SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A review of the literature showed that angiosarcomas of the anterior abdominal wall are rare neoplasms and that all published cases have been preceded by irradiation and/or prior surgery. We believe that our case of a primary angiosarcoma of the anterior abdominal wall is unique and that chronic lymphedema secondary to morbid obesity may be of etiologic importance.
BACKGROUND/AIMS: To investigate the technical ease and results of gasless laparoscopy-assisted distal gastrectomy with lymph node dissection via mini-laparotomy using abdominal wall lift for early gastric cancer. METHODOLOGY: We submitted 20 patients to laparoscopy-assisted distal gastrectomy for early gastric cancer located in the middle or lower stomach. The initial 10 cases underwent perigastric lymph node dissection (D1), and the subsequent 10 cases received further dissection around the left gastric and common hepatic arteries (D1 + a). Mini-laparotomy was placed at the beginning of the procedure. We lifted up the laparotomy and the subcutaneous tissue around the umbilicus by retractors. We accomplished the dissection, resection and reconstruction mainly via the mini-laparotomy using a direct view and a laparoscopic image. RESULTS: Two cases were converted to open. The operative time was significantly longer in D1 + a (225 +/- 49 min) than in D1 (172 +/- 38 min). Blood loss was significantly more in D1 + a (247 +/- 155 mL) than in D1 (109 +/- 60 mL). There was no difference between the two groups in terms of days to first flatus, first oral intake or discharge from the hospital. Postoperative complications included 2 wound infections each in D1 and D1 + a group, and 1 anastomotic stenosis in D1 + a group. CONCLUSIONS: Gasless laparoscopy-assisted distal gastrectomy with D1 + a via mini-laparotomy using abdominal wall lift seems to be feasible and useful for early gastric cancer.
We report the successful management of two patients with abdominal wall gas gangrene and emphasize the principles of proximal gastrointestinal diversion and the initial use of 100% fraction of inspired oxygen (FiO2). Each patient lacked an abdominal wall and intractable fistulas developed. Complete diversion of their gastrointestinal tracts at a proximal level facilitated closure of the fistulas and prevented possible peritoneal contamination. One patient's arterial oxygen pressure was maintained in the 200 to 300 range for two days after admission. This level has been shown to be adequate to stop clostridial alpha toxin production.
The surgical treatment of ventral abdominal wall hernias is still an unsolved problem despite considerable number of conventional methods. Mesh to replace or reinforce the defect by anterior approach has marginally reduced the recurrence rate, but not the infection rate. The authors describe the technique of laparoscopic repair of abdominal wall hernias using an intraperitoneal onlay prosthetic patch of expanded polytetrafluoroethylene (ePTFE) in two cases. Postoperative complications and the advantages of this technique and other published laparoscopic procedures are discussed and compared to the open ventral repairs. It is concluded that laparoscopic prosthetic ventral hernioplasty is a feasible and safe method. It appears to have less morbidity, especially with regard to the infection rate and recurrences, when compared to the open approach. However, authors believe that prospective randomized trials will be needed for further evaluation.
OBJECTIVE: The authors study reviewed patients who underwent operations for omphalocele and gastroschisis to determine survival, morbidity, and long-term quality of life. METHOD: Clinical follow-up of 94 patients cared for with omphalocele and gastroschisis during a 10- to 20-year period after birth. RESULT: Eighty-three patients survived initial treatment. Sixty-one had long-term follow-up. Mean follow-up in the group was 14.2 years. Survival was favorable in the absence of lethal or co-existing major congenital anomalies. Nineteen patients required 31 reoperations, most for abdominal wall hernias and the sequelae of intestinal atresia. Current quality of life was described as favorable (good) in 80% of patients. CONCLUSIONS: Survival rate in patients with abdominal wall defects is favorable and deaths occur substantially in patients with co-existing lethal, or multiple, congenital anomalies. Reoperative surgery is necessary principally in those patients who have postclosure abdominal wall hernias, and in those with bowel atresia at birth. Reoperations are not likely to be necessary after school age. Quality of life in survivors is patient-perceived as entirely satisfactory.
We report our experience with 3 children treated during infancy by abdominal wall reconstruction using lyophilized dura mater. Followup has been 36, 46 and 96 months postoperatively and they demonstrated adequate abdominal wall healing. One child has mild muscular diastasis, while 1 has completely healed. In 1 child a small defect developed in the repair, which was closed at a secondary procedure. Wound infection, dehiscence or herniation did not occur. There has been no evidence of Creutzfeldt-Jakob disease, which has been reported when allogenic dura was not obtained from registered tissue banks. Our experience with dura mater suggests that the material may be a useful adjunct in the repair and closure of complex abdominal defects.
