. Before starting injections, the surgical area must be cleaned with soap and water and antiseptic solution. Surgical equipment must be sterilized before use and between each animal. Each mouse is placed under inhaled isoflurane anesthesia (2-5% for induction, 1-3% for maintenance) and its bladder exposed by making a midline abdominal incision with scissors. If the bladder is full, it is partially decompressed by gentle squeezing between two fingers. The cell suspension of interest is intramurally injected into the wall of the bladder dome using a 29 or 30 gauge needle and 1 cc or smaller syringe. The wound is then closed using wound clips and the mouse allowed to recover on a warming pad. Bladder wall injection is a delicate microsurgical technique that can be mastered with practice.

  11. 86例剖宫产术后腹壁子宫内膜异位症病灶分布的临床分析%The Distribution Characteristic of Abdominal Wall Endometriosis Lesions after Cesarean Section:a Clinical Analysis of 86 Cases

    张坤; 邱伍英; 韩劲松; 王一婷


    Objective To analyze the distribution characteristic of abdominal wall endometriosis after cesarean section , and discuss the precautionary measure . Methods The clinical data of 86 cases admitted to our hospital for surgery due to abdominal wall endometriosis after cesarean section between February 2002 and August 2011 were collected and analyzed .The patients received combined spinal-epidural anesthesia or general anesthesia .The surrounding tissue away from the lesion by 0.5 to 1 cm was incised layer by layer, until the lesion was removed completely .The wounds were douched with normal saline when no lesions remained .The fascia and subcutaneous adipose layer were closed by interrupted sutures with absorbable thread , and the skin by intradermal sutures . Results All cases with 94 lesions(13 cases had more than one lesion ) underwent local lesion resection; 91.5% (86/94) of the lesions were located on both sides of the incisions and 8.5%(8/94) in the middle.In 44 cases (51.2%, 44/86), the fat and fascia of abdominal wall were mainly involved; in 14 cases (16.3%, 14/86), fascia and muscular were involved.All lesions were pathologically confirmed.A total of 61 patients were followed up for 2 to 118 months, and the recurrence rate was 11.45% (7/61), without malignant transformation in all cases . Conclusions Most of the abdominal wall endometriosis lesions after cesarean section are located on both sides of the incisions ,with fat, fascia and muscular being involved .It is recommended to protect the incision intraoperatively and thoroughly wash the incision .%目的:探讨剖宫产术后腹壁子宫内膜异位症( abdominal wall endometriosis , AWE)的病灶特点,探讨相应的防范措施。方法2002年2月~2011年8月对86例剖宫产术后AWE,在腰硬联合麻醉或全身麻醉下在病灶外0.5~1 cm逐层切开病灶周围组织,至病灶及其周边组织完全切除,探查无其他病灶存留,生理盐水冲洗手术创面,可

  12. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial.

    McDonnell, John G


    The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial.

  13. Therapeutic Prospect of Adipose-Derived Stromal Cells for the Treatment of Abdominal Aortic Aneurysm

    Parvizi, Mojtaba; Harmsen, Martin C.


    Aneurysm refers to the dilation of the vessel wall for more than 50%. Abdominal aortic aneurysm (AAA) refers to the dilation and weakening of all three layers of the abdominal aorta, which mostly occur infrarenally. The population aged above 50 years is at risk of AAA development, while a familiar h

  14. Reproducibility of ECG-gated Ultrasound Diameter Assessment of Small Abdominal Aortic Aneurysms

    Bredahl, K; Eldrup, N; Meyer, C


    No standardised ultrasound procedure to obtain reliable growth estimates for abdominal aortic aneurysms (AAA) is currently available. We investigated the feasibility and reproducibility of a novel approach controlling for a combination of vessel wall delineation and cardiac cycle variation....

  15. Avaliação da atividade mioelétrica do trato gastrointestinal em cães: avaliação de um sistema de fixação de eletrodos na parede abdominal Gastrointestinal myoelectric activity in dogs: evaluation of a fixation system of electrodes on the abdominal wall

    Álvaro Antônio Bandeira Ferraz


    Full Text Available OBJETIVO: A implantação de eletrodos intra-abdominais para captura de sinais de onda elétrica constitui instrumento de estudo da atividade mioelétrica do tubo gastrointestinal. O deslocamento destes eletrodos do local de implantação ocorre com certa freqüência em animais de experimentação não anestesiados, devido aos movimentos da musculatura diafragmática, abdominal, do peristaltismo gastrintestinal e sobretudo aos hábitos inerentes à espécie de animal estudada, particularmente presentes em caninos. No referido estudo foi proposto um procedimento que proporciona estabilidade ao referido sistema utilizando-se recursos simples e de custos irrelevantes. MÉTODOS: Os autores apresentam através de diagramas e fotos um sistema de ancoração dos eletrodos elétricos na pele dos animais com botões. RESULTADOS: Foram realizados 5 experimentos, fixando-se em cada animal 3 eletrodos bipolares. Os animais foram mantidos em repouso até a completa recuperação do íleo paralítico. Não foi identificado nos animais estudados nenhuma migração dos eletrodos. CONCLUSÃO: O procedimento proposto é eficiente, simples, de fácil confecção e permite o monitoramento da atividade mioelétrica, em cães não anestesiados, por períodos de tempo prolongado.OBJECTIVE: The use of intra-abdominal electrodes in the study of gastrointestinal electrical wave is an important instrument of the gastrointestinal mioelectric activity. However, the dislocations of the electrodes in non-anaesthetized animals due to diaphragmatic muscle movements, gastrointestinal movements and mainly due to the animals habits, especially in dogs. The study has the objective to demonstrate a procedure that stabilize the system using simple resources an irrelevant cost. METHODS: The authors demonstrate under diagrams and picture a fixed system to fix the electrical electrodes through the animal skin using bottoms. RESULTS: The system was used in 5 animals. Each animal had 3

  16. Screening for Abdominal Aortic Aneurysm

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final ...

  17. Abdominal aortic aneurysm repair - open

    ... this page: // Abdominal aortic aneurysm repair - open To use the sharing features on this page, please enable JavaScript. Open abdominal aortic aneurysm repair is surgery to fix a widened part ...

  18. Ultrasonographic abdominal anatomy of healthy captive caracals (Caracal caracal).

    Makungu, Modesta; du Plessis, Wencke M; Barrows, Michelle; Koeppel, Katja N; Groenewald, Hermanus B


    Abdominal ultrasonography was performed in six adult captive caracals (Caracal caracal) to describe the normal abdominal ultrasonographic anatomy. Consistently, the splenic parenchyma was hyperechoic to the liver and kidneys. The relative echogenicity of the right kidney's cortex was inconsistent to the liver. The gall bladder was prominent in five animals and surrounded by a clearly visualized thin, smooth, regular echogenic wall. The wall thickness of the duodenum measured significantly greater compared with that of the jejunum and colon. The duodenum had a significantly thicker mucosal layer compared with that of the stomach. Such knowledge of the normal abdominal ultrasonographic anatomy of individual species is important for accurate diagnosis and interpretation of routine health examinations.

  19. A case of lipoma of parietal peritoneum causing abdominal pain.

    Bang, Chang Seok; Kim, Yeon Soo; Baik, Gwang Ho; Han, Sang Hak


    Lipomas are common benign tumors of mature adipose tissue, enclosed by thin fibrous capsules. They can occur on any part of the body; however, peritoneal lipoma is extremely rare. We encountered a case of a 75-year-old man presenting with intermittent abdominal pain, who had undergone right hemicolectomy due to colon cancer. Abdominal computerized tomography showed a well-defined heterogenous fatty mass measuring 4.5 × 3.5 cm in size, suggesting fat necrosis located in the abdominal wall. Laparotomy showed a very large soft mass of peritoneum. Pathologically, the tumor was diagnosed as lipoma containing fat necrosis located in parietal peritoneum not fixed to any organs, but with small bowel adhesion. Due to its rare etiologic origin and obscure cause of development, we report on a case of lipoma of parietal peritoneum causing abdominal pain.

  20. 悬吊式与气腹腹腔镜手术治疗老年结直肠癌的对比研究%The comparative study between gasless laparoscopic surgery with abdominal wall lifting and traditional laparoscopic surgery for colorectal cancer in aged patients

    傅健; 张建立; 孙振青; 王政坤; 刘希春; 邱志刚


    Objective:To compare and analyze the effect of gasless laparoscopic surgery with abdominal wall lifting and traditional laparoscopic surgery for colorectal cancer in aged patients. Methods: Forty aged patients with colorectal cancer underwent either gasless laparoscopic surgery with abdominal wall lifting (n =20,gasless group) or traditional laparoscopic surgery (n = 20,pneumoper-itoneum group) from Jun. 2010 to Jun. 2012. The operating time, blood loss, harvested lymph nodes, intraoperative unexpected injury, postoperative exhaust time, complications and pain score were compared between groups. Results; Thirty-seven operations were successfully performed, and 1 case was converted to open surgery in pneumoperitoneum group and 2 in gasless group. Each group had 1 case of ureteral injury and 1 case of anastomotic stoma fistula. And 1 case of postoperative vagina-rectum fistula was observed in gasless group. No significant difference was observed in the operating time,blood loss,total harvested lymph nodes,postoperative exhaust time,complications or pain score between the 2 groups (P > 0. 05 ) . Conclusions: Gasless laparoscopic operations for colorectal cancer with abdominal wall lifting are safe and feasible. It is better than traditional laparoscopic operations in aged patients and those with poor cardio-pul-monary function with advantages of no pneumoperitoneum complications.%目的:对比分析悬吊式腹腔镜手术与传统腹腔镜手术治疗老年结直肠癌的可行性及临床疗效.方法:回顾分析2010年6月至2012年6月为40例老年患者行腹腔镜结直肠癌手术的临床资料,分别采用悬吊式免气腹法(悬吊组,n=20)及气腹法(气腹组,n =20),对比分析两组患者手术时间、出血量、淋巴结清扫数量、术后排气时间、术后疼痛评分、术中意外损伤、术后并发症情况.结果:37例成功施行腹腔镜手术,气腹组中转1例,悬吊组中转2例.术中两组各有1例损伤输尿管;术后

  1. 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


    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

  2. Thoraco-abdominal ectopia cordis in southwest Cameroon.

    Chishugi, John B; Franke, Trixy J


    Ectopia cordis is a rare congenital defect where the heart is completely displaced outside the chest wall. Cantrell's pentalogy is an embryologic anomaly with five classic midline deficiencies often associated with ectopia cordis. Here we present a case of thoraco-abdominal ectopia cordis, brief literature review, and possible implications for changes in antenatal care.

  3. Thoraco-abdominal Ectopia Cordis in Southwest Cameroon

    Chishugi, John B; Franke, Trixy J


    Ectopia cordis is a rare congenital defect where the heart is completely displaced outside the chest wall. Cantrell's pentalogy is an embryologic anomaly with five classic midline deficiencies often associated with ectopia cordis. Here we present a case of thoraco-abdominal ectopia cordis, brief literature review, and possible implications for changes in antenatal care.

  4. An experimental study on anatomical observation and functional foundation of construction of "abdominal wall-spinal cord center-bladder" artificial reflex arc in SD rat%构建SD大鼠"腹壁反射-脊髓中枢-膀胱"人工反射弧的解剖学观察和功能基础的实验研究

    梁耿祺; 周兴; 潘建刚; 史群伟


    traced to the intervertebral hole direction until its ventral root and dor-sal root were found. The netive potential of T13 nerve root was recorded by stimulating The abdominal wall, while the TI3 nerve rent's spentaneo neural discharge was recorded as the comparison without stimulation. There were 4 pairs sacral nervos. The ventral root and dorsal root of $2 spinal nerve were dissoeted under microscope. The active poten-tial of plexus vesica and the myeelectricity of bladder smooth muscle were reenrded by stimulating S2 nerve .root, while the S2 nerve root's spontaneous neural discharge was recorded as the comparison without stimulation. Then, it was a-chieved by intradural microanastomosis of the left T13 ventral root was anastomosed under microscope to S2 ventral root by autogenous nerve grafting intraduraly, with the left T13 dorsal root remaining intact. Results In anatomy,the diameter of T13' s ventral root was about 0.4ram,and the diameter of S2 ' s ventral root was about O. 3mm. Both of diameters were close,and both of ventral roots located at ventralis medialis and had no spinal ganglion. In func-tion, the TI3 intercostal nerve mainly dominated the abdominal wall's feeling and the movement,and the S2 nerve mainly dominated bladder function. Both of them can produce the similar figures by stimulation. So,it can be achieved by intradural microanastomosis of the left TI3 ventral root was anastomosed under microscope to S2 ventral root by an-togenous nerve grafting intraduraly, with the left TI3 dorsal root remaining intact. Then, "the abdominal wall-spinal cord center-bladder" artificial reflex was constructed. Conclusions The anatomical and functional characteris-tic of TI3 and S2 nerve root is the foundation to eoastruct "the abdominal wall-spinal cord center-bladder" artifi-cial reflex in SD rat.

