Spontaneous gas gangrene of the abdominal wall.
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Abdominal Wall↗
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Bladder pressure monitoring significantly enhances care of infants with abdominal wall defects: a prospective clinical study.
Increased intraabdominal pressure (IAP) has been demonstrated to cause intestinal and renal ischemia in both animals and humans. Neonates undergoing closure of anterior abdominal wall defects are at risk for these complications from markedly increased IAP, which are putatively responsible for a 13% to 20% mortality. In an effort to decrease morbidity and mortality we performed a 4-year prospective clinical study to determine if monitoring IAP using bladder pressure (BdP) measurements would significantly improve perioperative care in infants with abdominal wall defects. Forty-two consecutive infants with gastroschisis (28) and omphalocele (14) were prospectively studied. Intraoperative and serial postoperative measurements of BdP were obtained from an indwelling bladder catheter using a standard pressure transducer. Methods of initial closure, as well as manipulations in sedation, paralysis, and silo reduction, were selected to keep BdP < 20 mm Hg. Bladder pressure monitoring significantly altered the management of 64% of our patients, particularly those with gastroschisis (74%). Thirteen patients with gastroschisis underwent staged closure; in 7 (54%) this decision was based on high BdP even though bowel reduction was mechanically possible. Elevated BdP influenced the closure method and timing of silo reductions in 5 of 14 (42%) infants with omphalocele. There were no episodes of renal failure or refractory oliguria. There were three patients in a single cluster who developed uncomplicated, nonsurgical necrotizing enterocolitis late in their respective courses. One patient whose bowel was placed in a silo had severe hypotension associated with group B streptococcal sepsis and subsequently developed necrotic bowel despite low BdP.(ABSTRACT TRUNCATED AT 250 WORDS)
Abdominal Muscles↗
The fetus with an abdominal wall defect: management and outcome.
Despite prenatal diagnosis, maternal transport and early perinatal treatment in specialized hospitals, improvement in overall mortality has not been observed among newborns with abdominal wall defects (omphalocele and gastroschisis). A comparison has been made, for both anomalies, between 55 cases treated in the periods 1967-1979 and 30 treated in the periods 1980-1985. In this last group 14 prenatally detected cases were separated from cases discovered at birth. Recent advances in treatment have reduced mortality rates for both of these anomalies. This was especially true for gastroschisis; in omphalocele cases, associated abnormalities appeared to be an unavoidable limiting factor in survival. With prenatal diagnosis a surprising increase in mortality rate was observed among omphalocele cases detected before birth. A possible reason for this is the total number of antenatally diagnosed cases that, with maternal transport, are concentrated in centers where surgical facilities are available. Before introduction of antenatal diagnosis, most of these cases would never have been observed by the pediatric surgeon because of death prior to referral or treatment. Gastroschisis cases may benefit more from antenatal recognition and early treatment because multiple abnormalities or immaturity are not so important limiting factors in survival as in omphalocele cases. Reduced trauma and contamination of exposed viscera, immediate treatment and adequate supportive measures may significantly reduce mortality rate in gastroschisis cases. Operative delivery of fetuses with an abdominal wall defect is controversial. The risk of vaginal route delivery has been over emphasized. Intrapartum rupture of an omphalocelic sac was an extremely rare event before introduction of antenatal diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Abdominal Muscles↗
Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study.
The aim of this study was to determine the effectiveness of mechanical abdominal massage on postoperative pain and ileus after colectomy. We hypothesized that parietal abdominal stimulation could counteract induced pain and postoperative ileus, through common spinal-sensitive pathways, with nociceptive visceral messages. After preoperative randomization, 25 patients (age 52 +/- 5 years) underwent active mechanical massage by intermittent negative pressure on the abdominal wall resulting in aspiration (Cellu M50 device, LPG, Valence, France), and 25 patients (age 60 +/- 6 years) did not receive active mechanical massage (placebo group). Massage sessions began the first day after colectomy and were performed daily until the seventh postoperative day. In the active-massage group, amplitude and frequency were used, which have been shown to be effective in reducing muscular pain, whereas in the placebo group, ineffective parameters were used. Visual analogue scale (VAS) pain scores, doses of analgesics (propacetamol), and delay between surgery and the time to first passage of flatus were assessed. Types and dosages of the anesthetic drugs and the duration of the surgical procedure did not differ between groups. From the second and third postoperative days, respectively, VAS pain scores (P < 0.001) and doses of analgesics (P < 0.05) were significantly lower in patients receiving active massage compared to the placebo group. Time to first passage of flatus was also significantly shorter in the active-massage group (1.8 +/- 0.3 days vs. 3.6 +/- 0.4 days, P < 0.01). No adverse effects were observed. These results suggest that mechanical massage of the abdominal wall may decrease postoperative pain and ileus after colectomy.
