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At least 577 records · Page 32Linked to original sources
PubMed2005

A proposed algorithm for managing the open abdomen.

Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004. Of the 20 patients with open abdomen, two patients died within 24 hours and one was transferred. The remaining 17 were managed using an algorithm including a combination of delayed primary closure (DPC), vacuum-assisted fascial closure (VAFC), Wittmann Patch (WP) (Star Surgical, Inc., Burlington, WI), and planned ventral hernia via absorbable mesh with split thickness skin grafting (PVH). The mean Simplified Acute Physiology Scores (SAPS II) was 31 (predicted mortality 73%). All patients initially underwent VAFC and re-exploration 12-48 hours later. Indications for continued VAFC included 1) gross contamination, 2) massive bowel edema, 3) continued bleeding at re-exploration. If these conditions were absent, DPC was attempted or a WP was employed until fascial closure. Twenty-eight day mortality was 5.9 per cent (1/17 patients). Enterocutaneous fistulae occurred in two patients (11.7%). Fascial closure was achieved in 6 patients (35.3%). Eleven patients were managed with PVH. Using an algorithm with a combination of several techniques, open abdomen can be managed with minimal morbidity and acceptable closure rates.

Abdominal Injuries↗
PubMedDate not supplied

Endovascular treatment of mycotic hepatic artery aneurysm in the hostile abdomen--a case report.

Mycotic hepatic artery aneurysms are rare. This report documents a case in which a mycotic hepatic artery aneurysm was associated with Crohn's disease, renal adenocarcinoma, and a urinary tract infection. Endovascular management of this mycotic hepatic artery aneurysm was successful in the setting of a hostile abdomen based on multiple previous operations, a stoma, and a scarred abdomen.

Adult↗
PubMed1995

Entrance doses during lateral lumbar spine and antero-posterior abdomen examinations: generator waveform dependence.

In North Trent, UK, an entrance dose survey of lateral lumbar spine and antero-posterior (AP) abdomen examinations has been carried out in 17 radiology departments. The survey comprised 294 lateral lumbar spine and 322 AP abdomen entrance dose measurements. The mean entrance doses were found to be approximately half of the relevant national reference entrance dose levels of 30 mGy and 10 mGy, respectively. The effect of generator waveform on entrance dose was studied by separating the generators into two types: "pulsating potential" (PP) generators and "constant potential" (CP) generators for each examination. PP generators comprised 23% of the total number of examinations. The mean entrance dose and radiographic exposure factors from CP generators were found to be significantly lower than those from PP generators. The use of CP type generators, together with low attenuation components can significantly reduce patient entrance doses for these examinations.

Body Weight↗
PubMed2006

Spectrum of imaging findings in the abdomen after radiotherapy.

OBJECTIVE: The objective of this article is to describe the imaging appearances of radiation injury to normal tissues in the abdomen that may be seen during imaging surveillance of oncology patients. CONCLUSION: Therapeutic radiation is used to treat various malignant conditions in the abdomen. Radiation damages normal surrounding tissues as well as the intended tumor. Radiation changes vary based on the target organ and the time from completion of therapy. Familiarity with the spectrum of changes that may be seen on follow-up imaging studies should help in the differentiation of radiation injury from other causes such as recurrent malignancy.

Abdominal Neoplasms↗
PubMed1984

Evaluation of the gasless abdomen in the newborn and young infant with metrizamide.

The finding of a gasless abdomen on the abdominal radiograph of an infant over 12 hr old is usually abnormal and may reflect a serious pathologic disorder. Accurate diagnosis is important to plan appropriate therapy. A careful review of the clinical history and the plain chest and abdominal radiographs will often permit an accurate diagnosis to be made. In cases where the diagnosis remains in doubt, contrast studies of the bowel with metrizamide have proved helpful. This report presents six infants with gasless abdomens of unknown cause. In each case, a metrizamide contrast study of the bowel was helpful in providing an accurate diagnosis.

Child, Preschool↗
PubMed1993

Helical (spiral) CT of the abdomen.

Since its clinical introduction in the mid 1970s, techniques for CT have undergone many changes that have dramatically altered how CT scans are obtained. Helical (spiral) CT allows for faster acquisition of truly volumetric CT data than is possible with conventional scanners. Routine helical CT of the abdomen is now possible because of three major technical refinements: the development of the slip-ring gantry, improved detector efficiency, and greater tube cooling capability. This article reviews the technical principles that govern helical CT, the potential advantages and disadvantages of this technique, and initial clinical experience with helical CT of the abdomen.

Humans↗
PubMed1994

T2-weighted MR imaging of the abdomen: fast spin-echo vs conventional spin-echo sequences.