  5. Physicians' Abdominal Auscultation

    John, Gade; Peter, Kruse; Andersen, Ole Trier


    Background: Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination. Methods: In a semi-virtual setup 12 recordings...... of the intestinal sounds from 8 patients with acute abdominal pain and 4 healthy volunteers were presented to 100 physicians. The physicians were asked to characterize the intestinal sounds as normal or pathologic. Fisher's exact test was used for comparison between groups of physicians. Results: Overall, 72......% of the answers with regard to healthy volunteers concluded that the sounds were normal (equalling agreement), whereas 64% of answers with regard to intestinal obstruction concluded that the sounds were pathologic (but agreement was higher due to agreement on wrong diagnosis in one case). Bowel sounds from...

  6. Ruptured abdominal aortic aneurysm.

    Sachs, T; Schermerhorn, M


    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.


    姚京; 田文; 李佳


    目的 观察聚丙交己内酯(polylactide-co-caprolactone,PLC)、透明质酸(hyaluronic acid,HA)、胶原蛋白与聚丙烯(polypropylene,PP)网片复合,在污染环境下修补大鼠腹壁缺损后粘连情况和修补效果,比较3种复合补片特点及一期修补可行性.方法 成年雄性Wistar大鼠93只,体重150~250 g,随机分为3组(n=31):PP/PLC复合补片组(A组),PP/HA/PLC复合补片组(B组),PP/胶原蛋白/PLC复合补片组(C组).各组取1只大鼠小肠制备污染源匀浆.其余大鼠制备直径约1 cm的腹壁疝模型后,根据分组将直径1.5 cm的复合补片缝合于腹壁缺损处.术后观察大鼠一般情况;于术后30、60、90 d处死大鼠,大体观察腹腔脏器粘连情况;切取补片及其周围组织进行组织学观察.结果 术后10~70 d共6只大鼠死亡,其中A组2只,B组3只,C组1只;死亡原因均与补片修补无关.术后各时间点各组均见腹腔脏器与补片粘连,主要为肠管、网膜、肝.按照修正的Katada粘连评分方法,术后30、60 d各组间粘连评分比较,差异均无统计学意义(P>0.05);90 d时C组粘连评分显著低于A、B组(P<0.05).组织学观察,术后30 d各组补片周围可见炎性细胞浸润,成纤维细胞出现且胶原分泌增加,可吸收材料残留:60 d时补片周围炎性细胞较前减少,成纤维细胞数量及胶原分泌较前增加,各组仅见PLC残留;90d时成纤维细胞日趋成熟,可见胶原充填,腹腔面可见间皮层逐渐形成,各组残留PLC较前减少.结论 在污染环境下,PP/胶原蛋白/PLC复合补片在腹腔粘连及局部组织反应方面均优于PP/PLC及PP/HA/PLC复合补片,更适于一期修补大鼠腹壁缺损,但其远期效果及安全性仍待进一步确定.%Objective To observe the anti-adhesion and repair effect of 3 composite patches which composed of polylactide-co-caprolactone (PLC), hyaluronic acid (HA), collagen, and polypropylene (PP) mesh repairing abdominal wall defect in rats under

  8. Are there sex differences in Fetal Abdominal Subcutaneous Tissue (FAST) measurements?

    Farah, Nadine


    OBJECTIVE: To determine if Fetal Abdominal Subcutaneous Tissue (FAST) measurements using antenatal ultrasound differ between male and female fetuses. STUDY DESIGN: Women who had an ultrasound examination for fetal growth between 20 and 40 weeks gestation were studied. Women with diabetes mellitus were excluded. The fetal anterior abdominal subcutaneous tissue was measured on the anterior abdominal wall in millimetres anterior to the margins of the ribs, using magnification at the level of the abdominal circumference. The fetal sex was recorded after delivery. RESULTS: A total of 557 fetuses were measured, 290 male and 267 female. The FAST measurements increased with gestational age. The FAST increased at the same rate for both male and female fetuses and at any given week there was no sex difference. CONCLUSIONS: The increased fat composition in females reported after birth was not found in abdominal wall subcutaneous fat measurements using ultrasound during pregnancy. Antenatal centile charts for FAST do not need to be based on sex.

  9. 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


    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.

  10. Actinomycosis Presenting as an Abdominal Mass in a Child

    Rahsan Özcan


    Full Text Available Abdominal actinomycosis in childhood period is very rare and a relation to trauma is not well established. Herein we report a case that appeared subsequent to abdominal trauma. A 17 years old boy presented with left lower quadrant abdominal mass and signs of acute abdomen. The symptoms of abdominal discomfort began after a fall from height 3 months before admission. There were signs of acute abdomen at physical examination. Ultrasound of abdomen demonstrated a mass; CT scan findings pointed to a suspicious “internal hernia”. An emergency laparotomy was performed. During surgery, a mass located over sigmoid colon and infiltrating the lateral abdominal wall was found. It was removed en bloc with the adjacent omentum. Except for the thickened sigmoid colon, no other pathologies were present at laparotomy. The pathology specimen revealed the actinomyces infection. The patient was treated with oral penicillin after discharge and the follow-up was uneventful. We advocate, keeping the actinomyces infection in mind in cases presenting with abdominal mass of unknown origin in childhood period.

  11. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan


    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  12. Abdominal aortic aneurysm surgery

    Gefke, K; Schroeder, T V; Thisted, B


    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  13. Lower Abdominal Pain.

    Carlberg, David J; Lee, Stephen D; Dubin, Jeffrey S


    Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. Once a presumed or confirmed diagnosis is made, appropriate treatment is initiated, and may include surgery, antibiotics, and/or steroids. Appendicitis patients should be admitted. Diverticulitis and inflammatory bowel disease can frequently be managed on an outpatient basis, but may require admission and surgical consultation.

  14. Dolor abdominal recurrente .

    Rodrigo De Vivero


    Full Text Available El dolor abdominal recurrente (DAR es un problema frecuente en la consulta médica y en la subespecialidad médica y quirúrgica. El DAR es frecuentemente funcional, es decir, sin una causa orgánica aparente. El diagnóstico diferencial debe incluir pérdida de peso, sangrado gastrointestinal, fiebre persistente, diarrea crónica y vómito importante. En este artículo se revisa el diagnóstico y tratamiento, pruebas diagnósticas y manejo farmacológico y ambiental.

  15. Abdominal perfusion computed tomography.

    Ogul, Hayri; Bayraktutan, Ummugulsum; Kizrak, Yesim; Pirimoglu, Berhan; Yuceler, Zeynep; Sagsoz, M Erdem; Yilmaz, Omer; Aydinli, Bulent; Ozturk, Gurkan; Kantarci, Mecit


    The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis.

  16. Adventitial vasa vasorum arteriosclerosis in abdominal aortic aneurysm.

    Hiroki Tanaka

    Full Text Available Abdominal aortic aneurysm (AAA is a common disease among elderly individuals. However, the precise pathophysiology of AAA remains unknown. In AAA, an intraluminal thrombus prevents luminal perfusion of oxygen, allowing only the adventitial vaso vasorum (VV to deliver oxygen and nutrients to the aortic wall. In this study, we examined changes in the adventitial VV wall in AAA to clarify the histopathological mechanisms underlying AAA. We found marked intimal hyperplasia of the adventitial VV in the AAA sac; further, immunohistological studies revealed proliferation of smooth muscle cells, which caused luminal stenosis of the VV. We also found decreased HemeB signals in the aortic wall of the sac as compared with those in the aortic wall of the neck region in AAA. The stenosis of adventitial VV in the AAA sac and the malperfusion of the aortic wall observed in the present study are new aspects of AAA pathology that are expected to enhance our understanding of this disease.

  17. Abdominal pregnancy- a case report.

    Okafor, Ii; Ude, Ac; Aderibigbe, Aso; Amu, Oc; Udeh, Pe; Obianyo, Nen; Ani, Coc


    A case of abdominal pregnancy in a 39 year old female gravida 4, para 0(+3) is presented. Ultrasonography revealed a viable abdominal pregnancy at 15 weeks gestational age. She was initially managed conservatively. Surgical intervention became necessary at 20 weeks gestational age following Ultrasound detection of foetal demise. The maternal outcome was favourable. This case is presented to highlight the dilemma associated with diagnosis and management of abdominal pregnancy with a review of literature.

  18. A report of three cases and review of the literature on rectal disruption following abdominal seatbelt trauma.

    El Kafsi, J; Kraus, R; Guy, R


    Seatbelt associated blunt trauma to the rectum is a rare but well recognised injury. The exact mechanism of hollow visceral injury in blunt trauma is unclear. Stress and shear waves generated by abdominal compression may in part account for injury to gas containing structures. A 'seatbelt sign' (linear ecchymosis across the abdomen in the distribution of the lap belt) should raise the suspicion of hollow visceral injuries and can be more severe with disruption of the abdominal wall musculature. Three consecutive cases of rectal injury following blunt abdominal trauma, requiring emergency laparotomy and resection, are described. Lumbar spine injury occurred in one case and in the other two cases, there was injury to the iliac wing of the pelvis; all three cases sustained significant abdominal wall contusion or muscle disruption. Abdominal wall reconstruction and closure posed a particular challenge, requiring a multidisciplinary approach. The literature on this topic is reviewed and potential mechanisms of injury are discussed.

  19. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)


    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  20. An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report

    Shimodaira Masanori


    Full Text Available Abstract Background Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.

  1. Subtotal versus total abdominal hysterectomy

    Andersen, Lea Laird; Ottesen, Bent; Alling Møller, Lars Mikael


    a multiple imputation analysis, this difference disappeared (relative risk, 1.36; 95% confidence interval, 0.86-2.13; P = .19). No differences were seen in any of the secondary outcomes. CONCLUSION: Subtotal abdominal hysterectomy was not superior to total abdominal hysterectomy on any outcomes. More women...

  2. Abdominal Complications after Severe Burns


    abdominal compartment syndrome, schemic bowel, biliary disease , peptic ulcer disease and astritis requiring laparotomy, small bowel obstruction, rimary fungal...complications in- luded trauma exploratory laparotomy, abdominal com- artment syndrome, ischemic bowel, biliary disease , peptic lcer disease and gastritis, large...because it was almost uniformly ssociated with serious lethal burns. This was in the period efore effective gastric acid control, explaining the high

  3. Abdominal migraine in the differential diagnosis of acute abdominal pain.

    Cervellin, Gianfranco; Lippi, Giuseppe


    Although traditionally regarded as a specific pediatric disease, abdominal migraine may also be observed in adults. Unfortunately, however, this condition is frequently overlooked in the differential diagnosis of abdominal pain in the emergency department (ED). A 30-year-old woman presented to our ED complaining of abdominal pain and vomiting, lasting for 12 hours. The pain was periumbilical, continuous, and not associated with fever or diarrhea. The physical examination and the results of conventional blood tests were normal. The patient was treated with intravenous ketoprofen, metoclopramide, and ranitidine, obtaining a prompt relief of symptoms. She had a history of similar episodes in the last 15 years, with several ED visits, blood test examinations, ultrasonography of the abdomen, and upper gastrointestinal endoscopies. Celiac disease, porphyry, sickle cell disease, and inflammatory bowel disease were all excluded. In July 2012, she became pregnant, and she delivered a healthy baby on April 2013. Until November 2014, she has remained asymptomatic. Based on the clinical characteristics of the abdominal pain episodes, the exclusion of any alternative diagnosis, and the relief of symptoms during and after pregnancy, a final diagnosis of abdominal migraine could be established. A skilled emergency physician should always consider abdominal migraine in the differential diagnosis of patients admitted to the ED with abdominal pain, especially when the attacks are recurrent and no alternative diagnosis can be clearly established.


    Nevein Mohammed Mohammed Gharib


    Full Text Available Background: Obesity is a medical condition that may adversely affect wellbeing and leading to increased incidence of many health problems. Abdominal obesity tends to be associated with weight gain and obesity and it is significantly connected with different disorders like coronary heart disease and type II diabetes mellitus.This study was conducted to investigate the efficacy of vacuum therapy as compared to abdominal exercises on abdominal obesity in overweight and obese women. Methods: Thirtyoverweight and obese women participated in this study with body mass index > 25 kg/m2andwaist circumference ≥ 85 cm. Their ages ranged from 28 - 40 years old.The subjects were excluded if they have diabetes, abdominal infection diseases or any physical limitation restricting exercise ability. They were randomly allocated into two equal groups; group I and group II. Group I received vacuum therapy sessions (by the use of LPG device in addition to aerobic exercise training. Group II received abdominal exercises in addition to the same aerobic exercisesgiven to group I. This study was extended for successive 8 weeks (3 sessions/ week. All subjects were assessed for thickness ofnthe abdominal skin fold, waist circumference and body mass index. Results: The results of this study showeda significant difference between group I and group II post-interventionas regarding to the mean values of waist circumference and abdominal skin fold thickness (p<0.05. Conclusion: It can be concluded that aerobic exercises combined with vacuum therapy (for three sessions/week for successive 8 weeks have a positive effect on women with abdominal obesity in terms of reducing waist circumference and abdominal skin fold thickness.