Abdominal Muscles↗
Computed tomographic peritoneography in the investigation of abdominal wall and genital swelling in patients on continuous ambulatory peritoneal dialysis.
Computed tomography (CT) of the abdomen following the intraperitoneal instillation of water soluble contrast medium was employed in seven patients with lower abdominal wall and/or scrotal swelling which had developed whilst on continuous ambulatory peritoneal dialysis. In all seven patients contrast medium was seen to leak into the tissues of the anterior abdominal wall from the site of insertion of the Tenckhoff catheter, and in two male patients was shown to track into the scrotum (in one via a patent processus vaginalis). This technique gave accurate anatomical detail which was useful for planning subsequent management.
Abdominal Muscles↗
Primary actinomycosis of the abdominal wall.
A rare case of primary actinomycosis of the abdominal wall presenting as a tumour is described. The patient responded to penicillin therapy well. A brief account of the literature is included.
Abdominal Muscles↗
[Recurrence of transitional cell carcinoma in bilateral upper urinary tracts and ileal conduit with invasion in the abdominal wall around nephrostomy after total cystectomy: a case report].
A case of recurrence of transitional cell carcinoma in bilateral upper urinary tracts and ileal conduit with invasion in the abdominal wall around nephrostomy after total cystectomy is presented. A 33-year-old man with right nephrostomy, after total cystectomy, construction of ileal conduit, bilateral partial ureterectomy and left nephrectomy for transitional cell carcinoma at another hospital was referred to our hospital because of further recurrence in the right renal pelvis and ileal conduit. He had had left nephrostomy before the left nephrectomy was performed. Right nephrectomy and total extirpation of ileal conduit were performed and hemodialysis was started from the day after the operation. However, several weeks later, transitional cell carcinoma was detected pathologically in the left abdominal wall around the left nephrostomy which had been inserted. The renal pelvis was inferred to have leaked urine around the nephrostomy and invasion arose in this region. After radiation therapy he was discharged but he died from recurrence of carcinoma 9 months after the operation. After total cystectomy, examinations by percutaneous puncture of the renal pelvis are very effective for evidence of recurrence in the upper urinary tract. However, we emphasize that the percutaneous technique carries the risk of tumor invasion through the percutaneous urinary tract.
Abdominal Muscles↗
Amyloid (AL) in an octogenarian diagnosed by abdominal wall fat biopsy.
Systemic amyloid (AL) was diagnosed by abdominal wall fat biopsy in an 81 year old woman presenting with severe postural hypotension. The advantages of this little-used diagnostic method are discussed.
Abdominal Muscles↗
A technique for skin grafting around abdominal wall fistulas.
A simple method of grafting around draining abdominal wall fistulas is described. A Silastic sump drain stapled into a doughnut configuration is used. This produces a barrier around the fistula which drains the fluid off as it reaches the perforations of the sump drain.
Abdominal Muscles↗
[Incisional subcutaneous endometrioma of the abdominal wall: report of two cases].
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.
Abdominal Wall↗
Dura covered with fibrin glue reduces adhesions in abdominal wall defects.
Dura can greatly facilitate the closure of abdominal wall defects. However, a main disadvantage of its use are the adhesions which develop between omentum, bowel and dura and may lead to bowel obstructions. In this study various groups of rats had either the anterior wall replaced by untreated dura or by dura covered with fibrin glue prior to implantation. Adhesions were found in 75% of sham operated rats, 100% after untreated dura implantation and 50% after the implantation of fibrin glue treated dura.
Abdominal Muscles↗
[A case of cystadenocarcinoma developing from an ovary autografted to the abdominal wall].
A 73-year-old woman developed an abdominal tumor. We performed tumor resection. The tumor, located between the fascia and peritoneum, was removed completely. The histological finding was cystadenocarcinoma. Thirty-eight years earlier she had undergone total hysterectomy and bilateral oophorectomy because of abnormal genital bleeding. At that time, her own ovary had been transplanted to the abdominal wall. We diagnosed this tumor as having developed from the autografted ovary. The complication of ovarian autografting is cystic degeneration. This complication is rare in Japan. Moreover, malignant change is extremely unusual in ovarian autografting.
