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At least 937 records · Page 52Linked to original sources
PubMed2000

Postoperative necrotizing soft-tissue infections of the abdominal wall.

OBJECTIVE: The aim of the underlying study was the evaluation of an aggressive surgical regimen for treatment of postoperative necrotizing soft-tissue infection (NSTI). METHODS: Eight patients with postoperative NSTI of the abdominal wall after emergency (n=6) and elective (n=2) surgery were reviewed over a 9-year period. RESULTS: Initially, three patients presented with general peritonitis. Cultured swabs from the necrotic tissue revealed three to four different types of bacteria in each patient. The mean interval between the primary operation and clinical symptoms of NSTI was 63.0 h. Control of NSTI and intra-abdominal infection was attained by scheduled re-operations on a daily basis accounting for three to six re-interventions in each patient. Temporary closure of the abdominal wall by absorbable polyglactid-acid mesh was used in six cases. Mean hospital stay was 65.3 days (18-110 days). Two of the eight patients died from cardiac arrest and multiple organ failure, respectively. CONCLUSIONS: Rapid diagnosis and onset of treatment is accomplished by the surgeons' knowledge of this disease and a close follow-up of the patients in an intensive care unit.

Abdominal Muscles↗
PubMed2006

Omentum as a cover for abdominal wall loss.

A case of necrotising fasciitis with full-thickness loss of the entire abdominal wall is reported after an uncomplicated elective low anterior resection. Salvage was accomplished by early wide surgical extirpation and repeated re-explorations and debridements. The presence of ample omentum helped prevent evisceration and allowed granulation tissue to gradually seal the abdominal cavity over a period of 4 months without further reconstructive procedures.

Abdominal Wall↗
PubMed2000

Abdominal wall hernia: an uncommon complication of in utero vesicoamniotic shunt placement.

Three cases are reported in which placement of a vesicoamniotic shunt in utero for the treatment of obstructive uropathy led to the rare complication of abdominal wall hernia. All 3 patients underwent vesicoamniotic shunt placement for severe oligohydramnios and a markedly dilated bladder in an effort to preserve renal function and to prevent pulmonary hypoplasia. All three shunts were initially placed at or above the umbilicus. The abdominal wall hernias were closed postnatally at the time of temporary vesicostomy for urethral obstruction. All 3 patients had sufficient pulmonary development, but 2 of 3 had renal failure, requiring dialysis. Management and potential etiology of this rare complication are discussed.

Amnion↗
PubMed1991

Abdominal wall characterization with magnetic resonance imaging and computed tomography. The effect of obesity on the laparoscopic approach.

Laparoscopic complications are most often related to insertion of the Veress cannula or primary trocar. We evaluated the midline abdominal walls of 33 women using magnetic resonance imaging (MRI) or computed tomography to determine if the location and angle of placement of the Veress cannula and primary trocar should be chosen according to the patient's weight to minimize the risk of both preperitoneal placement and retroperitoneal vessel injury. The anterior abdominal wall thickness was measured for three standard approaches used for placement of laparoscopic instruments through the umbilicus at both 45 degrees and 90 degrees from the horizontal. In addition, the distance from the base of the umbilicus to the retroperitoneal vessels was measured. We found that in the nonobese patient, both the Veress cannula and primary trocar can be inserted at 45 degrees, at either the lower margin or base of the umbilicus, with little risk of preperitoneal placement or major vessel injury. In the overweight patient the cannula and trocar can still be inserted at 45 degrees, but placement through the base of the umbilicus rather than the lower margin will minimize the chance of preperitoneal placement. In the majority of obese patients it is only by placing both the Veress cannula and sharp trocar through the base of the umbilicus at or near 90 degrees that preperitoneal placement can be avoided. Alternatively, an open laparoscopic technique can be considered in such high-risk patients to decrease the risk of major vessel injury.

Body Mass Index↗
PubMed1994

Color Doppler flow mapping of abdominal wall perforating arteries for transverse rectus abdominis myocutaneous flap in breast reconstruction: method and preliminary results.