  5. Pulsatile blood flow in Abdominal Aortic Aneurysms

    Salsac, Anne-Virginie; Lasheras, Juan C.; Singel, Soeren; Varga, Chris


    We discuss the results of combined in-vitro laboratory measurements and clinical observations aimed at determining the effect that the unsteady wall shear stresses and the pressure may have on the growth and eventual rupturing of an Abdominal Aortic Aneurysm (AAA), a permanent bulging-like dilatation occurring near the aortic bifurcation. In recent years, new non-invasive techniques, such as stenting, have been used to treat these AAAs. However, the development of these implants, aimed at stopping the growth of the aneurysm, has been hampered by the lack of understanding of the effect that the hemodynamic forces have on the growth mechanism. Since current in-vivo measuring techniques lack the precision and the necessary resolution, we have performed measurements of the pressure and shear stresses in laboratory models. The models of the AAA were obtained from high resolution three-dimensional CAT/SCANS performed in patients at early stages of the disease. Preliminary DPIV measurements show that the pulsatile blood flow discharging into the cavity of the aneurysm leads to large spikes of pressure and wall shear stresses near and around its distal end, indicating a possible correlation between the regions of high wall shear stresses and the observed location of the growth of the aneurysm.

  6. Recording of uterine activity from the abdominal lead EMG


    With external tocography some form of pressure or force transducer is fastened to the abdominal wall by means of an elastic belt. Uterine contractions produce changes in the displacement of a sensor pin which acts on the transducer, producing an electrical signal that corresponds to the relative uterine pressure. External tocography, however, has the drawback that it is subject to many factors which may influence the results of the measurement. We feel that the limitations of tocography canno...

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

    Kavic, Michael S.


    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.

  8. Optical characterization and composition of abdominal wall muscle from rat

    Oliveira, Luís; Lage, Armindo; Pais Clemente, M.; Tuchin, Valery


    Complete optical characterization of biological tissue is desirable to develop clinical methods using optical technologies. Particularly, to develop optical clearing methods in biological tissues, it is necessary to know the composition of the tissue, the percentage of each constituent and corresponding refractive indexes. To obtain such information for rat muscle, we used a simple method to characterize tissue constituents for both content percentage and refractive index. The study consisted on measuring mass with a precision weighting scale and the refractive index with an Abbe refractometer during tissue dehydration. With the collected data, we used a theoretical model to calculate the refractive index and percentage for both interstitial fluid and solid part of the rat muscle. The results obtained are in good agreement with data published by other authors, and were considered of vital information for the optical clearing studies that we planned to perform.

  9. Ramos colaterais parietais e terminais da aorta abdominal em Myocastor coypus (nutria Terminal and parietal colateral branches of the abdominal aorta in Myocastor coypus (nutria

    Paulete de Oliveira Vargas Culau


    , in order to irrigate part of the diaphragm and the cranial lateral abdominal walls. The abdominal aorta emitted, dorsally, the median sacral artery, cranially to its bifurcation into the common iliac arteries. These common iliac arteries, terminal branches of the aorta, originate the internal and external iliac arteries. The internal iliac artery was distributed along the pelvic cavity viscera. The external iliac artery emitted an umbilical artery and, before reaching the inguinal ring, emitted the deep circunflex iliac artery to 2/3 of the caudal lateral abdominal wall. The external iliac artery emitted the pudendoepigastric trunk, wich has originated the caudal epigastric artery, to the ventral abdominal wall, and the external pudendal artery, wich passed through the inguinal ring to irrigate the external genital. The direct parietal branches of the abdominal aorta were the lumbar arteries and the median sacral artery, while the phrenicoabdominal arteries, deep circunflex iliac and the caudal epigastric artery were indirect colateral parietal branches. The terminal branches of the abdominal aorta were the common iliac arteries with its branches, the internal and external iliac arteries.

  10. The Houdini effect--an unusual case of blunt abdominal trauma resulting in perforative appendicitis.

    O'Kelly, F


    We present a unique case of perforative appendicitis that occurred in an adult following blunt abdominal trauma. This case represents the first such reported case from Ireland. It also represents a modern practical example of Laplace\\'s theory of the effect of increased pressure on colonic wall tension leading to localized perforation, and serves to highlight not only the importance in preoperative imaging for blunt abdominal trauma, but also the importance of considering appendiceal perforation.

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

    Avendano-Peza, Héctor; Novitsky, Yuri W.


    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.

  12. Micromanaging Abdominal Aortic Aneurysms

    Lars Maegdefessel


    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  13. Abdominal aortic feminism.

    Mortimer, Alice Emily


    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  14. Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

    Edivaldo Massazo Utiyama


    Full Text Available OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years; 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

  15. Significance of bacterial flora in abdominal irradiation-induced inhibition of lung metastases

    Matsumoto, T.; Ando, K.; Koike, S.


    We have previously reported that abdominal irradiation prior to i.v. injection of syngeneic tumor cells reduced metastases in lung. Our report described an investigation of the significance of intestinal organisms in the radiation effect. We found that eliminating intestinal organisms with antibiotics totally abolished the radiation effect. Monoassociation of germ-free mice revealed that the radiation effect was observable only for Enterobacter cloacae, never for Streptococcus faecium, Bifidobacterium adlesentis, or Escherichia coli. After abdominal irradiation of regular mice, E. cloacae multiplied in cecal contents, adhered to mucous membranes, invaded the cecal wall, and translocated to mesenteric lymph nodes. Intravenous administration of E. cloacae in place of abdominal irradiation inhibited metastases. E. cloacae-monoassociated mice developed fewer metastases than germ-free mice, and the reduction was further enhanced by abdominal irradiation. We concluded that abdominal irradiation caused the invasion of E. cloacae from the mucous membrane of the intestine and inhibited formation of lung metastases.

  16. 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


    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.

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


    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

  18. Intra-abdominal tuberculous peritonitis

    Schneider, G.; Ahlhelm, F.; Altmeyer, K.; Kramann, B. [Dept. of Diagnostic Radiology, University Hospital, Homburg (Germany); Hennes, P. [Dept. of Pediatrics, University Hospital, Homburg (Germany); Pueschel, W. [Dept. of Pathology, University Hospital, Homburg (Germany); Karadiakos, N. [Dept. of Pediatric Surgery, University Hospital, Homburg (Germany)


    We report the case of a 15-year-old boy suffering from progressive dyspnea on exertion and painful abdominal protrusion. Final diagnosis of intra-abdominal tuberculosis (TB), including lymphadenopathy and abdominal abscess formation, was made following elective laparotomy. This type of disease is a rare manifestation of extrapulmonary tuberculosis. The imaging findings in unenhanced and contrast-enhanced MRI and laparoscopic images are presented. Differential diagnosis of abdominal abscess formation and other fungal or bacteriological infections, as well as the imaging findings of this type of lesion, are discussed. This case demonstrates that atypical manifestation of TB may remain unrecognized; thus, awareness of this kind of manifestation of tuberculosis may prevent patients from being subjected to inappropriate therapies. (orig.)

  19. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... valuable for evaluating abdominal, pelvic or scrotal pain in children. Preparation will depend on the type of ... examinations do not use ionizing radiation (as used in x-rays ), thus there is no radiation exposure ...

  20. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... children. Except for traumatic injury, appendicitis is the most common reason for emergency abdominal surgery. Ultrasound imaging ... of page How is the procedure performed? For most ultrasound exams, you will be positioned lying face- ...

  1. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... of page What are some common uses of the procedure? Abdominal ultrasound imaging is performed to evaluate ... for ultrasound examinations. top of page What does the equipment look like? Ultrasound scanners consist of a ...

  2. Different Anti-Contractile Function and Nitric Oxide Production of Thoracic and Abdominal Perivascular Adipose Tissues.

    Victorio, Jamaira A; Fontes, Milene T; Rossoni, Luciana V; Davel, Ana P


    Divergent phenotypes between the perivascular adipose tissue (PVAT) surrounding the abdominal and the thoracic aorta might be implicated in regional aortic differences, such as susceptibility to atherosclerosis. Although PVAT of the thoracic aorta exhibits anti-contractile function, the role of PVAT in the regulation of the vascular tone of the abdominal aorta is not well defined. In the present study, we compared the anti-contractile function, nitric oxide (NO) availability, and reactive oxygen species (ROS) formation in PVAT and vessel walls of abdominal and thoracic aorta. Abdominal and thoracic aortic tissue from male Wistar rats were used to perform functional and molecular experiments. PVAT reduced the contraction evoked by phenylephrine in the absence and presence of endothelium in the thoracic aorta, whereas this anti-contractile effect was not observed in the abdominal aorta. Abdominal PVAT exhibited a reduction in endothelial NO synthase (eNOS) expression compared with thoracic PVAT, without differences in eNOS expression in the vessel walls. In agreement with this result, NO production evaluated in situ using 4,5-diaminofluorescein was less pronounced in abdominal compared with thoracic aortic PVAT, whereas no significant difference was observed for endothelial NO production. Moreover, NOS inhibition with L-NAME enhanced the phenylephrine-induced contraction in endothelial-denuded rings with PVAT from thoracic but not abdominal aorta. ROS formation and lipid peroxidation products evaluated through the quantification of hydroethidine fluorescence and 4-hydroxynonenal adducts, respectively, were similar between PVAT and vessel walls from the abdominal and thoracic aorta. Extracellular superoxide dismutase (SOD) expression was similar between the vessel walls and PVAT of the abdominal and thoracic aorta. However, Mn-SOD levels were reduced, while CuZn-SOD levels were increased in abdominal PVAT compared with thoracic aortic PVAT. In conclusion, our results

  3. Cough induced rib fracture, rupture of the diaphragm and abdominal herniation

    Wurl Peter


    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.

  4. Updates on abdominal desmoid tumors


    Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequentiy after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.

  5. Ambiguous walls

    Mody, Astrid


    The introduction of Light Emitting Diodes (LEDs) in the built environment has encouraged myriad applications, often embedded in surfaces as an integrated part of the architecture. Thus the wall as responsive luminous skin is becoming, if not common, at least familiar. Taking into account how wall...

  6. Wonderful Walls

    Greenman, Jim


    In this article, the author emphasizes the importance of "working" walls in children's programs. Children's programs need "working" walls (and ceilings and floors) which can be put to use for communication, display, storage, and activity space. The furnishings also work, or don't work, for the program in another sense: in aggregate, they serve as…

  7. Common abdominal emergencies in children.

    D'Agostino, James


    Because young children often present to EDs with abdominal complaints, emergency physicians must have a high index of suspicion for the common abdominal emergencies that have serious sequelae. At the same time, they must realize that less serious causes of abdominal symptoms (e.g., constipation or gastroenteritis) are also seen. A gentle yet thorough and complete history and physical examination are the most important diagnostic tools for the emergency physician. Repeated examinations and observation are useful tools. Physicians should listen carefully to parents and their children, respect their concerns, and honor their complaints. Ancillary tests are inconsistent in their value in assessing these complaints. Abdominal radiographs can be normal in children with intussusception and even malrotation and early volvulus. Unlike the classic symptoms seen in adults, young children can display only lethargy or poor feeding in cases of appendicitis or can appear happy and playful between paroxysmal bouts of intussusception. The emergency physician therefore, must maintain a high index of suspicion for serious pathology in pediatric patients with abdominal complaints. Eventually, all significant abdominal emergencies reveal their true nature, and if one can be patient with the child and repeat the examinations when the child is quiet, one will be rewarded with the correct diagnosis.

  8. 免气腹悬吊式腹腔镜与常规腹腔镜胆囊切除术术后呕吐的研究%A Comparative Study of Vomiting after Gasless Laparoscopic Cholecystectomy of Abdominal Wall Lifting and Conventional Laparoscopic Cholecystectomy

    王淑贤; 于跃利; 陈彪; 董玉红


    Objective:To compare and analyse the patients′ state of postoperative nausea and vomiting(PONV)after gas-less laparoscopic cholecystectomy of abdominal wall lifting(GLC)and convention laparoscopic cholecystectomy(CLC). Meth-ods:60 patients hospitalized for chronic cholecystitis,cholecystolithiasis and gall bladder polypi in the First Affiliated Hospital of Baotou Medical College from July 2009 to March 2010 were randomly divided into GLC group(group A)and CLC group(group B),with 30 patients in each group. Results:The incidence of PONV went down with time in two groups. The incidence of PONV in group B was higher than that in group A at various stages. There was significant difference( P ﹤ 0. 05)in the incidence of nausea within 24 hours after the operation,and significant difference( P ﹤ 0. 05)in the incidence of vomiting within 12 hours after the operation,between the two groups. Conclution:Compared with that in CLC,The incidence of PONV was lower in GLC.%目的:研究悬吊式免气腹腹腔镜胆囊切除术术后发生恶心、呕吐的情况。方法:随机选择包头医学院第一附属医院2009年5月至2010年5月患有胆囊炎、胆囊结石或胆囊息肉入院的患者,随机分为免气腹腹腔镜胆囊切除术组(A 组)30例、传统腹腔镜胆囊切除术组(B 组)30例。结果:术后两组恶心、呕吐发生率随时间而降低,B 组各时间段恶心、呕吐发生率均高于 A 组,在术后24 h 内两组恶心发生率差异均有统计学意义( P ﹤0.05),在术后12 h 内两组呕吐发生率差异均有统计学意义( P ﹤0.05)。结论:免气腹腹腔镜胆囊切除术恶心、呕吐发生率低于传统腹腔镜胆囊切除术。

  9. Plasma levels of cathepsins L, K, and V and risks of abdominal aortic aneurysms

    Lv, Bing-Jie; Lindholt, Jes S; Wang, Jing;


    Cathepsin L (CatL), cathepsin K (CatK), and cathepsin V (CatV) are potent elastases implicated in human arterial wall remodeling. Whether plasma levels of these cathepsins are altered in patients with abdominal aortic aneurysms (AAAs) remains unknown.......Cathepsin L (CatL), cathepsin K (CatK), and cathepsin V (CatV) are potent elastases implicated in human arterial wall remodeling. Whether plasma levels of these cathepsins are altered in patients with abdominal aortic aneurysms (AAAs) remains unknown....