OBJECTIVE: The purpose of this study was to compare one optimized T2-weighted fast spin-echo sequence with one T2-weighted conventional spin-echo sequence to determine the impact of fast spin echo on image quality and diagnostic efficacy for evaluation of the abdomen. SUBJECTS AND METHODS: A total of 32 patients with 43 lesions involving various abdominal organs were examined. T2-weighted fast spin-echo (4000/119/4, echo train length = 16, matrix = 256 x 256) and T2-weighted conventional spin-echo (3400-3800/80/2, matrix = 128 x 256) images were compared qualitatively and quantitatively to determine whether the two types of images differed with respect to tissue contrast, conspicuousness of lesions, image quality, and artifacts. RESULTS: The signal intensity of all abdominal structures (except gallbladder and fat) was significantly lower on fast spin-echo images than on conventional spin-echo images. Qualitative liver-to-spleen contrast was significantly reduced on fast spin-echo images, whereas quantitative liver-to-spleen contrast was not significantly different. Blurring of anatomic structures, vascular pulsation, and chemical-shift misregistration artifacts were significantly reduced on fast spin-echo images. The qualitative conspicuousness and contrast-to-noise ratio for all lesions evaluated together were not significantly different (p = .5 and p = .069, respectively) on fast spin-echo vs conventional spin-echo images. However, qualitative conspicuousness and contrast-to-noise ratio of solid lesions were significantly reduced on fast spin-echo images (p = .022 and p = .01, respectively). The contrast-to-noise ratio of cystic lesions was significantly better (p = .002) on fast spin-echo images than on conventional spin-echo images. CONCLUSION: Although the fast spin-echo protocol used in this study provides better image quality and contrast-to-noise ratio for cystic abdominal lesions than does conventional spin echo, the qualitative conspicuousness and contrast-to-noise ratio of solid abdominal lesions are decreased. Fast spin echo provides high-quality images with fewer artifacts in significantly less time than is possible with conventional spin-echo images. Further evaluation is necessary to determine the optimal protocol for T2-weighted fast spin-echo MR imaging of the abdomen.

Abdominal Neoplasms↗
PubMed2000

Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT.

OBJECTIVE: We determined the pattern of spread of metastatic lobular carcinoma in the chest, abdomen, and pelvis on CT. MATERIALS AND METHODS: We identified 57 women (age range, 30-79 years; mean age, 57 years) with metastatic lobular carcinoma of the breast who underwent CT of the chest, abdomen, or pelvis between 1995 and 1998. Then two experienced oncology radiologists retrospectively reviewed 78 CT examinations of those patients to identify sites of metastatic disease and to identify complications caused by metastases. RESULTS: Metastases were identified in bone in 46 patients (81%), lymph nodes in 27 patients (47%), lung in 19 patients (33%), liver in 18 patients (32%), peritoneum in 17 patients (30%), colon in 15 patients (26%), pleura in 13 patients (23%), adnexa in 12 patients (21%), stomach in nine patients (16%), retroperitoneum in nine patients (16%), and small bowel in six patients (11%). Eighteen patients (32%) had gastrointestinal tract involvement that manifested as bowel wall thickening. Hydronephrosis was present in six patients (11%). CONCLUSION: Although lobular carcinoma metastasized to common metastatic sites of infiltrating ductal carcinoma, lobular carcinoma frequently metastasized to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa. Gastrointestinal tract involvement was as frequent as liver involvement, appearing as bowel wall thickening on CT. Hydronephrosis was a complication of metastatic lobular carcinoma.

Abdominal Neoplasms↗
PubMed1994

Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects.

A method for stereotactic high-dose radiotherapy of malignancies in the abdomen has been developed. A stereotactic frame for the body has been developed and a method for fixation of the patient in the frame is described. The reproducibility in the stereotactic system of tumours in the liver and the lung was found to be within 5-8 mm for 90% of the patient set-ups. The diaphragmatic movements were reduced to 5-10 mm, by applying a pressure on the abdomen. An analytical method is used to calculate dose distributions for a continuum of beams in an isocentric treatment technique. The advantage of a heterogeneous target dose is demonstrated and proposed for the present application. A non-coplanar treatment technique, using eight individually shaped beams is proposed and has been used for patient treatments. The dose distribution for a patient with a metastasis in the liver is shown as well as dose volume histograms for the target and the liver.

Abdominal Neoplasms↗
PubMed1998

[Clinical thinking and decision making in practice. A patient with pain in the upper abdomen].