PURPOSE: To describe the use of color Doppler flow ultrasound (US) in preoperative mapping of small perforating arteries in the abdominal wall that supply the transverse rectus abdominis myocutaneous (TRAM) flap used primarily for breast reconstruction. MATERIALS AND METHODS: With a grid (clear x-ray film) and a high-frequency linear-array transducer, the size and position of perforating arteries as they exit the rectus abdominis muscle were mapped preoperatively in 35 patients. Twenty-three of these patients had previously undergone abdominal surgery; 26 underwent reconstruction and clinical follow-up. RESULTS: Operating time was decreased and flap design was planned to include the largest perforating arteries and minimize the overall abdominal wall defect. Two of the 26 patients who underwent TRAM flap reconstruction had partial flap loss: One continued to smoke, which may have caused microvascular compromise; and a paucity of perforating arteries was seen in the second patient. CONCLUSION: Preoperative mapping of perforating arteries for TRAM flap reconstruction provides a rational basis for flap design and patient selection, which may affect flap survival.

Abdominal Muscles↗
PubMed1994

[Abdominal wall implantation metastasis 2 years after apparently uneventful laparoscopic cholecystectomy].

An extraordinary rare case of implant metastasis at the laparoscopic working port, two years after an apparent uncomplicated laparoscopic cholecystectomy is presented. The histological reexamination of the gallbladder with the detection of a minimal carcinomatous lymphangiosis in newly prepared sections, the exclusion of other primary tumors and also the tumor-free interval of six months until now, after radical excision of the abdominal wall, are strongly suggestive for an intraoperative tumor cell dissemination into the abdominal wall by a histologically unrecognized carcinoma of the gallbladder.

Abdominal Muscles↗
PubMed1997

Uterine leiomyoma particle growing in an abdominal-wall incision after laparoscopic retrieval.

BACKGROUND: As laparoscopic myomectomy gains acceptance among patients and pelvic surgeons, new laparoscopic techniques create a risk for complications that were not encountered in classic laparotomy myomectomy. Report of such complications will allow surgeons to undertake appropriate steps to prevent them. CASE: Fragments of uterine leiomyomas unintentionally implanted and growing in abdominal-wall incisions after laparoscopic myomectomy presented clinically with incisional pain and an abdominal-wall mass of increasing size. Diagnosis was confirmed by the histology, and treatment was achieved by excision. CONCLUSION: In the differential diagnosis of a progressively increasing incisional mass and pain after laparoscopic myomectomy, inadvertent implantation and growing particles of uterine leiomyomas should be considered when fragmented tumors are removed through a trocar sleeve.

Abdomen↗
PubMed2000

Changing profile of abdominal wall defects in Japan: results of a national survey.