Abscess as a complication of extracorporeal shock wave lithotripsy is a rare condition. We present the computed tomography findings of an abdominal wall abscess that occurred after extracorporeal shock wave lithotripsy for which prophylactic antibiotics had not been given. The abscess destroyed the posterior abdominal wall muscles and dissected into the thorax. The muscles were thickened and showed enhancement. A parenchymal defect in the right kidney adjacent to a caliceal stone, with strands extending from this defective region to the abscess, was observed, and was thought to be the result of parenchymal destruction caused by the shock waves. Other parts of the kidney and psoas muscle were normal. Microbiologic examination revealed Escherichia coli.
The "components separation" technique involves separating the layers of the abdominal wall to allow midline advancement. The purpose of the study was to compare the success rate of the components repair versus other methods. Repair methods included components separation (n = 11), mesh (n = 15), primary (n = 21), TFL grafts (n = 5), TFL or latissimus flaps (n = 4), and rectus turnover (n = 4). The results were: 16 of 60 hernias recurred, with significant risk factors being body mass index (BMI) greater than 30 kg/m2 (p = 0.04), wound infection or breakdown (p < 0.03), and possibly concurrent colostomy or enterocutaneous fistula repair (p = 0.11). Only one of 11 hernias recurred using the components methods, four of 15 recurred using mesh repairs, three of 21 recurred using primary repairs, four of five recurred using TFL grafts, two of four recurred using TFL/latissimus flaps, and two of four recurred using rectus turnovers. There were 19 complications (infection or wound breakdown), with risk factors being smoking (p = 0.002) and possibly BMI greater than 30 kg/m2 (p = 0.08). The results suggest that the components separation method is a viable option for repair of complex abdominal wall hernias without the use of distant flaps or grafts.
We report a case of subcutaneous splenosis in the abdominal wall of a 23-year-old oligophrenic man. It presented as a well-demarcated 8 x 7 x 5-cm subcutaneous tumor in the left inguinal area closely above the scar after a previous operation for hernia. The lesion simulated clinically a hernia or a tumor due to its large size and location and, additionally, no history could be taken from the patient due to his mental handicap.
A total of 6 boys with the prune belly syndrome underwent total abdominal wall reconstruction by a technique that permits simultaneous bilateral orchiopexy and/or urinary tract reconstruction. Until now, the psychosocial implications of the abdominal wall disfigurement caused by this syndrome have been ignored. This procedure provides an excellent cosmetic result that, in turn, promotes psychological health and a positive body image in these children.
Sandifer syndrome designates abnormal posturing in patients with gastroesophageal reflux. To explore its mechanisms via examining relationships among Sandifer syndrome posturing, abdominal wall contractions, and reflux episodes, we studied an affected child in detail. The study utilized esophageal pHmetry, surface electromyography, and split-screen videography. The multichannel physiologic study demonstrated association of rectus abdominis contraction with onset of reflux episodes (P < 0.001) and association of reflux episodes with Sandifer syndrome posturing. This child's subsequent course confirmed his diagnosis and suggested mechanisms of the association of reflux and Sandifer syndrome. We conclude that abdominal wall contractions may induce reflux episodes. Sandifer syndrome may be due to gastroesophageal reflux even without hiatal hernia, macroscopic esophagitis, or reflux symptoms. Despite the absence of more typical reflux symptoms and failure to respond to very aggressive medical therapy, Sandifer syndrome may resolve after fundoplication.
Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other diseases such as hematomas, abscesses and neoplasia. In this study we examined the CT images of 94 patients affected by abdominal wall hernias observed over a period of 6 years. Computed tomography clearly demonstrates the anatomical site of the hernial sac, the content and any occlusive bowel complications due to incarceration or strangulation. Clinical diagnosis of external hernias is particularly difficult in obese patients or in those with laparotic scars. In these cases abdominal imaging is essential for a correct preoperative diagnosis and to determine the most effective treatment.