  10. Postpartum intra-abdominal haemorrhage: Case report

    Tubić-Pavlović Aleksandra


    Full Text Available Introduction. The most frequent cause of gynaecological haemoperitoneum is ruptured ectopic pregnancy. Haemoperitoneum after a normal vaginal delivery is rare and it is associated with high maternal mortality. Case report. A 22-year-old primipara had a normal vaginal delivery. She experinced acute abdominal pain and hypovolemic shock ten hours after the delivery and was referred to our hospital twenty one hours after the delivery. An urgent ultrasound profile was done, which revealed free fluid in pelvis and in the whole abdomen. An immediate laparotomy was done and 2 litres of blood were found within the peritoneal cavity. The uterine wall was intact. We found a haematoma on the anterior wall of rectum and livid colours of broad ligament. The peritoneal cavity was cleaned and revised. Any injury of the spleen or liver was excluded. Discussion and conclusion. Haematoperitoneum after a normal vaginal delivery is rare but life threatening to mothers. It is important to recognize this condition to avoid delay in diagnosis and treatment because of high maternal mortality. Our patient was bleeding from superficial rectal vessels. Only a few cases with undefined aetiologies have been reported in literature.

  11. A comparative study of trans-umbilicus laparoendoscopic one-trocar surgery and trans-umbilicus and abdominal wall two-trocar surgery in the treatment of pediatric hydrocele%经脐单穿刺孔与经脐及腹侧壁双穿刺孔腹腔镜治疗小儿鞘膜积液比较

    宋晋秋; 郝春生; 叶辉; 李龙; 白东升; 邱颖


    目的 探讨经脐单穿刺孔腹腔镜治疗小儿鞘膜积液的临床价值,并与经脐及腹侧壁双穿刺孔方法进行比较研究.方法 回顾性对比分析2012年1至5月首都儿科研究所附属儿童医院收治的实施腹腔镜下鞘突高位结扎术的鞘膜积液患儿78例,均为男性,其中经脐单穿刺孔腹腔镜(单孔组)32例,经脐及腹侧壁双穿刺孔(双孔组)46例.比较两组手术时间、术后住院时间、术后并发症及费用.结果 两组手术均顺利完成,无中转手术.单孔组单侧、双侧手术时间分别为(20±10)、(31±11)min,双孔组单侧、双侧手术时间分别为(20±8)、(29 ±9) min,差异均无统计学意义(均P>0.05).术中单孔组腹腔镜下视野暴露良好,与双孔组视野暴露情况相比无明显差别,仅在视野角度方面,双孔组腹腔镜视野较为灵活.两组患儿术后随访3~6个月,术后均无复发.单孔组、双孔组住院费用分别为(5199±599)和(5117±684)元,差异无统计学意义(P>0.05).结论 脐部单穿刺孔腹腔镜手术治疗鞘膜积液安全可行,对比双孔法手术时间、术后住院时间、术后并发症及手术费用差异均无统计学意义,仅脐部褶皱一处切口,美容效果满意,且由术者单人操作,节省人力,在小儿外科工作中有重要的临床意义.%Objective To explore the feasibility and clinical efficacies of unbilical one-trocar laparoendoscopic surgery versus trans-umbilicus and abdominal wall two-trocar laparoendoscopic surgery in the treatment of pediatric hydrocele.Methods Retrospective comparative analysis was conducted for 78cases of hydrocele undergoing laparoscopic surgery at our hospital from January 2012 to May 2012.They were divided into two groups of umbilical one-trocar laparoscopic surgery (one-trocar,n =32) and transumbilicus and abdominal wall two-trocar laparoscopic surgery (two-trocar,n =46).And their profiles of operative duration,post-operative hospital stay and

  12. Estudo comparativo entre sling pubovaginal de parede vaginal e sling de fáscia do reto abdominal no tratamento da incontinência urinária de esforço Comparative study between vaginal wall sling and rectus fascia pubovaginal sling in the treatment of stress urinary incontinence

    Arlindo Monteiro de Carvalho Júnior


    Full Text Available OBJETIVO: A cirurgia de sling pubovaginal é utilizada no tratamento da incontinência urinária de esforço (IUE do tipo III e como resgate na falha de procedimentos anteriores. Tem índice de sucesso variando de 73 a 89%. Podem ser utilizados diversos materiais autólogos e sintéticos com semelhantes resultados. Nosso objetivo foi comparar o sling de parede vaginal com o de fáscia do reto abdominal quanto à eficácia e às complicações. MÉTODO: Foram estudadas 27 pacientes no período de 04/98 a 09/00, divididas em dois grupos: grupo I com nove pacientes submetidas a sling de parede vaginal; grupo II com 18 pacientes submetidas a sling de fáscia do reto abdominal. Todas foram submetidas a um estudo urodinâmico completo, classificadas quanto ao tipo de IUE, e seguidas no ambulatório de urologia. RESULTADOS: grupo I com média de idade de 51,4 anos, tempo de seguimento médio de 14,3 meses. Pressão de Perda aos Esforços (PPE variando de 50 a 100cmH2O com média de 81,1cmH2O. Houve 66% de complicações. Taxa de sucesso de 88,8% e índice de satisfação 85 pontos. Grupo II com média de idade de 54,2 anos, seguimento médio de 19,3 meses. PPE variando de 45 a 92cmH2O, média de 65,5cmH2O. Houve 72% de complicações e sucesso de 88,8%. Índice de satisfação de 74 pontos. CONCLUSÕES: Os dados encontrados estão de acordo com a literatura, sendo os dois grupos comparáveis quanto à eficácia em período curto de seguimento. O grupo II apresentou maior número de complicações, assim como maior tempo de cateter vesical e menor índice de satisfação geral.BACKGROUND: Pubovaginal sling is being currently used for the treatment of type III Stress Urinary Incontinence (SUI and for recurrences after previous procedures. Success rates vary from 73 to 89%. Many autologous and allogênic materials have being used with a variable rate of complications. Our objective was to compare the vaginal wall sling to the rectus fascia pubovaginal

  13. A clinical dilemma: abdominal tuberculosis

    Oya Uygur-Bayramicli; G(u)l Dabak; Resat Dabak


    AIM: To evaluate the clinical, radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis.METHODS: Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital,Istanbul, Turkey were evaluated prospectively. Complete physical examination, medical and family history, blood count erythrocyte sedimentation rate, routine biochemical tests,Mantoux skin test, chest X-ray and abdominal ultrasonography (USG) were performed in all cases, whereas microbiological examination of ascites, upper gastrointestinal endoscopy, colonoscopy or barium enema, abdominal tomography, mediastinoscopy, laparoscopy or laparotomy were done when needed.RESULTS: The median age of patients (14 females, 17males) was 34.2 years (range 15-65 years). The most frequent symptoms were abdominal pain and weight loss.Eleven patients had active pulmonary TB. The most common abdominal USG findings were ascites and hepatomegaly. Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2 %). Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients. Colonoscopy performed in 20 patients showed ulcers in 9 (45 %), nodules in 2 (10 %)and, stricture, polypoid lesions, granulomatous findings in terminal ileum and rectal fistula each in one patient (5 %).Laparoscopy on 4 patients showed dilated bowel loops,thickening in the mesentery, multiple ulcers and tubercles on the peritoneum. Patients with abdominal TB were divided into three groups according to the type of involvement.Fifteen patients (48 %) had intestinal TB, L1 patients (35.2 %) had tuberculous peritonitis and 5 (16.8 %)tuberculous lymphadenitis. The diagnosis of abdominal TB was confirmed microbiologically in 5 (16 %) and histopathologically in 19 patients (60.8 %). The

  14. Wall Turbulence.

    Hanratty, Thomas J.


    This paper gives an account of research on the structure of turbulence close to a solid boundary. Included is a method to study the flow close to the wall of a pipe without interferring with it. (Author/JN)

  15. [Abdominal pregnancy care. Case report].

    Morales Hernández, Sara; Díaz Velázquez, Mary Flor; Puello Tamara, Edgardo; Morales Hernández, Jorge; Basavilvazo Rodríguez, Maria Antonia; Cruz Cruz, Polita del Rocío; Hernández Valencia, Marcelino


    Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.

  16. Blunt abdominal trauma in sports.

    Rifat, Sami F; Gilvydis, Rimas P


    Abdominal injuries are rare in sports, but when they do occur it is important that the physician recognize the warning signs of potentially life-threatening injury to the liver, spleen, or hollow abdominal viscera. Though the sports medicine physician may not always provide definitive treatment of many of these conditions, he or she should be familiar with the preferred diagnostic modalities and latest treatment options. This information is not only essential to appropriately participate in treatment decisions, but is also important in order to make return-to-play determinations.

  17. [Gallstone ileus. Abdominal CT usefulness].

    Sukkarieh, F; Brasseur, P; Bissen, L


    The authors report the case of a 93-year old woman referred to the emergency department and presenting with an intestinal obstruction. Abdominal CT reveals a biliary ileus caused by the migration and the impaction of a 3 cm gallstone in the small bowel. Surgical treatment by enterolithotomy was successful. In over 90% of cases, gallstone ileus is a complication of cholelithiasis and accounts for 25% of intestinal obstruction in patients over 65 years. To reduce morbidity and mortality, early diagnosis and prompt treatment are essential. Abdominal CT-scan is the gold standard technique.

  18. CT appearances of abdominal tuberculosis

    Lee, W.-K., E-mail: [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Van Tonder, F.; Tartaglia, C.J.; Dagia, C. [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Cazzato, R.L. [Department of Radiology, Universita Campus Bio-Medico di Roma, Rome (Italy); Duddalwar, V.A. [Department of Radiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California (United States); Chang, S.D. [Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, British Columbia (Canada)


    The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.

  19. Diagnosis in acute abdominal pain and ongoing abdominal sepsis

    Kiewiet, J.J.S.


    Acute abdominal pain is a common reason for presentation at the emergency department. To establish a timely and adequate diagnosis, doctors use the pattern of complaints and physical examination as the basis for the evaluation of a patient. In this thesis we conducted a study that showed that surgeo

  20. The reverse abdominal reduction and the 'waistcoating' procedure for the correction of the fixated Pfannenstiel incision.

    Harrison, Douglas H


    The principles of a standard abdominal reduction are well understood; this technique has been used for many years. However, a reverse abdominal reduction may be considered in some cases, for example, continued weight loss, and thus skin redundancy on the upper abdomen in patients who have already undergone abdominal reduction and upper abdomen improvement in patients requiring a mastopexy or breast reduction simultaneously. Reverse abdominal reduction is rarely mentioned in the medical literature, but it can prove successful; although the scar across the lower sternum has often been considered to be unsatisfactory, often it does not prove to be so. Thus, this procedure can be proven to be successful in suitable cases. Secondly, the Pfannenstiel incision, if not satisfactorily repaired in the first instance, can become fixated to the abdominal wall; this fixation along with the inevitable migration of skin and fat at its cephalic edge causes a rather displeasing contour defect when wearing tight-fitting swimwear. The principle of the waistcoating procedure is essentially to chamfer the fat cephalically; this procedure is employed for removing the Pfannenstiel scar from the abdominal wall. The principle is simple and effective and can be applied in cases with fixated scars. These two aforementioned principles are not commonly used, but they can prove particularly effective in suitable cases. We illustrate the principles.

  1. Elderly Woman with Abdominal Pain: Bedside Ultrasound Diagnosis of Diverticulitis

    Jason D. Heiner


    Full Text Available A 72-year-old otherwise healthy female presented to the emergency department with two weeks of worsening abdominal pain. She was afebrile with normal vital signs. Her physical examination was notable for moderate abdominal tenderness without rebound to the left and suprapubic regions of the abdomen. Laboratory studies were remarkable for a white blood cell count of 13,000/mm3. A focused bedside ultrasound over the patient’s region of maximal discomfort revealed a thickened bowel wall and several small contiguous hypoechoic projections surrounding a hyperechoic center, suggestive of diverticulitis (Figure. She was given metronidazole and ciprofloxacin and her diagnosis of uncomplicated colonic diverticulitis was confirmed by computed tomography (CT.