BACKGROUND/PURPOSE: The incidence of gastroschisis has increased over the past 3 decades in a number of countries. To elucidate the Japanese status of anterior abdominal wall defects, the Japanese Society of Pediatric Surgeons conducted a national survey in Japan. METHODS: Information was obtained by sending out a questionnaire to 192 University Hospitals, Children's hospitals, and general hospitals that each had more than 200 beds. The characteristics of the patients including the birth date, birth weight, gestations, rate of associated anomalies, rate of antenatal diagnosis and prognosis, maternal age, gravidity, history of smoking, and drug use were analyzed. RESULTS: The authors obtained answers from 149 institutions, including 1,785 cases of omphalocele and 970 cases of gastroschisis, which were treated between 1975 to 1997. There was a significant increase in the incidence of gastroschisis, from 0.131 in 1975 to 1980, 0.269 in 1981 to 1985, 0.337 in 1986 to 1990, 0.461 in 1991 to 1995 to 0.467 per 10,000 births in 1996 to 1997. The incidence of omphalocele was 0.322 in 1975 to 1980, 0.567 in 1981 to 1985, 0.657 in 1986 to 1990, 0.741 in 1991 to 1995 to 0.626 per 10,000 births in 1996 to 1997, respectively. In the omphalocele group, 43.1% of the mothers were between 25 to 29 years of age, whereas in the gastroschisis group 42.6% of the mothers were 20 to 24 years of age. In the gastroschisis group, the number of primipara mothers was larger than that of multipara mothers. In the omphalocele group, approximately 10% of the mothers smoked during each period, whereas in the gastroschisis group, the percentage of smoking mothers increased chronologically from 12.9% in 1981 to 1985, 18.7% in 1986 to 1990, 23.5% in 1991 to 1995 and 29.3% in 1996 to 1997. A history of drug use by the mother was approximately 10% for both the omphalocele and gastroschisis groups. In the omphalocele group, 55.9% had associated anomalies against 21.8% in the gastroschisis group. Approximately 10% in the omphalocele group and less than 3% in the gastroschisis group showed chromosomal abnormalities. From 1986, a significant number of cases detected antenatally has been observed. CONCLUSIONS: There have been substantial changes in the incidence of anterior abdominal wall defects, particularly regarding gastroschisis in Japan. The reasons for such changes are most likely multifactorial, further epidemiological monitoring is thus called for.

Abnormalities, Multiple↗
PubMed1981

The use of preserved human dura for closure of abdominal wall and diaphragmatic defects.

The surgical management of large body wall defects presents special challenges. The prosthetic materials employed for these defects, although readily available, have the disadvantage of susceptibility to infection. Autologous tissue is frequently not available in sufficient quantity. The long-term functional and histologic results of the use of preserved human dura for closure of abdominal wall and diaphragmatic defects have been evaluated. Dural patches were sutured into abdominal wall and diaphragmatic defects of six dogs, using interrupted sutures of Dexon and Prolene. The animals were killed eight, 16 and 24 weeks after patch placement. The strength of the material was tested with a pneumoperitoneum prior to death and in all animals it appeared firmly incorporated into the host tissue. Histologically there was a mononuclear inflammatory response seen at eight weeks, with resolution by 24 weeks. Ingrowth of surrounding collagen and muscular tissue produced a firm union between the homologous material and the host tissue. The results of this study indicate that preserved human dura is an excellent material for closure of body wall defects. It appears to be well tolerated by host tissue and maintains its strength over prolonged periods of time.

Abdominal Muscles↗
PubMed2004

Chronic abdominal wall pain: clinical features, health care costs, and long-term outcome.

BACKGROUND & AIMS: Chronic abdominal wall pain (CAWP) often is misdiagnosed. We evaluated CAWP patients regarding diagnosis accuracy, clinical features, comorbidity, referral frequency, use of care, and long-term outcome. METHODS: We reviewed the records of all outpatients referred to a gastroenterologist in 5 years, recorded referral indications, and identified patients initially diagnosed with CAWP or irritable bowel syndrome (IBS). Charts of all CAWP patients were reviewed, and direct costs were estimated for abdominal pain-related physician visits and imaging studies during the 12 months before and 12 months after consultation. We appraised long-term pain status by telephone. RESULTS: Of 2709 patients, CAWP was diagnosed by physical examination in 137 patients; the diagnosis remained unchanged after 47.3 +/- 17.7 (mean +/- SD) months in 133 (97.1%) patients. Women predominated over men 4 to 1, pain was usually upper abdominal, had lasted 25.3 +/- 46.3 months, and obesity and painful comorbidities and depression were common. CAWP and IBS comprised 7.8% and 16.3% of symptomatic referrals, respectively. Prereferral, physicians rarely suspected CAWP and often prescribed therapy for acid-peptic disease. Postconsultation, primary care, emergency and specialist visits, and radiologic examinations markedly decreased (P < 0.001), and estimated annual costs decreased from $1133.87 +/- 953.37 to $541.33 +/- 989.04 (P < 0.0001). Therapy varied, and 44 (47.3%) patients had no pain at follow-up evaluation. CONCLUSIONS: CAWP is a common underrecognized disorder. Comorbidities are frequent, and health care use is high. Diagnosis is accurate and reduces health care costs. Over the long term, pain disappearance and persistence occurs in approximately equal proportions of patients.