Congenital diaphragmatic hernia (CDH) and its attendant lack of abdominal domain can create major technical challenges with respect to diaphragmatic and abdominal wall reconstruction, especially in seriously ill infants who require extracorporeal membrane oxygenation (ECMO). The authors reviewed the medical records of all infants with CDH repaired on ECMO at their institution (group 1, 15 patients), and compared them with infants having CDH repair before ECMO (group 2, 20 patients) and with those who had CDH repair but did not require ECMO (group 3, 15 patients). Thirty-seven of 50 patients survived (74%): 10 in group 1, 12 in group 2, and all 15 in group 3. There was a statistically significant difference (P < .001) with respect to the requirement of a polytetrafluoroethylene (PTFE) diaphragmatic patch for patients in group 1 versus those in both groups 2 and 3. There was also a significant difference in the number of patients in whom the abdomen could not be closed (P < .001 for group 1 v groups 2 and 3). Infants who require ECMO before CDH repair are more likely to have large diaphragmatic defects that require prosthetic reconstruction, and abdominal wall closure problems resulting from loss of abdominal domain, which further complicate the management of the physiological derangements from pulmonary hypoplasia and persistent pulmonary hypertension.
The preoperative diagnosis of a cecal perforation associated with Salmonella infection as a cause of abdominal-wall necrotizing fasciitis (AWNF) is clinically difficult. Computed tomography of the abdomen is helpful, and can detect the combined presence of a pneumoscrotum and pneumoperitoneum. Its presence indicates a patent processus vaginalis, which acts as the primary route for the spread of the intra-abdominal infectious process into the abdominal wall. An exploratory laparotomy should be done to confirm the presence of intra-abdominal pathology in order to avoid delayed treatment.
A case of a gravid uterus in an incisional hernia in the anterior abdominal wall of a 27-year-old Nigerian woman is presented. The patient developed an ulceration of the anterior abdominal wall necessitating prolonged hospitalization. She was delivered by emergency lower segment cesarean section at 35 weeks gestational age because of premature labor. The patient unfortunately died from primary postpartum hemorrhage.
The use of transanal excision to remove rectal carcinomas is a relatively new application of this surgical procedure, which may require full thickness excision. Retroperitoneal and abdominal wall emphysema are potential complications of surgical procedures that breach the wall of the colon and rectum. Computed tomographic scans provide the clearest diagnostic picture of developing emphysema, and prompt diagnosis through accurate interpretation of the scans is essential to minimize morbidity and mortality. When the diagnosis is made early and no active infection accompanies the emphysema, the preferred approach to initial treatment is nonsurgical. This article presents a case in which local transanal excision was performed on a 70-year-old male to remove a superficial adenocarcinoma from the lower rectal wall. He developed postoperative retroperitoneal and abdominal wall emphysema. Conservative treatment is discussed.
The varying sites of extrapancreatic tissue necrosis in acute pancreatitis seldom include the anterior abdominal wall. In cases of liver enlargement causing a high portal pressure, the umbilical vein serves as a vent, shunting the portal blood through the teretic hepatic ligament to the anterior abdominal wall. Corticosteroids make the tissues even more susceptible to the activated pancreatic enzymes and are thus a contributing factor to the tissue necrosis. We describe a case of necrosis of the teretic hepatic ligament and the anterior rectus abdominis muscle following acute biliary pancreatitis.
INTRODUCTION: Composite biomaterials designed for the repair of abdominal wall defects are usually composed of a reticular component and a second component, or barrier, which is laminar (absorbable or non-reabsorbable) and which is placed in contact with the visceral peritoneum. This study was designed to evaluate how the composition of this second component affects the biological behavior of the biomaterial and the formation of adhesions. MATERIAL AND METHODS: Defects (7 x 5 cm) comprising all the tissue planes except the skin were created in the anterior abdominal wall of white, New Zealand rabbits. In group A (n = 12) the defects were then repaired with composite prostheses with a non-reabsorbable physical barrier, polypropylene + ePTFE (PL + ePTFE) and PL + polyurethane (PL + PU). In group B (n = 12) the defects were repaired with a reabsorbable chemical barrier, polyester + a polyethyleneglycol/glycerol film (PO + gl) and PL + hyaluronate (PL + hy). Fourteen days after surgery, the animals were sacrificed and specimens were taken for light and scanning electron microscopy and immunohistochemical labeling for macrophages (RAM-11). Adhesions forming at the prostheses/visceral peritoneum interface were quantified. RESULTS: All the materials showed optimal tissue infiltration and mesothelialization. Adhesion formation was similar in prostheses with a physical barrier (PL + ePTFE, 0.49 +/- 0.14%; PL-PU, 0.29 +/- 0.2%). In contrast, those with a chemical barrier showed a significant difference in adhesion formation (PO + gl, 0.55 +/- 0.06%; PL + hy, 18.55 +/- 4.96%; p < 0.05). CONCLUSIONS: Physical barriers seem to induce similar adhesions, while adhesions formed to prostheses with chemical barriers can vary considerably, possibly depending on the chemical composition of the barrier.