Abdominal Muscles↗
[Influence of laser -- infrared irradiation on local complications of early postoperative period in hernias of anterior abdominal wall].
Results of laser-infrared irradiation (LIRI) of postoperative wound after surgical treatment of recurrent hernias of anterior abdominal wall were analyzed. LIRI decreased number of local complications in early postoperative period in patients both with recurrent and primary hernias. The method was more effective for the treatment of local complication in patients with recurrent hernia that is confirmed by reduced of frequency of infiltrates, seromas and suppurations.
Abdominal Wall↗
Effect of intra-abdominal pressure on abdominal wall blood flow.
Adverse effects of increased intra-abdominal pressure (IAP) on cardiac, pulmonary, and renal function have been well described. Abdominal wound healing complications seen in the massively injured patient may also be associated with IAP. The effects of IAP on abdominal wall blood flow, however, have not been documented. This study examines rectus sheath (RS) blood flow in a porcine model of increased IAP. Seven domestic swine were anesthetized with pentobarbital and maintained with isoflurane. Swan-Ganz and femoral arterial catheters were placed for measurement of mean arterial pressure (MAP), cardiac output (CO), and pulmonary capillary wedge pressure (PCWP). A midline incision was performed for placement of laser flow probe on the RS and for placement of catheters to raise and measure IAP. Intra-abdominal pressure was then increased by installation of lactated ringers (LRs) into the peritoneum. Mean arterial pressure was maintained throughout the procedure with intravenous LR. Hemodynamics and RS blood flow data were obtained at baseline, 10, 20, 30, and 40 mm Hg IAP. Analysis of data was done by paired t-test with level of significance at P less than 0.05 and linear regression. Rectus sheath blood flow was significantly reduced at all pressure levels when compared to baseline and negatively correlated (r = -0.82) with increasing IAP. Since indices of systemic perfusion were maintained with increasing IAP, the decreased RS blood flow is most likely due to increased compartmental pressure within the abdomen.
Abdomen↗
The prevention and repair of large abdominal-wall defects by muscle transposition: a preliminary communication.
Abdominal-wall defects, whether occurring as perioperative or postoperative phenomena, have been variously managed. Where the defect cannot be repaired by the use of the patient's own tissues, synthetic material is commonly utilized. Where both the preceding are unsuccessful, closure by means of muscles transferred from the thigh should be considered. Muscles have distinct advantages over fascial grafts or synthetic materials: they are dynamic structures that are effective in controlling herniae, may relieve symptoms in the case of symptomatic scoliosis resulting from the muscle loss, and may improve bowel action by improving expulsive abdominal efforts. Preliminary experience with for patients is presented, together with details of the operative technique. Since this report was submitted, a fifth patient suffering from a congenital "prune belly" syndrome has been treated.
Abdominal Muscles↗
[Computed tomography imaging of abdominal wall metastases after laparoscopy].
We report a case of abdominal wall metastases which occurred after diagnostic laparoscopy in a 64-year-old man presenting with gallbladder carcinoma and peritoneal carcinomatosis. CT showed enhancing masses along the laparoscopic tracts, suggesting metastatic seeding at the time of the surgery. This unusual complication fuels the current debate regarding indications of laparoscopic surgery in patients with malignancy.
Abdominal Muscles↗
Abdominal wall pain--the primary diagnosis.
Localized pain in the abdominal wall is a specific entity too frequently mistaken for major intraperitoneal lesions. The present report covers 14 years' experience with this syndrome, discussing its locations, patterns, potential causes and treatment in 269 patients. By the method utilized, primary cure was achieved in 209 cases or 77.7 per cent. The remaining 58 patients responded to further therapy, with a final cure rate of 99 per cent.
Abdominal Muscles↗
Malignant mesenchymoma arising in an incisional scar of the abdominal wall.
A case of malignant mesenchymoma of the anterior abdominal wall, composed of leiomyosarcoma, chondrosarcoma and osteosarcoma is described. The tumour, arising in the old scar of a previous operation, was completely removed surgically. Eleven months after the operation the patient is well with no evidence of recurrence. There have been no previous reports of malignant mesenchymoma developing in operation scars. We believe that this traumatic factor played a significant role in the aetiology of this rare soft-tissue neoplasm.
Abdominal Muscles↗