Abdominal Pain↗
PubMed2000

Abdominal wall necrosis following transcatheter arterial chemoembolization for hepatocellular carcinoma.

A 76-year-old man, who had inoperable hepatocellular carcinoma, had been treated with transcatheter arterial chemoembolization (TACE) 11 times, percutaneous ethanol injection therapy three times and conformal radiotherapy once, all in other hospitals. At this admission, he developed myocutaneous necrosis in the right abdominal wall after TACE, via the collateral of the right internal mammary artery (IMA). Necrosis of the abdominal wall was due to ischemic changes caused by embolization of the distal branches of the IMA, which were aggravated by previous radiation therapy. We advise that embolization of the IMA in patients who have received radiotherapy should be avoided, if possible.

Abdominal Muscles↗
PubMed1994

[Closure of the abdominal wall after removal of a mucocutaneous flap from the transverse rectus abdominis for breast reconstruction. Apropos of 48 cases. Review of the literature].

In view of the good results of breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap, we used this method in 48 patients, but we observed abdominal complications, which are difficult to accept for cosmetic surgery. Hartrampf, one of pioneers of this technique, reports a very low complication, rate by closing the abdominal wall without the use of prosthetic mesh. However his results are not reproducible as numerous authors, following his technique, have reported abdominal hernias and now use prosthetic reinforcement. In the light of our experience, we analyse these complications, not only hernias, but also abdominal weakness, indicating a new operation in some cases (6/9). The quality and duration of the follow-up (52 months) accounts for the fairly high complication rate. A review of literature examines the various means of abdominal wall closure and their results. The functional injury of muscular harvesting must also be considered, especially in sports women.

Abdominal Muscles↗
PubMedDate not supplied

[Use of a Gore-Tex patch in the primary repair of congenital defects of the anterior abdominal wall].

The surgical treatments for large omphaloceles and gastroschisis have to avoid a dangerous primary fascial closure when it's not feasible, so the pediatric surgeon can use staged surgical procedures that achieve a gradual increase in size of the abdominal cavity. Therefore, a staged approach is mandatory to avoid a complicated reduction and it's the best treatment for large congenital abdominal wall defects. Gore-Tex soft tissue is easy to handle, pliable, soft and well tolerated, so Gore-Tex patch closure is a safe and good alternative to staged repair in large omphaloceles and gastroschisis. The Authors report about five newborns with large congenital abdominal wall defects, in whom primary fascial closure could not be accomplished, so they were successfully treated by primary repair with Gore-Tex patch. The Authors also describe the surgical technique and they reconsider the last surgical techniques for large omphaloceles and gastroschisis.

Abdominal Muscles↗
PubMed2001

[Abdominal wall metastases as a complication of percutaneous endoscopic gastrostomy in carcinoma of the upper aerodigestive tract].

Percutaneous endoscopic gastrostomy (PEG) has become an important adjunct in the care of head and neck cancer patients. In the literature of the last 10 years, 16 cases of abdominal wall metastasis after PEG implantation were reported. We performed 387 PEG procedures in patients with head and neck cancers. In this paper, we describe two patients with advanced head and neck cancers who underwent PEG prior to cancer therapy and developed metastatic cancer at the PEG site 3 or 4 months later. Although the mechanism of spread cannot be confirmed, direct seeding from passage through the cancer seems likely. Methods of establishing enteral access which avoid tumor-contaminated fields, such as the use of an overtube during conventional PEG or PEG procedure after tumor resection, may be appropriate in head and neck cancer patients. Another possibility of origin is the hematogenous spread of cancer cells from metastases on the abdominal wall.

Abdominal Muscles↗