  2. Hereditary angioedema (HAE): a cause for recurrent abdominal pain.

    Soni, Parita; Kumar, Vivek; Alliu, Samson; Shetty, Vijay


    A 44-year-old Hispanic woman presented to the emergency room with a 2-day history of sudden onset of severe cramping left lower quadrant abdominal pain associated with ∼20 episodes diarrhoea. Abdominal CT scan exhibited bowel wall oedema and acute extensive colitis. On the basis of the preliminary diagnosis of acute abdomen, the patient was admitted under the surgical team and treated for acute colitis. Since her family history was significant for hereditary angioedema (HAE), complement studies were performed which revealed low complement C4 levels and abnormally low values of C1q esterase inhibitor. Thus, the diagnosis of HAE type I was established. This case report summarises that the symptoms of HAE are often non-specific, hence making the underlying cause difficult to diagnose.

  3. Aneurisma de aorta abdominal na infância Abdominal aortic aneurism in childhood

    Abdo Farret Neto


    Full Text Available The authors report a case of an abdominal aortic aneurism involving all visceral branches minus the Inferior Mesenteric artery in a 4-year-old girl. There was sugestive evidence that the arterial disease had an inflamatory or infectious etiologic factor. The most probable etiological factors could be salmonelas infection of the arterial wall or Takayasu's disease secondary to tuberculosis. The treatment with antibiotic to salmonelas infection during ten days, followed by tuberculostatic therapy for six months was chosen. Concerning the age, the arteries involved and the inflamatory aspect of the aneurysm, the surgical option became an alternative to the clinic treatment in case of any future evidence of the aneurysm enlargement. The patient became asymptomatic as soon as the antibiotic has been started. The control of the aneurysm evolution will be made by ecography each three months.

  4. Clinical management of abdominal trauma

    FANG Guo-en; LUO Tian-hang; DU Cheng-hui; BI Jian-wei; XUE Xu-chao; WEI Guo; WENG Zhao-zhang; MA Li-ye; HUA Ji-de


    Objective: To improve the prognosis of patients with abdominal trauma. Methods: Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years ranging from 3-82 years. All abdominal traumas consisted of closed traumas 360 cases, 86.7% and open traumas 55 cases, 13.3%. Results: Atotal of 407 cases 98.1% were fully recovered from trauma and the other 8 cases 1.9% died of multiple injuries. The mean injury severity score ISS of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds 6 cases, pancreatic fistula 2 cases and intestinal fistula 1 case. All these postoperative complications were cured by the conservative treatment. Conclusion: Careful case history inquisition and physical examination are the basic methods to diagnose abdomi- nal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.

  5. Chronic Abdominal Pain in Children

    C.F.M. Gijsbers (Carolien)


    textabstractRecurrent abdominal pain (RAP) was first defined in 1958 by Apley as “at least 3 bouts of pain, severe enough to affect activities, over a period of at least 3 months” (1). This was a landmark publication with great impact, showing, that emotional disturbances played a role in many patie

  6. Economic costs of abdominal obesity

    Højgaard, Betina; Olsen, Kim Rose; Søgaard, Jes


    BACKGROUND: To examine the relationship between waist circumference and future health care costs across a broad range of waist circumference values based on individual level data. METHOD: A prospective cohort of 31,840 subjects aged 50-64 years at baseline had health status, lifestyle and socio-e...... be a potential for significant resource savings through prevention of abdominal obesity....

  7. In vivo strain assessment of the abdominal aortic aneurysm.

    Satriano, Alessandro; Rivolo, Simone; Martufi, Giampaolo; Finol, Ender A; Di Martino, Elena S


    The only criteria currently used to inform surgical decision for abdominal aortic aneurysms are maximum diameter (>5.5 cm) and rate of growth, even though several studies have identified the need for more specific indicators of risk. Patient-specific biomechanical variables likely to affect rupture risk would be a valuable addition to the science of understanding rupture risk and prove to be a life saving benefit for patients. Local deformability of the aorta is related to the local mechanical properties of the wall and may provide indication on the state of weakening of the wall tissue. We propose a 3D image-based approach to compute aortic wall strain maps in vivo. The method is applicable to a variety of imaging modalities that provide sequential images at different phases in the cardiac cycle. We applied the method to a series of abdominal aneurysms imaged using cine-MRI obtaining strain maps at different phases in the cardiac cycle. These maps could be used to evaluate the distensibility of an aneurysm at baseline and at different follow-up times and provide an additional index to clinicians to facilitate decisions on the best course of action for a specific patient.

  8. [The Abdominal Ultrasonographic Appearance of Acute Phlegmonous Gastritis].

    Odai, Tsuyoshi; Hibino, Takenori


    Phlegmonous gastritis (PG) is a nonspecific suppurative inflammation disease arising from the submucosal layer, and extending to the full thickness of the stomach. We herein report on a case of acute PG which was diagnosed with abdominal ultrasonography. A 64-year-old man presented at a hospital after having recently undergone pacemaker implantation for the treatment of complete atrioventricular block. He was admitted as an emergency due to a fever of 39 degrees C. He showed anorexia, epigastralgia, vomiting of coffee-ground emesis on the second hospital day, and abdominal ultrasonography (AUS) performed on the third hospital day showed the disappearance of the normal laminated structure and hypoechoic thickening of the stomach walls. Upper gastrointestinal endoscopy revealed significant hyperplasia of the stomach walls, an erythrogenic mucosa, and poor extension. On the fourth hospital day, computed tomography revealed concentric thickening of the stomach walls. Streptococcus pyogenes was cultured from his blood sample. Based on those findings, the patient was diagnosed as having acute phlegmonous gastritis. His clinical symptoms improved and the abnormal ultrasonographic examination findings thereafter returned to normal following the administration of antibiotics. PG should therefore be included in the differential diagnosis when encountering patients with acute abdomen. We experienced a rare case of acute phlegmonous gastritis and AUS was useful for making an early diagnosis.

  9. Abdominal aortic aneurysm repair - open - discharge

    ... this page: // Abdominal aortic aneurysm repair - open - discharge To use the sharing features ... References Orandi BJ, Black JH. Open repair of abdominal aortic aneurysms. In: Cameron JL, Cameron AM, eds. Current Surgical ...

  10. Implanting intra-abdominal radiotransmitters with external whip antennas in ducks

    Korschgen, C.E.; Kenow, K.P.; Gendron-Fitzpatrick, A.; Green, W.L.; Dein, F.J.


    We developed and evaluated a surgical procedure for implanting intra-abdominal radiotransmitters with external whip antennas in captive mallards (Anas platyrhynchos). Transmitters were implanted in the abdominal cavity and the antennas exited through the caudal abdominal wall and skin. Birds with implanted transmitters developed mild to moderate localized air sac reactions. These reactions involved adhesions of the right anterior abdominal air sac to the liver with contractions around the transmitters and antenna catheters. The adhesions were reinforced by a proliferation of connective tissue and lined by multinucleated giant cells (foreign body reaction). Casual observation indicated that neither behavior nor activity of the birds was altered by the histological reaction to the transmitter implant. No increase in systemic lesions (particularly liver or kidney) could be correlated with the histological reactions. Our evaluations indicate that the procedure is a reliable method for radiomarking ducks and the technique has been successfully used in 2 field studies.

  11. Randomized clinical trial comparing blunt tapered and standard needles in closing abdominal fascia.

    Nordkam, R.A.; Bluyssen, S.J.; Goor, H. van


    Glove perforation frequently occurs during the course of surgical procedures, introducing risks for both surgeons and patients. The aim of this study was to compare the use of blunt tapered and "sharp" needles during abdominal wall closure with respect to the incidence of glove perforation and the c

  12. Unexpectedly ease surgery for a worrisome abdominal mass: Pedunculated GISTs☆

    Baskiran, Adil; Otan, Emrah; Aydin, Cemalettin; Kayaalp, Cuneyt


    INTRODUCTION Discovery of abdominal masses often poses significant diagnostic difficulties. GISTs are mesenchymal masses, with specific histological features. Dimensions may vary from millimeters to giant tumours. We would like to present our case, which had an unexpectedly easy operative course which was easily handled with a simple surgical excision with a short operative duration. PRESENTATION OF CASE A 38 years old female patient was diagnosed to have an abdominal heterogen mass of 15 cm × 12 cm × 10 cm in dimension. Abdominal computed tomography revealed the solid mass between the stomach and pancreas corpus and tail, possibly orginating from the pancreas. With the preoperative diagnosis of locally invasive distal pancreas cancer the patient underwent laparotomy, following the dissection, the mass was observed to be originating from the posterior gastric Wall, extending exophytically with a peduncle of 5 cm in width, without any visual evidence for peritoneal invasion and metastasis. The tumour and the peduncle was resected with stapler device. Total operation time was 30 min. Postoperative course was uneventful. Pathologic diagnosis was gastrointestinal stromal tumour (GIST). DISCUSSION Pedunculated large GISTs are not frequent and they can enlarge as 15 cm in diameter and compress the neighbouring organs. When they were huge, it is difficult to differentiate the origin of the masses. GISTs should be considered in differential diagnosis of giant abdominal masses. CONCLUSION When GISTs are huge and pedunculated, it can be difficult to differentiate the origin of the masses. This case report presents unexpectedly ease surgery for a worrysome abdominal mass. PMID:23999120

  13. Abdominal Compartment Syndrome: pathophysiology and definitions

    Cheatham Michael L


    Abstract "Intra-abdominal hypertension", the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome", the development of pressure-induced organ-dysfunction and failure, have been increasingly recognized over the past decade as causes of significant morbidity and mortality among critically ill surgical and medical patients. Elevated intra-abdominal pressure can cause significant impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous ...

  14. Diagnosis and Management of Severe Acute Pancreatitis Complicated with Abdominal Compartment Syndrome

    陶京; 王春友; 陈立波; 杨智勇; 许逸卿; 熊炯炘; 周峰


    Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered.Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7 %) while in the later, 4 (80%)died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.

  15. Superman play and pediatric blunt abdominal trauma.

    Machi, J M; Gyuro, J; Losek, J D


    Two pediatric patients with life-threatening intra-abdominal injuries associated with Superman play are presented. The cases illustrate the importance of knowing the mechanism of injury in the assessment of children with blunt abdominal trauma. The diagnostic value of liver enzymes and the controversies surrounding the radiographic assessment of pediatric blunt abdominal trauma are presented.

  16. Abdominal Incisional Endometriosis Following Cesarean Section: Report of 2 Cases

    Azam Azargoon


    Full Text Available Endometriosis is described as the presence of functioning endometrial tissue (glands and stroma outside the uterine cavity. The most common location is within the pelvis. However, extra pelvic endometriosis is a fairly uncommon disorder and difficult to diagnose. It can sometimes occur in a surgical scar. Scar endometriosis is a rare condition and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. It presents as a painful, slowly growing mass in or near a surgical scar. We report two cases of abdominal wall endometriosis following hysterotomy and cesarean section. Consequently the pathogenesis, diagnosis and treatment are discussed.

  17. Arrhythmogenic right ventricular dysplasia masquerading as an abdominal episode.

    Kaya, Mehmet Gungor; Yalcin, Ridvan; Ozin, Bulent; Altunkan, Sekip; Cengel, Atiye


    A 19-year-old woman presented with abdominal pain. Aside from epigastric tenderness, the patient's physical examination was unremarkable. She developed ventricular tachycardia with left bundle branch block morphology shortly after admission. Echocardiography revealed a thin, enlarged, and hypokinetic right ventricle. Electron beam computed tomography demonstrated hypodense areas in the right ventricular free wall suggestive of fatty infiltration, which suggested arrhythmogenic right ventricular dysplasia. The diagnosis was confirmed with the use of cardiac magnetic resonance imaging. The patient received an implantable cardioverter-defibrillator. This case illustrates a noncardiac presentation of a rare yet treatable cardiac condition.

  18. Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease

    Ali Ridha


    Full Text Available Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003. This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms.

  19. Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease

    Oguejiofor, Njideka; Al-Abayechi, Sarah; Njoku, Emmanuel


    Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003). This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms. PMID:28299215

  20. The Diagnostic Value of Intra-abdominal Pressure in Patients with Blunt Acute Abdominal Trauma

    Huseyin Narci


    Full Text Available Purpose:The objective of this study was to determine the diagnostic value of intra-abdominal pressure measurement in blunt abdominal trauma patients. Method: A prospective study was performed in 49 patients with blunt trauma in our university hospital for 1 years. Patients were randomly into two groups as intra-abdominal trauma (n=28 and extraabdominal trauma (n=21 groups. Intra-abdominal pressures was measured an classified as normal (10 cm H2O or less, elevated (more than 10 cm H2O determined indirectly. Results: No significant differences were found between abdominal trauma and extra-abdominal trauma groups from the point of intra-abdominal pressure (IAP. One the other hand, in abdominal trauma group; significant differences were observed between operated patients. Intra-abdominal bleeding was found in 10 patients and all of them elevated IAP values (exceeding 16 cm H2O. For determining the intra-abdominal injury, IAP had a sensitivity of 93%, specificity 38% in patients. Conclusion: IAP exceeding 16 cm H2O with blunt abdominal trauma patients abdominal trauma can be detected. It is thought that IAP, indirect monitoring of abdominal trauma patients is a reproducible, scientific guide and simple method.To determine the efficacy of the measurement of intra-abdominal pressure in blunt abdominal trauma patients, further studies should be done. [Cukurova Med J 2012; 37(3.000: 157-161

  1. Acupuncture Treatment of Abdominal Pain



    @@ Case History Mr. Li, a university student aged 23 years, paid his first visit on July 16, 2001, with the chief complaint of abdominal pain for one day. The patient stated that one day before when it happened to be the weekend, he got abdominal pain after supper, which went worse gradually and caused him to roll all over in bed. The pain was slightly alleviated half an hour later after he had taken some pain killers. Upon inquiry, the patient said that because of their newly graduation from the university, he and his classmates were so excited that they went to have a sumptuous lunch with alcoholic drinks. And in the evening he ate again a delicious supper cooked for him by his mother, after which he continued to have some fruit and dessert.