A 74-year-old woman was admitted because of abdominal pain. A few weeks before this admission she had had a cerebral infarction in the right hemisphere, reflected by a left sided paralysis, dysarthria, depression and a slight cognitive disorder. The night before admission she woke up from a sharp, continuous pain in the right upper abdomen. Physical examination disclosed pain in the right upper abdomen on palpation. Laboratory tests showed a slight elevation of all 'liver' enzymes. A differential diagnosis of cholecystitis or pyelonephritis was made. Additional tests did not confirm either of these diagnoses. Because of immobilisation pulmonary embolism was then suspected. This diagnosis was confirmed by scintigraphy. The patient was treated and made a full recovery. Diagnostic errors can be made by faulty triggering and omitting verification. The diagnostic strategy for pulmonary embolism is a ventilation perfusion scan, which is followed in case of a non high-probability result by pulmonary angiography. It is emphasized that the presentation of pulmonary embolism can be aspecific.

Abdominal Pain↗
PubMed1999

Abnormal calcification on plain radiographs of the abdomen.

The purpose of this pictorial review is to facilitate recognition and understanding of calcifications seen on conventional radiographs of the abdomen. Calcifications can be categorized by organ system and location in the abdomen. Both common and rare calcifications in the urinary tract, liver, gallbladder, spleen, pancreas, adrenal glands, digestive tract, genital tract, peritoneal cavity, and retroperitoneum are illustrated. Abnormal calcifications in the urinary tract are subcategorized by kidneys, ureters, bladder, and urethra. The density, shape, size, margins, pattern, position, and mobility of calcifications are emphasized for differential diagnoses.

Adrenal Glands↗
PubMed1999

[Liposuction of the abdomen].

The abdomen is a difficult region for liposuction which can be responsible for serious systemic complications and local sequelae, which are difficult to correct. However, spectacular results can also be obtained in the abdomen, provided a very rigorous approach is observed at to each step: indications, technique, postoperative care. In most cases, when well conducted, abdominal liposuction can even avoid abdominoplasty, with all of the risks that it comprises.

Abdominal Muscles↗
PubMed1999

[Complications of plastic surgery of the abdomen].

Plastic surgery of the abdomen remains difficult and is therefore associated with a number of complications of varying severity, but whose global incidence appears to justify a separate chapter. The most serious complications of abdominoplasty are thromboembolic complications, which may be life-threatening. The incidence of these complications must be minimized by rigorous preventive measures. Prevention is based on early mobilization of the patient, perioperative treatment with low molecular weight heparin and wearing of anti-thrombosis stockings. Skin necrosis is generally associated with one or several aetiological factors: excessive tension at the end of the operation, development of a haematoma, excessive or too superficial detachment. The so-called "Morel-Lavallée" fluid collection is best prevented by well performed postoperative compression applied continuously for three weeks after the operation. Complications of isolated abdominal liposuction are exceptional, or at least they should be, when the indication and technique are rigorously respected. The combination of liposuction and abdominoplasty does not add any complication not already described in the case of abdominoplasties and does not increase the incidence of these complications. Liposuction appears to decrease the number of abdominoplasties, but also their extent, which is beneficial in terms of the quality and safety of the postoperative course. A better definition of indications and improvement of techniques have therefore markedly decreased the severity and incidence of complications of plastic surgery of the abdomen. Truly effective preventive measures are available for each of these complications.

Abdominal Muscles↗
PubMed1999

[Gunshot wounds of the abdomen studied by computed tomography. The authors' personal experience in 30 cases].

INTRODUCTION: CT plays an important role in depicting gunshot wounds in parenchymal and hollow organs in the abdomen. Relative to other techniques and to emergency laparotomy, CT permits good assessment of abdominal content, major injuries and changes in other districts, such as chest, pelvis and skull. We investigated the yield and role of CT in diagnosing abdominal gunshot wounds, with their rich and varied radiological signs and associated injuries. MATERIAL AND METHODS: We retrospectively reviewed the findings of 30 patients with abdominal gunshot wounds examined in 4 years at Loreto-Mare Hospital, Naples. All patients were men, age ranging 19-54 years (mean: 35); 6 of them were not from the European Union. Examinations were carried out from diaphragm to pubis with i.v. contrast injection and the CT angiography technique. CT was integrated with chest studies in 6 cases and with skull studies in 5. Subsequent CT follow-ups were necessary in 12 cases submitted to conservative treatment. RESULTS: Liver was the most damaged parenchyma, with hemorrhage and lacerocontusion in 7 cases and mashed in 1 case; spleen was involved in 4 cases; hemoperitoneum was found in 18 cases. Diaphragm was involved in 5 cases and pancreas in 2; gallbladder, stomach and duodenum were involved in 1 case each and jejunum-ileum and colon in 3 and 6 cases, respectively. CT showed renal injury in 3 cases and bladder injury in 2. Eight patients had vertebral gunshot damage. Pneumothorax, hemothorax and lacerocontusion were found in 7 cases; brain was injured in 4 cases and limbs in 16. DISCUSSION AND CONCLUSIONS: Tissue damage extent depends on the speed and kinetic energy the bullet carries into the abdomen. Abdominal radiography shows the bullet and its site, pneumoperitoneum from gastrointestinal perforation, crash bone injuries, vertebral trauma and subcutaneous emphysema. Instead, CT depicts early parenchymal damage and vascular injury and thus becomes a complete and necessary tool for imaging gunshot wounds. CT provides early diagnostic information which help plan emergency treatment and thus decrease mortality. As for angiography and US, we suggest they be used subsequently because in emergency they may delay the diagnosis. Moreover, vessel rupture and active intraabdominal bleeding are easily detected with spiral CT, which appears the best tool for prompt assessment of the injuries associated with gunshot wounds in other districts such as, the skull. To conclude, CT permits adequate planning of emergency surgery and helps select the cases for follow-up, intensive care and conservative treatment.