  2. Wireless energy transmission through the abdominal wall for operating implanted actuators and recharging implanted energy storages with due consideration to the simultaneous undisturbed transcutaneous transmission of encoded signals for controlling various functions of the implant; Drahtloser Energietransfer durch die Bauchdecke zum Betrieb von implantierten Aktoren und zur Wiederaufladung von implantierten Energiespeichern unter Beruecksichtigung der gleichzeitigen ungestoerten transkutanen Uebertragung von codierten Signalen zur Steuerung verschiedener Funktionen eines Implantats

    Peter, S.


    One of the two goals of this study was to provide a power supply for a medical implant for artificial micturition such that the energy storages integrated in the system could be recharged without a need for wires passing through the abdominal wall. This goal was achieved by the development and use of an inductive, transcutaneous energy transfer technique adapted to the requirements of an urological implant. The technique provides the following advantages to patients: complete avoidance of infections that would otherwise be provoked by the presence of a permanent open wound in the abdominal wall allowing wires to pass through. This in turn permits reducing medication and eliminates the costs of constant wound treatment. The system can largely be operated independently of stationary power supply systems, since it can run for several days without the patient requiring a wall outlet close by. This greatly improves patient mobility. The development of a transcutaneous signal transmission technique based on infrared or radiofrequency has been a decisive step towards restoring patients' volitional control of micturition, thus eliminating one of their main concerns, namely the prospect of having to live an externally controlled life dominated by a fixed around-the-clock discharge schedule. The additional facility of being able to query the reservoir's filling level allows patients to check on this at any time, making it much easier for them to plan their visits to the toilet. This was the second goal of the study. The combination of transcutaneous energy and signal transfer has produced, amongst other things, a package solution which will substantially improve the quality of life of patients having undergone total bladder extirpation and will also reduce aftercare costs for payers. [German] Eines der beiden ziele der vorliegenden Arbeit war, das medizinische Implantat des kuenstlichen harnableitenden Systems so mit Energie zu versorgen, dass die im System



    The FIRE AND RESCUE Group of TIS Commission informs that the climbing wall in the yard of the Fire-fighters Station, is intended for the sole use of the members of that service, and recalls that access to this installation is forbidden for safety reasons to all persons not belonging to the Service.CERN accepts no liability for damage or injury suffered as a result of failure to comply with this interdiction.TIS/DI

  4. Intraabdominal desmoplastic small cell tumor: radiological aspects - a case report; Tumor de pequenas celulas desmoplasico intra-abdominal - relato de um caso

    Santos, Leonardo Velloso; Siciliano, Antonio Alexandre O.; D' Annunciacao, Gisele Esteves; Nunes, Vania Cristina S.R. [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Dept. de Radiologia; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia


    The authors describe a case of a 21-year-old white female admitted with abdominal pain and distension, as well as bowel movement alteration. A hard, lobulated and painful abdominal mass was found at physical exam and signs of ascitis were also presented. Abdominal and pelvic ultrasound and computed tomography demonstrated and heterogeneous mass, adhering to the anterior abdominal wall, extending from the umbilicus to the pelvis and displacing the urinary bladder inferiorly and bowel loops posteriorly. Cul-the-sac implants were also noted. The major omentum was diffusely infiltrated by nodules as laparotomy. A desmoplastic small cell tumor was found after histopathological analysis of the surgical specimen. (author)

  5. Catastrophic necrotizing fasciitis after blunt abdominal trauma with delayed recognition of the coecal rupture--case report.

    Pecic, Vanja; Nestorovic, Milica; Kovacevic, Predrag; Tasic, Dragan; Stanojevic, Goran


    Necrotizing fasciitis (NF) is a rare bacterial infection with dramatic course, characterized by widespread necrosis of the skin, subcutaneous tissue, and superficial fascia which can often lead to death. We present a case of a 27-year-old male with NF. One day after experiencing blunt abdominal trauma caused by falling over bike handlebars, the patient was admitted to a regional hospital and treated for diffuse abdominal pain and large hematoma of the anterior abdominal wall. Due to worsening of general condition, he was referred to our hospital the following day and operated on urgently. Surgery revealed rupture of the coecum with peritonitis and abdominal wall infection. After surgery, fulminant necrotizing fasciitis developed. Antibiotics were prescribed according to wound cultures and subsequent necrectomies were performed. After 25 days, reconstruction of the abdominal wall with skin grafts was obtained. Despite all resuscitation measures including fluids, blood transfusions, and parenteral nutrition, lung infection and MODS caused death 42 days after initial operation. Blunt abdominal trauma can cause the rupture of intestine, and if early signs of peritoneal irritation should present, emergency laparotomy should be performed. Disastrous complication are rare but lethal.

  6. Urgent Abdominal Re-Explorations

    Peskersoy Mustafa


    Full Text Available Abstract Background Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs, the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs and factors that affect mortality. Methods Demographic characteristics; initial diagnoses; information from and complications of the first surgery received; durations and outcomes of UAR(s performed in patients who received early RLs because of complicated abdominal surgeries in our clinic between 01.01.2000 and 31.12.2004 were investigated retrospectively. Statistical analyses were done using the chi-square and Fisher exact tests. Results Early UAR was performed in 81 out of 4410 cases (1.8%. Average patient age was 50.46 (13–81 years with a male-to-female ratio of 60/21. Fifty one (62.96% patients had infection, 41 (50.61% of them had an accompanying serious disease, 24 (29.62% of them had various tumors and 57 (70.37% patients were operated under emergency conditions during first operation. Causes of urgent abdominal re-explorations were as follows: leakage from intestinal repair site or from anostomosis (n:34; 41.97%; hemorrhage (n:15; 18.51%; intestinal perforation (n:8; 9.87%; intraabdominal infection or abscess (n:8; 9.87%; progressive intestinal necrosis (n:7; 8.64%; stomal complications (n:5; 6.17%; and postoperative ileus (n:4; 4.93%. Two or more UARs were performed in 18 (22.22% cases, and overall mortality was 34.97% (n:30. Interval between the first laparotomy and UAR averaged as 6.95 (1–20 days, and average hospitalization period was 27.1 (3–78 days. Mortality rate was found to be higher among the patients who received multiple UARs. The most common (55.5% cause of mortality was sepsis/multiple organ failure (MOF. The rates for common mortality and sepsis/MOF-dependent mortality that occured following UAR were

  7. [Abdominal aortic aneurysm treated by endovascular surgery: a case report].

    Alconero-Camarero, Ana Rosa; Cobo-Sánchez, José Luis; Casaus-Pérez, María; García-Campo, María Elena; García-Zarrabeitia, María José; Calvo-Diez, Marta; Mirones-Valdeolivas, Luz Elena


    An aneurysm is an abnormal dilation or irreversible convex of a portion of an artery. The most common site of aneurysms is the abdominal aorta and their appearance is often due to degeneration of the arterial wall, associated with atherosclerosis and favored by risk factors such as smoking and hypertension, among others. Left untreated, aneurysm of the abdominal aorta usually leads to rupture. Treatment is surgical, consisting of the introduction of a prosthesis, composed basically of a stent and an introducer, into the aorta. We report the case of a person diagnosed with abdominal aortic aneurysm in a routine examination who was admitted for ambulatory surgical treatment. We designed a nursing care plan, following Virginia Henderson's conceptual model. The care plan was divided into 2 parts, a first preoperative phase and a second postimplantation or monitoring phase. The care plan contained the principal nursing diagnoses, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), nursing interventions classification (NIC) and nursing outcomes classifications (NOC), and collaboration problems/potential complications. The patient was discharged to home after contact was made with his reference nurse in the primary health center, since during the hospital phase, some NOC indicators remained unresolved.

  8. Abdominal actinomycosis: barium enema and computed tomography findings.

    Uchiyama, N; Ishikawa, T; Miyakawa, K; Iinuma, G; Nakajima, H; Ushio, K; Yokota, T; Akasu, T; Shimoda, T


    A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy. Past history included the use of an intrauterine device (IUD) until 10 years before manifestation of these symptoms. We followed up the patient, via diagnostic imaging, for 7 months. On initial barium enema, a polypoid lesion was visualized at the bottom of the cecum and there was constriction of the sigmoid colon; the appendix was not seen. Seven months later, poor extension at the cecum, severe constriction in the sigmoid colon, and narrowing of the terminal ileum were also visualized. On computed tomography (CT), the lesion was initially localized only in the ileocecal region adjacent to the sigmoid colon. After 7 months, the lesion had infiltrated adjacent anatomic components and showed direct infiltration of the pelvic space. Differential diagnosis was difficult, as it was not obvious whether this was a pelvic abscess due to inflammation or appendiceal carcinoma. Laparotomy was performed. Macroscopically, the lesion was not limited to the ileocecal region, but involved the right ureter, tubes the Fallopian and ovary, bladder, psoas muscle, and abdominal wall. Pathology findings showed, chronic inflammatory tissue with evidence of actinomycosis. Although previous reports have described a lack of specific findings in this disease. When actinomycosis is suspected, CT is recommended to define its extent.

  9. Low-Grade Myxofibrosarcoma of the Rectus Abdominus Muscle Infiltrating into Abdominal Cavity: A Case Report.

    Nomura, Tadashi; Sakakibara, Shunsuke; Moriwaki, Aya; Kawamoto, Teruya; Suzuki, Satoshi; Ishimura, Takeshi; Hashikawa, Kazunobu; Terashi, Hiroto


    Objective: Myxofibrosarcoma (MFS) is a relatively rare tumor that is histologically characterized by myxoid stroma and spindle cell proliferation. This tumor most commonly arises as a slow growing, enlarging painless mass in the extremities of elderly patients. Methods: We report a case of a primary, low-grade MFS in the rectus abdominis muscle infiltrating the abdominal cavity of a 75-year-old man. Results: The patient underwent a wide excision of the right abdominal wall mass with a 3-cm surgical margin from the scar due to a biopsy. The tumor infiltrated the urinary bladder, peritoneum, and external iliac vessels. Twenty-six months after the initial operation, he had recurrences in his abdominal wall, urinary bladder, and right iliac vessels. Conclusions: To our knowledge, primary MFS of the muscle in the abdomen has not been documented previously. Although this case was histopathologically classified as a low-grade tumor, it infiltrated the abdominal cavity. The tumor is suspected to have penetrated the abdominal cavity below the linea arcuata, which lacks the posterior sheath of the rectus abdominis muscle; from there, it could easily spread without being blocked by any biological barriers.

  10. Gasless iaparoendoscopic single-site cholecystectomy with abdominal wall iift:a trial compared with conventional laparoscopic cholecystectomy%悬吊式经脐单孔腹腔镜胆囊切除术与传统腹腔镜胆囊切除术的对比研究

    刘南; 张光永; 胡三元


    目的:对比分析免气腹悬吊式经脐单孔腹腔镜胆囊切除术(gasless laparoendoscopic single-site cholecystectomy,GLESC)和传统腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的优缺点.方法:2009年6月至2010年7月为34例患者行GLESC,为35例患者行传统LC.观察两组患者的体重指数(BMI)、合并症、手术时间、出血量、中转开腹率、C反应蛋白(C-reactive protein,CRP)水平、疼痛指数、肩背部疼痛发生率、恢复进食时间、术后住院时间及切口并发症等.结果:GLESC组2例患者因BMI过高显露欠佳,改行悬吊合并低气腹单孔腹腔镜手术,32例成功施行GLESC,35例成功实施LC.术后随访48~174d,平均120d.平均手术时间GLESC组[(78.91±24.59)min]长于LC组[(46.84±9.60)min](P<0.05).两组术后6h疼痛指数相似[GLESC组为(4.96±0.98),LC组为(5.42±1.17)].术后24h疼痛指数GLESC组(3.39±1.12)明显低于LC组(4.84±1.42)(P=0.001).GLESC组肩背部疼痛发生率低于LC组(P=0.009).两组术中出血量、CRP水平、住院时间均相似,差异无统计学意义.两组均无切口并发症发生.结论:对大多数胆囊疾病患者而言,GLESC是安全、有效、可行的,具有优于传统腹腔镜手术的美容效果及术后疼痛轻、康复快等优点.对于一定BMI和身高的患者,术野显露满意,手术入路简单有效.GLESC可在将来成为标准的、可普遍施行的手术.%Objective:On the request to make laparoscopic surgery even more minimally invasive,laparoscopic single-site surgeries have been described. A novel technique of gasless [aparoendoscopic single-site surgery with abdominal wall lift (AWL) was presented for cholecystectomy. This study aimed to compare the outcome and morbidity parameters of gasless laparoendoscopic single-site cholecystectomy (GLESC) and standard laparoscopic cholecystectomy (LC). Methods: Data from 34 patients who underwent GLESC and 35 patients who underwent LC between Jun. 2009 and Jul. 2010


    施馨博; 王莉莉


    group) .Control group implemented perioperative routine nursing ,while the observation group re‐ceived perioperative implementation of evidence-based nursing .On 15 d ,30 d after preoperative and post‐operative ,the anxiety ,depression ,and quality of life score changes ,catheter days ,hospitalization days ,com‐plication rate and clinical satisfaction were compared between the two groups .Results There were no obvi‐ous difference between the two groups on preoperative anxiety ,depression ,and quality of life score (P>0 . 05) .On 15 d and 30 d after two groups of SAS and SDS scores were significantly decreased compared with preoperative (P0 .05) .Conclu‐sions Evidence-based nursing is celebrated for to patients as the center ,critical thinking is used to seek and formulate nursing plan and strictly implemented ,can significantly improve the clinical nursing quality , shorten the treatment time , reduce the patients'psychological and physiological burden ,prevention and treatment of complications ,abdominal wall built in bladder cancer all cut the ileum generation bladder fistula perioperative implementation effect is remarkable .It is worthy of popularization and application .