Abdominal Injuries↗
PubMedDate not supplied

Recurrent liposarcomas of the abdomen and retroperitoneum: three case reports.

We report three cases of patients with liposarcomas of the abdomen who had been treated during the last 13 years (1980-1993). Two patients were men, aged 29 and 51 years, with tumors of the retroperitoneal space and the third patient was a woman aged 64 years with a tumor in the peritoneal cavity. Therapeutic treatment was as aggressive as possible excision of the tumor. In the case of the first male patient, the histological examination revealed a retroperitoneal myxoid liposarcoma which recurred 5 times within 13 years. In the second male patient, it revealed a well differentiated retroperitoneal liposarcoma of the sclerosing type which recurred 5 times within 5 years since the first treatment. Finally, the one female patient had 2 recurrences of myxoid liposarcoma of the abdomen 9 years after the first operation, presented with an infected mass and has been well since then.

Adult↗
PubMed2000

Gunshot wounds of the abdomen: association of surface wounds with internal injuries.

OBJECTIVE: To evaluate and quantify the correlation between surface wounds and internal injuries. METHODS: The medical records of 55 patients, admitted over a two year period with a diagnosis of gunshot wound of abdomen, were reviewed retrospectively. Imaginary trajectories of each bullet track were reconstructed on real scale abdominal anatomy models, and data regarding expected injuries was obtained. This data was then matched with the laparotomy findings for each patient and the percent correlation between observed and expected injuries was calculated. RESULTS: The mean correlation between expected and observed injuries was found to be 31%. Most of the wounds were in the upper abdomen, and the correlation was strongest for fixed organs such as liver and lowest for mobile viscera like small intestine. CONCLUSIONS: The assessment of internal injuries on the basis of entrance and exit wounds is hazardous, due to cavitation and ricochet effects of bullets. The chances of visceral injuries remote from the trajectory are greater than 50%.

Abdominal Injuries↗
PubMedDate not supplied

Multiple chylous cysts of abdomen causing intestinal obstruction.

A case of multiple chylous cysts of the abdomen in a 35 years old female is presented here. The patient presented with signs and symptoms of acute intestinal obstruction. Exploratory laparotomy revealed few intestinal adhesions along with multiple small cysts containing blood stained gelatinous material in the abdominal cavity, some of which were excised alongwith lymph nodes. The abdomen was closed after a saline peritoneal lavage. Chylous nature of the cysts was confirmed on histopathology. The post-operative course was asymptomatic.

Adult↗
PubMed1992

[Gunshot and stab injuries of the abdomen].

From 1973 to 1991 a total of 422 patients underwent surgery because of an abdominal trauma. 12 patients had gunshot wounds and 46 patients stab wounds. In a retrospective study the diagnostic and therapeutic procedure and the indication for surgery are analysed. After gunshot wounds of the abdomen we always performed a laparotomy. In 11 od 12 cases we found serious intra-abdominal injuries. Only in one case the laparotomy was "unnecessary", because of a tangential wound without penetrating of the abdominal wall. After stab wounds the diagnostic and therapeutic management was more selective. Indications for mandatory laparotomy after stab wounds were a manifest hemorrhagic shock, evisceration and a still left weapon in the abdomen (n = 22). The first clinical examination was completed by ultrasound or peritoneal lavage. Pathological findings like free intraperitoneal fluid or a positive lavage also were indications for laparotomy (n = 9). The other patients were observed closely, including repeated physical examination. The indication for surgery then based on the development of clinical signs. The time between first examination and laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy. The mortality rate was 3.4%, but there was no death as a result of the selective approach.

Abdominal Injuries↗