  12. Comparação entre o uso de fio inabsorvível (polipropileno e fio absorvível (poliglactina 910 na fixação de prótese de polipropileno em correção de defeitos músculo-aponeurótico da parede abdominal: estudo experimental em ratos Comparison between fixation of polypropylene mesh with polypropylene suture and polyglactin 910 suture for treatment of muscle-aponeurotic defects of abdominal wall: experimental study in rats

    Álvaro Gianlupi


    (polypropylene one. METHODS: Eighty-one male rats of the Wistar breed, weighing from 180g to 220g, were submitted to a longitudinally resection of a musculoaponeurotic and peritoneal segment (3x2 cm of the abdominal wall. Reconstruction was performed by reinforcement with polypropylene mesh, overlaid on the aponeurosis. They were distributed in two groups according to the thread used for mesh fixation as follows: (1 polyglactin 910 group, fixed with 8 stitches 4.0 Polyglactin 910 suture; and (2 Polipropylene group, fixed with 4.0 polypropylene suture. The skin suture was performed with 4.0 nylon continuous stitches. After 90 days, animals were sacrificed and submitted to macroscopic evaluation for the presence of hernias. Histologic samples were stained for Hematoxylin-Eosine and Sirius-Red and were assessed for signs of cicatrization such as chronic inflammatory reaction, fibrosis, suture absortion and percentage of fibrosis by computer-assisted video morfometric technic. RESULTS: There was no significant difference between the groups studied in relation to hernia formation (p=0,194. The histologic study showed significant increase of fibrotic reaction in the polipropylene group (p=0,0005, but this finding was not confirmed in the video-morfometric evaluation. Considering chronic inflammatory reaction, there was no difference between groups in relation to giant cells, lymphocytes and neutrophils. However, in the polipropylene group, macrophages were significantly increased (p=0,02. Polyglactin 910 has not been absorved 90 days after the procedure. CONCLUSIONS: The results of this study suggest that the fixation of polipropilene mesh is effective using absorbable sutures in the repair of ventral (incisional hernias.

  13. The clinical application of multi-slice spiral CT angiography in abdominal aortic disease


    Objective: To evaluate the clinical application of multi-slice spiral CT angiography(MSCTA) in the assessment of abdominal aortic disease. Methods: Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent (Omnipaque 300 I g/L) 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique,Tll level abdominal aorta was set as the target vessel and the threshold was 180-200 Hu, slice width was 3 mm and with a pitch of 4-6.Original data were transferred to working-station to perform functional reconstruction. Results: Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms (Debakay type Ⅲ ) and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rupture site of abdominal aorta intima and mural thrombus. Conclusion: MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.

  14. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper.

    Sartelli, Massimo; Abu-Zidan, Fikri M; Ansaloni, Luca; Bala, Miklosh; Beltrán, Marcelo A; Biffl, Walter L; Catena, Fausto; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Demetrashvili, Zaza; Demetriades, Demetrios; Diaz, Jose J; Di Saverio, Salomone; Fraga, Gustavo P; Ghnnam, Wagih; Griffiths, Ewen A; Gupta, Sanjay; Hecker, Andreas; Karamarkovic, Aleksandar; Kong, Victor Y; Kafka-Ritsch, Reinhold; Kluger, Yoram; Latifi, Rifat; Leppaniemi, Ari; Lee, Jae Gil; McFarlane, Michael; Marwah, Sanjay; Moore, Frederick A; Ordonez, Carlos A; Pereira, Gerson Alves; Plaudis, Haralds; Shelat, Vishal G; Ulrych, Jan; Zachariah, Sanoop K; Zielinski, Martin D; Garcia, Maria Paula; Moore, Ernest E


    The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.

  15. Peritoneoscopy of the liver after abdominal surgery.



    Full Text Available The incidence of intraperitoneal adhesion after abdominal surgery was studied. Peritoneoscopy was performed in 933 patients with liver diseases over the 6 year 5 month period from March 1974 to July 1980. Of the patients, 352 (37.7% had undergone an abdominal operation, and intraperitoneal adhesion was detected in 205 (58.2% of these patients. The liver was not observable in 5 out of 61 patients with adhesions after upper abdominal operations. Whereas, the liver was clearly observable in patients with lower abdominal operations in spite of adhesions. Out of the 581 patients without any abdominal operations, 30 patients (5.2% had adhesions in the abdominal cavity, and 6 of them had extensive adhesions that partially obscured the observation of liver surface. In all patients, peritoneoscopy was performed without complications by avoiding the surgical scar for puncture sites and ensuring a free air lumen before trocar puncture.

  16. Abdominal compartment syndrome. Interesting aspects.

    Nicolás Rubio Silveira


    Full Text Available The management of the abdominal compartiment syndrome is still a controversial point nowadays. Its early diagnosis and treatment constitute a challenge for surgeons and physicians at the intensive care unit who have to face these cases . The physiopathologic changes that can occur can lead to the patients death, constituting pulmonary thromboembolism and multiorgan failure the principal causes of death. This paper presents the principal clinical parameters and technical procedures for its diagnosis and treatment with the aim of diminishing its morbi-mortality raits in our hospitals

  17. [Internationalization and innovation of abdominal acupuncture].

    Wang, Yong-Zhou


    Characteristics of abdominal acupuncture are analyzed through three aspects of inheriting and innovation, collaborated research as well as international visual field. It is pointed that abdominal acupuncture is based on clinical practice, focuses on enhancing the therapeutic effect and expending the clinical application. It also promots the thinking on how to recall the tradition and how to inherit tradition availably. The modern medical problems should be studied and innovation resolutions should be searched, which can help the internationalization and modernization of abdominal acupuncture.

  18. Clinical profile of abdominal tuberculosis in children

    Ira Shah; Ramya Uppuluri


    Aim: A retrospective study was conducted in children, suffering from abdominal TB, attending Pediatric TB clinic from 2007 to 2009. Materials And Methods: Age-wise distribution and type of abdominal TB were analyzed with clinical features. Results : Out of 285 children with TB, 32 (11.2%) had abdominal tuberculosis. Male: Female ratio was 2.1:1. 7 (21.9%) children were 10 years of age. The most comm...

  19. Abdominal Compartment Syndrome due to OHSS

    Firoozeh Veisi


    Full Text Available Abdominal compartment syndrome is a dangerous clinical situation, usually following abdominal injuries&operations. It is seldom observed in patients with gynecologic and obstetric problems. Abdominalcompartment syndrome may be consequence ovarian hyperstimulation syndrome. A 28-year-old womanpresented as a sever ovarian hyperstimulation.The increased IAP indicated that OHSS may beconsidered a compartment syndrome. Abdominal compartment syndrome needs laparotomy orparacentesis for reduction of pressure.

  20. Abdominal Pain in the Geriatric Patient.

    Magidson, Phillip D; Martinez, Joseph P


    With an aging population, emergency department clinicians can expect an increase in geriatric patients presenting with abdominal pain. Compared with younger patients, this patient population is less likely to present with classic symptoms, physical examination findings, and laboratory values of abdominal disease. However, the morbidity and mortality associated with elderly patients presenting with abdominal pathologic conditions are significant. For this reason, the clinician must be familiar with some subtle and not so subtle differences when caring for the geriatric patient with abdominal pain to ensure timely diagnosis and appropriate treatment.

  1. Abdominal migraine in childhood: a review

    Scicchitano B


    Full Text Available Beatrice Scicchitano,1 Gareth Humphreys,1 Sally G Mitton,2 Thiagarajan Jaiganesh1 1Children's Emergency Department, 2Department of Paediatric Gastroenterology, St Georges Hospital, St Georges Healthcare NHS Trust, Tooting, London, United Kingdom Abstract: The childhood condition of abdominal migraine has been described under many different synonyms, including "abdominal epilepsy", "recurrent abdominal pain", "cyclical vomiting syndrome", and "functional gastrointestinal disorder". In the early literature, abdominal migraine is included in the "childhood periodic syndrome", first described by Wyllie and Schlesinger in 1933. Abdominal migraine has emerged over the last century as a diagnostic entity in its own right thanks to the development of well defined diagnostic criteria and its recent inclusion in the International Headache Society's Classification of Headache disorders. Despite this progress, little is known about the pathophysiology of the condition, and the treatment options are poorly defined. Here we summarize the recent literature, with particular focus on establishing the diagnosis of abdominal migraine and its pathophysiology, and suggest an approach to management. Keywords: abdominal migraine, recurrent abdominal pain, abdominal epilepsy, cyclical vomiting

  2. Percutaneous drainage of abdominal abcess

    Men, Sueleyman E-mail:; Akhan, Okan; Koeroglu, Mert


    The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that have been described to drain pelvic abscesses include transrectal or transvaginal approach with sonographic guidance, a transgluteal, paracoccygeal-infragluteal, or perineal approach through the greater sciatic foramen with CT guidance. Both the renal and the perirenal abscesses are amenable to percutaneous drainage. Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses as well.

  3. MR angiography in abdominal neoplasms

    Squillaci, E. [Dept. of Radiology, Rome-2 Univ., Hospital S. Eugenio, Rome (Italy); Crecco, M. [Dept. of Radiology, Cancer Research Inst. (Regina Elena), Rome (Italy); Grandinetti, M.L. [Dept. of Radiology, Cancer Research Inst. (Regina Elena), Rome (Italy); Maspes, F. [Dept. of Radiology, Rome-2 Univ., Hospital S. Eugenio, Rome (Italy); Lo Presti, G. [Dept. of Radiology, Rome-2 Univ., Hospital S. Eugenio, Rome (Italy); Squillaci, S. [Dept. of Radiology, Cancer Research Inst. (Regina Elena), Rome (Italy); Simonetti, G. [Dept. of Radiology, Rome-2 Univ., Hospital S. Eugenio, Rome (Italy)


    The role of magnetic resonance angiography (MRA) in the evaluation of vascular involvement was studied in 55 patients with abdominal neoplasms. A 2-D time-of-flight (TOF) technique was used in all patients. All patients underwent CT and MR examinations before MRA. Also, MR angiograms were compared with digital subtraction angiography in 22 cases, with Doppler US in 13 cases, and with surgical findings in 20 cases. In all patients with liver neoplasms (n=29) MRA demonstrated the absence of flow in the infiltrated segments. Pericapsular neovascularization was observed in 12 patients. Portal vein involvement was correctly detected in 27 patients. In all cases MRA demonstrated in relationship between the tumor and venous structures. Portosystemic shunts were visualized in 20 of 21 patients with portal hypertension. Vena cava thrombosis (3 cases), compression (5 cases), and displacement (2 cases) were correctly demonstrated. In renal (n=6) and adrenal gland (n=3) tumors renal vein compression was correctly detected in 2 cases, displacement in 1 case, and thrombosis in 3 cases, with only 1 false-positive finding. In 7 patients with pancreatic tumors MRA demonstrated splenic vein thrombosis in 2 cases and compression in 2 cases, with one false-positive finding. Our results indicate that MRA provides precise information regarding venous vascular involvement in abdominal neoplasms, but preoperative arterial mapping is still problematic. (orig.)

  4. Development of the ventral body wall in the human embryo.

    Mekonen, Hayelom K; Hikspoors, Jill P J M; Mommen, Greet; Köhler, S Eleonore; Lamers, Wouter H


    Migratory failure of somitic cells is the commonest explanation for ventral body wall defects. However, the embryo increases ~ 25-fold in volume in the period that the ventral body wall forms, so that differential growth may, instead, account for the observed changes in topography. Human embryos between 4 and 10 weeks of development were studied, using amira reconstruction and cinema 4D remodeling software for visualization. Initially, vertebrae and ribs had formed medially, and primordia of sternum and hypaxial flank muscle primordium laterally in the body wall at Carnegie Stage (CS)15 (5.5 weeks). The next week, ribs and muscle primordium expanded in ventrolateral direction only. At CS18 (6.5 weeks), separate intercostal and abdominal wall muscles differentiated, and ribs, sterna, and muscles began to expand ventromedially and caudally, with the bilateral sternal bars fusing in the midline after CS20 (7 weeks) and the rectus muscles reaching the umbilicus at CS23 (8 weeks). The near-constant absolute distance between both rectus muscles and approximately fivefold decline of this distance relative to body circumference between 6 and 10 weeks identified dorsoventral growth in the dorsal body wall as determinant of the 'closure' of the ventral body wall. Concomitant with the straightening of the embryonic body axis after the 6th week, the abdominal muscles expanded ventrally and caudally to form the infraumbilical body wall. Our data, therefore, show that the ventral body wall is formed by differential dorsoventral growth in the dorsal part of the body.

  5. Ultrasound Evaluation of an Abdominal Aortic Fluid-Structure Interaction Model

    Traberg, Marie Sand; Jensen, Jørgen Arendt


    Ultrasound measurements are used for evaluating biomechanics of the abdominal aorta (AA) predicted by a fluid- structure interaction (FSI) simulation model. FSI simulation models describe the complete arterial physiology by quantify- ing the mechanical response in the vessel wall caused by the pe......Ultrasound measurements are used for evaluating biomechanics of the abdominal aorta (AA) predicted by a fluid- structure interaction (FSI) simulation model. FSI simulation models describe the complete arterial physiology by quantify- ing the mechanical response in the vessel wall caused...... by the percolating pulsating blood. But the predictability of FSI models needs validation for these to be usable for diagnostic purposes. Ultrasound measurements are suitable for such an evaluation as the wall displacement can be measured in vivo and compared to the wall displacement simulated in the FSI model....... Spectral Doppler velocity data from 3 healthy male volunteers were used to construct inlet profiles for the FSI model. Simultaneously, wall movement was tracked and used for comparison to FSI model results. Ultrasound data were acquired using a scanner equipped with a research interface. The wall...

  6. Uso da peritoneostomia na sepse abdominal Laparostomy in abdominal sepsis

    Juvenal da Rocha Torres Neto


    Full Text Available Dentre as modalidades terapêuticas da sepse abdominal, a peritoneostomia tem papel decisivo permitindo explorações e lavagens da cavidade de forma facilitada. Observamos pacientes com diagnóstico clínico de sepse abdominal internados no Serviço de Coloproctologia do Hospital Universitário da Universidade Federal de Sergipe, e que foram submetidos a peritoneostomia de janeiro de 2004 a janeiro de 2006. Foram avaliados quanto ao diagnóstico primário e secundário, tipo de peritonite secundária, antibioticoterapia, esquema de lavagens, tempo de peritoneostomia, complicações e desfecho. Estudamos 12 pacientes, com idade de 15 a 57, média de 39,3 anos. Diagnóstico primário: abdome agudo inflamatório em 6(50%, abdome agudo obstrutivo em 2(16,7%, abdome agudo perfurativo em 2(16,7%, fístula enterocutânea em 1(8,3% e abscesso intra-cavitário em 1(8,3%. Diagnóstico secundário: perfuração de cólon em 4(33,3%, abscessos intra-cavitários em 3(25%, deiscências de anastomoses em 3(25%, 1(8,3% com tumor perfurado de sigmóide e 1(8,3% com necrose de cólon abaixado. Peritonite fecal em 10(83,3% e purulenta em 2(16,7%. A antibioticoterapia teve duração média de 19 dias. Lavagens de demanda em 6(50%, programadas em 4(33,3% e regime misto em 2(16,7%. O tempo médio de peritoneostomia foi de 10,9 dias (1-36. Como complicações: evisceração em 2(16,7% e fistulização em 1(8,3%. Quatro pacientes evoluíram com óbito.Among the therapeutics approach form of abdominal sepsis, the laparostomy has a decisive role allowing cavity explorations and lavages in an easier way. We study patients with abdominal sepsis diagnoses admitted to our surgical service of Coloproctology form Sergipe´s Federal University Hospital who underwent a Bogotá Bag laparostomy associated or not with polypropylene mesh from January 2004 to January 2006. These patients were assessed as: first and second diagnosis; secondary peritonitis type; antibiotic

  7. Complications of transcatheteral occlusion of abdominal arteries

    Vogel, H.; Belz, Buecheler, E.


    The number of transcatheteral occulsion of abdominal arteries reported so far enables us to differentiate between complications, which are specific for the methods used, or which are organ-specific and material-specific. Among the complications specific for the methods concerned are: complications occuring in angiography; tumour embolism in the lung; transport of embolic material into the lung; transport of embolic material into the arteries of the lower half of the body; renal insufficiency; necrosis; and, finally, abscess formation. Among the organ-specific complications are: necrosis (especially of the spleen and in the operated upper gastro-intestinal tract); abscess formation (spleen, kidneys, liver); retroperitoneal phlegmones (kidney); relapsing haemorrhages (gastro-intestinal tract, kidneys); renal insufficiency (in case of pre-existing renal damage); hypertension (described so far as transient blood pressure increase only); hypertensive crisis (after renal artery occulsion for malignant hypertension); hepatic insufficiency and gallbladder infarction (in embolisation of the liver); transport of embolic material into adjacent arteris (in case of embolisation, into the vessels of the truncus coeliacus); and, finally, hypoglycaemia (in embolisation of the liver). Among the material-specific complications are: adhesion of the catheter tip to the vascular wall (Bucrylate); dislocation of Gianturco's spiral; allergic (anaphylactic) reaction to the embolic material (not described so far); recanalisation (in case of absorbable substances such as Fibrospum and Gelfoam); substitutive blood supply via the formation or extension of collaterals; necrosis in peripherally (capillary) occluding substances such as Bucrylate and Ethibloc; and, finally, abscess formation (in case of non-sterile embolic material). Some of these complications can be classified under more than one category.

  8. Prephonatory chest wall posturing in stutterers.

    Baken, R J; McManus, D A; Cavallo, S A


    The possibility that prephonatory chest wall posturing is abnormal in stutterers was explored by observing rib cage and abdominal hemicircumference changes during the interval between the presentation of a stimulus and the production of/alpha/by a group of stutterers (N = 5). It was found that the patterns of chest wall adjustment for phonation were qualitatively identical in the stutterers and in a comparable group of normal men studied previously. There was, however, a significant difference in the way in which lung volume changed during the execution of the chest wall adjustment. This was considered to be indicative of delayed glottal closure among the stutterers rather than representative of a primary ventilatory disturbance.

  9. Trichobezoar – A Rare Cause of Abdominal Mass and Gastric Outlet Obstruction

    Ana Couceiro


    Full Text Available The authors present the clinical case of a 14-year old girl with weight loss, anorexia, epigastric abdominal pain and postprandial vomiting with 5 months duration. There was a background of trichophagia for 2 years without evidence of alopecia or psychiatric history. The physical examination revealed an epigastric mass motionless, stony, with poorly defined limits, painful on palpation and about 7 cm diameter. Abdominal ultrasonography showed thickening of the gastric wall and antrum with gastric distension. The abdominal tomography scan and endoscopic examination revealed the presence of a bulky trichobezoar occupying almost the entire gastric lumen. It was decided to undergo gastrotomy and extraction of the bezoar. The postoperative period was uneventful.

  10. Simulation of bifurcated stent grafts to treat abdominal aortic aneurysms (AAA)

    Egger, Jan; Freisleben, Bernd


    In this paper a method is introduced, to visualize bifurcated stent grafts in CT-Data. The aim is to improve therapy planning for minimal invasive treatment of abdominal aortic aneurysms (AAA). Due to precise measurement of the abdominal aortic aneurysm and exact simulation of the bifurcated stent graft, physicians are supported in choosing a suitable stent prior to an intervention. The presented method can be used to measure the dimensions of the abdominal aortic aneurysm as well as simulate a bifurcated stent graft. Both of these procedures are based on a preceding segmentation and skeletonization of the aortic, right and left iliac. Using these centerlines (aortic, right and left iliac) a bifurcated initial stent is constructed. Through the implementation of an ACM method the initial stent is fit iteratively to the vessel walls - due to the influence of external forces (distance- as well as balloonforce). Following the fitting process, the crucial values for choosing a bifurcated stent graft are measured, ...

  11. The preventive effect of fish oil on abdominal aortic aneurysm development.

    Kugo, Hirona; Zaima, Nobuhiro; Mouri, Youhei; Tanaka, Hiroki; Yanagimoto, Kenichi; Urano, Tetsumei; Unno, Naoki; Moriyama, Tatsuya


    Abdominal aortic aneurysm (AAA) is a vascular disease involving gradual dilation of the abdominal aorta and high rupture-related mortality rates. AAA is histologically characterized by oxidative stress, chronic inflammation, and extracellular matrix degradation in the vascular wall. We previously demonstrated that aortic hypoperfusion could cause the vascular inflammation and AAA formation. However, the preventive method for hypoperfusion-induced AAA remains unknown. In this study, we evaluated the effect of fish oil on AAA development using a hypoperfusion-induced AAA animal model. Dilation of the abdominal aorta in the fish oil administration group was smaller than in the control group. Collagen destruction and oxidative stress were suppressed in the fish oil administration group than in the control group. These results suggested that fish oil could prevent the development of AAA induced by hypoperfusion.

  12. Well Leg Compartment Syndrome After Abdominal Surgery

    Christoffersen, Jens Krogh; Hove, Lars Dahlgaard; Mikkelsen, Kim Lyngby;


    BACKGROUND: Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature. METHODS: Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal...

  13. Actinomycosis mimicking abdominal neoplasm. Case report

    Waaddegaard, P; Dziegiel, Morten Hanefeld


    In a patient with a 6-month history of nonspecific abdominal complaints, preoperative examination indicated malignant disease involving the right ovary, rectum and sigmoid, but laparotomy revealed abdominal actinomycosis. Removal of the ovary and low anterior colonic resection followed by penicil...

  14. Thoraco-abdominal aortic aneurysm branched repair

    Verhoeven, E. L. G.; Tielliu, I. F. J.; Ferreira, M.; Zipfel, B.; Adam, D. J.


    Open thoraco-abdominal aortic aneurysm repair is a demanding procedure with high impact on the patient and the operating team. Results from expert centres show mortality rates between 3-21%, with extensive morbidity including renal failure and paraplegia. Endovascular repair of abdominal aortic aneu

  15. Falling walls

    It was 20 years ago this week that the Berlin wall was opened for the first time since its construction began in 1961. Although the signs of a thaw had been in the air for some time, few predicted the speed of the change that would ensue. As members of the scientific community, we can take a moment to reflect on the role our field played in bringing East and West together. CERN’s collaboration with the East, primarily through links with the Joint Institute for Nuclear Research, JINR, in Dubna, Russia, is well documented. Less well known, however, is the role CERN played in bringing the scientists of East and West Germany together. As the Iron curtain was going up, particle physicists on both sides were already creating the conditions that would allow it to be torn down. Cold war historian Thomas Stange tells the story in his 2002 CERN Courier article. It was my privilege to be in Berlin on Monday, the anniversary of the wall’s opening, to take part in a conference entitled &lsquo...

  16. Acute spontaneous isolated dissection of abdominal aorta

    Ali Akbar beigi


    Full Text Available

    • Aortic dissection occurs when the layers of the aorta separate as a result of extra luminal cavity of blood through an intimal tear. Dissection limited to the abdominal aorta is rare. Unfortunately, the appropriate management of dissecting aneurysm of abdominal aorta is not documented yet. A 43 years old man was admitted to Al-zahra hospital in Isfahan with sudden onset of periumbilical abdominal pain. CT scan confirmed infrarenal dissection of abdominal aorta. Performing laparotomy, aorta was repaired using bifurcate collagen-coated Dacron graft. Surgical intervention with synthetic graft is recommended in patients with dissecting aortic aneurysm of infrarenal segments where the extent of dissection is limited and accessible.
    • Keywords: Aneurysm, Aortic dissection, Aortic aneurysm abdominal surgery.

  17. 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.

  18. Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain

    Wewer, Anne Vibeke; Strandberg, C; Pærregaard, Anders;


    We report on our experience with routine abdominal ultrasonography in 120 children (aged 3-15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n...... = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. CONCLUSION: The diagnostic value of abdominal ultrasonography in unselected children with recurrent abdominal pain is low. However, the direct visualization...... of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain....

  19. Distribution, size, and shape of abdominal aortic calcified deposits and their relationship to mortality in postmenopausal women

    Ganz, Melanie; de Bruijne, Marleen; Dam, Erik B.


    -of-the-art AC24 marker introduced by Kauppila. Methods. For 308 postmenopausal women, we quantified the number of AAC and the percentage of the abdominal aorta that the lesions occupied in terms of their area, simulated plaque area, thickness, wall coverage, and length. We analysed inter...

  20. Randomized clinical trial of mast cell inhibition in patients with a medium-sized abdominal aortic aneurysm

    Sillesen, H; Eldrup, N; Hultgren, R


    BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard...