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PubMed2001

Detection of expiratory flow limitation by manual compression of the abdominal wall.

We have assessed a new method, manual compression of the abdominal wall (MCA) during expiration, in the detection of expiratory flow limitation. Twelve stable patients with chronic obstructive pulmonary disease (COPD) and five normal subjects were studied during spontaneous breathing in the supine and seated posture. MCA was performed during expiration with one hand at the umbilical level and we measured flow, volume, pleural (Ppl) and gastric (Pga) pressures and abdominal anteroposterior (AP) diameter at the umbilical level with magnetometers. No increase in expiratory flow during MCA relative to the preceding breath despite associated increases in pressures was considered as indicating expiratory flow limitation. In seven additional patients with increased upper airway collapsibility (obstructive sleep apnea syndrome [OSAS]), MCA was compared with negative expiratory pressure (NEP). In normal seated subjects, MCA was associated with a decrease in abdominal AP dimension (mean +/- SD: -27 +/- 6%), an increase in Pga (14.7 +/- 7.4 cm H(2)O) and Ppl (6.2 +/- 2.2 cm H(2)O), and an increase in expiratory flow. MCA caused similar changes in abdominal AP dimension and pressures in seated patients with COPD but six of them (50%), including four patients with FEV(1) less than 1 L, had no increase in expiratory flow. In the supine posture, MCA always increased expiratory flow in normal subjects but four additional patients with COPD showed evidence of flow limitation. MCA invariably increased expiratory flow in patients with OSAS whereas the NEP method suggested flow limitation in some cases. We conclude that MCA is a very simple method that allows detection of flow limitation in different positions.

Abdominal Muscles↗
PubMed2003

Abdominal wall metastasis of a cervical adenocarcinoma at the laparoscopic trocar insertion site after ovarian transposition: case report and review of the literature.

BACKGROUND: Laparoscopic ovarian transposition is currently used in the preirradiation management of cervical cancer in young women. This surgical technique helps avoid the short- and long-term complications of early menopause. Because there remains a risk of metastasis at the site where the laparoscopic trocar is inserted, more precise indications for this surgery are required. CASE: We report the case of a patient with an abdominal wall metastasis that followed laparoscopic ovarian transposition performed before radiation therapy and surgical treatment for a stage IIb cervical adenocarcinoma. Observations during the laparotomy nonetheless led us to resect the transposed ovary during the laparotomy. The pathology examination of the ovary found a microscopic metastasis. Several months later, a left abdominal parietal nodule, corresponding to a metastasis of the adenocarcinoma, was found on the site through which the trocar had been inserted during the laparoscopy and was probably associated with the ovarian transposition. CONCLUSION: This is the only published case to describe an abdominal wall metastasis due to laparoscopic trocar insertion during ovarian transposition. The decision to perform a laparoscopic ovarian transposition in cervical cancer must take into account the frequency of trocar site metastases, which seems to be higher with advanced-stage cervical cancers, in cases of lymph node involvement and especially in adenocarcinomas.

Abdominal Neoplasms↗
PubMed1987

Sonographic visualization of physiologic anterior abdominal wall hernia in the first trimester.

Ultrasonography is able to detect some fetal abnormalities as early as the first trimester of pregnancy. Using high-resolution ultrasound equipment, it is possible to demonstrate physiologic herniation of the midgut, which usually occurs between eight and nine weeks' gestation (calculated by last menstrual period). Fourteen cases have been studied with weekly ultrasound examinations between seven and 12 weeks' gestation. This herniation varied to a large extent in the different embryos depending on the amount of protruding intestine. In embryologic terms, the return of the intestine into the peritoneal cavity, and its rotation and fixation to the posterior abdominal wall, should be concluded at ten to 12 weeks. In all cases studied, the persistence of umbilical herniation could be ruled out by sonographic visualization of the umbilical cord insertion between ten and 12 weeks. Therefore, the suspicion of a severe congenital abdominal wall defect, such as omphalocele, umbilical herniation, or gastroschisis can reliably be confirmed only after 12 weeks' gestation.

Abdominal Muscles↗
PubMed1993

Abdominal wall thickness as a means of assessing peritoneal fibrosis in mice.

Herein we describe a method for the quantitative assessment of connective tissue deposition within the peritoneal cavity. Female C57BL/6 mice (8-10 weeks) were given a single intraperitoneal injection of varying concentrations of talc (100 mg, 50 mg, 30 mg, 20 mg) in 1 ml of PBS or PBS alone. After 14 days, animals were killed. Adhesion formation was measured by the standard method of Myllârniemi et al. (1966), namely a gross visual inspection of the peritoneal cavity. This analysis gave a crude assessment of connective tissue deposition in the abdominal cavity but did not allow one to distinguish more subtle differences between intermediate dosage groups. In addition, a histological evaluation was performed. For the latter method, portions of the abdominal wall of mice were fixed and processed for histological analysis using Masson's Trichrome stain which allows for differentiation of connective tissue components. The thickness of connective tissue between the parietal peritoneum and the underlying abdominal wall muscle was measured. A dose-dependent increase in connective tissue deposition was observed in talc-treated animals compared to saline control animals. A differential cell count of the peritoneal exudate cells (PEC) showed that there was no change in cell populations in talc treated animals (compared to control animals). Given the above results, the measurement of connective tissue thickness was found to give the most accurate assessment of peritoneal fibrosis than other previously used methods.

Abdominal Muscles↗
PubMedDate not supplied

Tuberculous abscess of the abdominal wall and multiple splenic abscesses in an immunocompetent patient.

We report a case of a 39-year-old human immunodeficiency virus (HIV)--negative male who presented with a progressively increasing swelling in the left hypochondrium. He did not manifest fever or toxaemic symptoms. Computerised tomographic scan (CT scan) of the abdomen revealed an abscess in the anterior wall and multiple splenic abscesses. Fine needle aspiration from the abscesses in the anterior abdominal wall and the spleen confirmed the diagnosis of tuberculosis as the aetiology. The patient responded well to antituberculosis treatment and the abscesses regressed considerably.

Abdominal Abscess↗
PubMed1992

[A case of Paragonimiasis westermani with pleural effusion eight months after migrating subcutaneous induration of the abdominal wall].

Patients with Paragonimiasis westermani show a typical ring form or nodular shadow on chest X-ray, cough, sputum, and hemosputum. Recently, case reports of Paragonimiasis westermani, accompanied by pneumothorax and pleural effusion, as for Paragonimiasis miyazakii, have been increasing. Paragonimus westermani often causes an ectopic infection in various organs such as the peritoneal cavity, pleural cavity, pericardium, liver, adrenal gland and brain. Cutaneous paragonimiasis is considered one of the typical forms of ectopic infection in its earlier phase, but a few unexpected cases of cutaneous Paragonimiasis westermani have also been reported. A 68-year old man, who had never eaten fresh-water crab or raw sliced meat of wild boar, noticed subcutaneous induration of the abdominal wall. The induration had been gradually moving upwards and to the right from the infraumbilical region for over 20 days, and then disappeared at the right upper lateral abdominal wall. Eight months later, he developed severe pain in the right lower chest, and a chest X-ray showed right pleural effusion. Laboratory examinations revealed eosinophilia (WBC 3940/mm3, eosinophil 9%), elevated ESR, and an elevated serum total IgE level (5517 IU/ml). Ouchterlony's double diffusion test performed with the patient's serum in agarose showed strong bands toward Paragonimus westermani antigen, compared to Paragonimus miyazakii antigen. Immunoelectrophoresis with the patient's serum showed specific bands toward Paragonimus westermani antigen. This patient was finally diagnosed as having Paragonimiasis westermani infection, and he responded to praziquantel administration. The clinical course of this patient appears to be rare in cases of Paragonimiasis westermani infection. The clinical course of this case resembled some cases of Paragonimiasis miyazakii infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed2000

[Mechanical intestinal obstruction caused by abdominal wall hernias].

Mechanical intestinal obstructions form important part of pathologies those necessitates emergent surgical intervention. Length of time between symptoms and surgery, preference of surgical procedure and prevention of recurrence are still under discussion. While the most frequent etiological factor is postoperative adhesions in developed countries, strangulated hernias are more common in developing countries. In this study, among 147 cases operated on with the diagnosis of mechanical intestinal obstruction between 1993-1999, 80 strangulated were 50 males (%62.5) and 30 females (%37.5). Mean age was 59 years (range 4-94). The most frequent type of hernia was inguinal hernia and observed in 49 cases. Small intestine was detected most frequently in hernia sac. In 14 cases (%17.5), beside hernia repair, additional surgical interventions were performed. Total morbidity was %22.5 and mortality was %7.5. Patients with mechanical intestinal obstruction should be evaluated for abdominal wall hernias because of high incidence of mech surgical intervention have high morbidity and mortality rates, elective surgery should be recommended when abdominal wall hernia is diagnosed.

Adolescent↗
PubMed1976

[Evaluation of the results of auto- and alloplasty of defects of the anterior abdominal wall].

Since 1961 till present time 331 plastic reconstructions of the abdominal wall were performed, in 192 of these only proper patients' tissues being employed, in 110--autoplasty with alloplasty, in 29--alloplasty with a capron mesh. Death in the immediate postoperative period was noted in 4 patients due to cardiopulmonary insufficiency, insult and thrombosis of pulmonary vessels. The late results within the terms from 1 to 29 years were followed up in 297 patients.

Abdominal Muscles↗
PubMed1992

[Irritation of the anterior nerves of the abdominal wall--Ibrahim syndrome].

The irritation of the nerves of the anterior abdominal wall (nervi intercostals X-XII) may imitate salpingitis, appendicitis or intraabdominal adhesion. By gentle palpation of the wall of the lower abdomen, spec. in the region of the lateral part of the musculus rectus, the points of pain are to be localized. Xylocaine-injection may give a pain-relieve for a short period of time. Mostly, there must be an operation to loosen adhesions and to dilate the nerve-exits from the lateral part of the musculus rectus.

Abdominal Muscles↗
PubMed2007

Patterns of severe abdominal wall defects: insights into pathogenesis, delineation, and nomenclature.

BACKGROUND: During the last decade, descriptions of malformation complexes involving an abdominal wall defect (AWD) have repeatedly appeared in the literature, and there has been frequent confusion regarding nomenclature, definitions, and delineations. The aims of this work were to evaluate possible embryological relationships among AWD cases, review the related nomenclature, identify patterns involving AWDs, and stress the importance of complete clinical descriptions. METHODS Cases diagnosed as AWD complexes were selected from live--and stillborn infants of the Hospital Materno Infantil Ramón Sardá, Buenos Aires, and from the Laboratory of Perinatal Pathology, Buenos Aires, Argentina. They were sorted by the location of the AWD, the umbilical cord length, and the presence or absence of a persistent cloaca. The findings in 26 cases were described, according to proposed definitions. RESULTS: Three patterns could be identified: 1) the AWD involving the umbilical ring, a persistent or exstrophic cloaca, and a spinal cord anomaly; 2) the AWD extending laterally to the umbilical ring, severe unilateral limb defects, and same-sided agenesis of abdominal organs; and 3) the AWD not involving the umbilical ring, clefts, exencephaly, and amputations. Furthermore, overlapping among these patterns was observed, and possible involved mechanisms are discussed. CONCLUSIONS: The observed overlapping among patterns suggested that malformation complexes involving AWDs might not be independent conditions but rather belong to a common and broader spectrum of anomalies. Complete clinical descriptions, the avoidance of synonyms and generalizations, and strictly defined inclusion criteria are proposed for a better understanding of pathogenetic pathways in, and relationships among, AWD complexes.

Abdominal Wall↗
PubMed1988

Acquired progressive lymphangioma as a flat erythematous patch on the abdominal wall of a child.

An erythematous patch was noted on the abdominal wall of an 8-year-old boy. The lesion showed a prolonged initial clinical course, followed by rapid later growth, finally reaching 3.7 X 7.0 cm in size over four years. Despite the harmless clinical appearance, the lesion was histologically characterized by tortuous vascular channels with some cellular atypia. Immunoperoxidase staining disclosed no factor VIII-related antigen or reaction to Ulex europaeus I lectin on tumor cells. There has been no recurrence three years after local excision. Although many features in our case resemble those reported in the literature under the term low-grade angiosarcoma, our preferred designation for such cases is acquired progressive lymphangioma, rather than angiosarcoma, because of their benign behavior.

Abdominal Muscles↗
PubMed1987

Prenatal diagnosis and management of congenital defects of the anterior abdominal wall.

Between the years 1980 and 1985, 25 cases of anterior abdominal wall defects were identified within the University of Toronto Perinatal Complex. There were 17 cases of omphalocele and eight cases of gastroschisis. Associated anomalies were found in 71% of infants with omphalocele and 50% with gastroschisis. They were the major cause of neonatal death. Prematurity was the second most common cause of death. The neonatal death rate was 59% in omphalocele and 38% in gastroschisis; the prematurity rates were 53% and 50%, respectively. In omphalocele, there was a 47% cesarean section rate, with a 50% neonatal death rate. Vaginal delivery was associated with a 67% death rate. In gastroschisis, there was a 50% cesarean section rate, with a 50% neonatal death rate. Vaginal delivery was associated with a 25% death rate. There is no evidence that cesarean section offers improved neonatal survival.

Abdominal Muscles↗
PubMedDate not supplied

Primary abdominal wall clear cell carcinoma arising in a Caesarean section scar endometriosis.

BACKGROUND: Endometriosis occurring in a surgical scar is well recognized and occurs mainly in patients with a history of hysterectomy or Caesarean section. Scar endometriosis, as well as endometriosis at other sites, can undergo malignant change. Endometrioid carcinoma is the most common malignant tumour arising in endometriosis. However, clear cell carcinoma can also occur but is unusual. AIM: To discuss the diagnosis and management of such a case. METHODS: We report a case of primary clear cell carcinoma in endometriosis of a Caesarean section scar and review the literature. RESULTS: The patient presented with a large right lower quadrant abdominal wall mass within a Caesarean section scar. Histological examination revealed a clear cell carcinoma. The patient had a prior history of pelvic endometriosis. According to the Irish National Cancer Registry, this is the first reported case of a primary abdominal wall clear cell carcinoma developing within a Caesarean section scar in Ireland. CONCLUSION: Any lesion occurring in a Caesarean section scar with a history of previous endometriosis cannot be underestimated and warrants careful clinical follow-up and histological evaluation as appropriate.

Adenocarcinoma, Clear Cell↗
PubMed1999

[Meshes within the abdominal wall].

The marked reduction in recurrence rates following reinforcement of the abdominal wall by meshes in incisional hernia has promoted their increasingly widespread use. The primary suture in technique failed more than half of the cases; therefore, the closure method needs to be changed and improved, particularly with regard to a possibly underlying defect in collagen metabolism. After more than 100 years of mesh development they are mainly placed in a sublay or onlay position, ePTFE, polyester and polypropylene are preferred. In any case the mesh has to overlap the defect sufficiently because of wound contraction. On the basis of our experience and reports in the literature, the advantages and disadvantages of various mesh techniques and mesh materials are discussed. However, because long-term studies are missing, the relevance of the cumulative risk for long-term complications such as mesh migration and fistula formation, the extent of patient complaints or the potential risk of a persistent foreign-body reaction cannot yet be ascertained. Nevertheless, because there are no surgical alternatives, meshes represent an improvement in hernia surgery that cannot be overestimated.

Follow-Up Studies↗
PubMed2003

[Eventration of the abdominal wall].

Incisional hernia is one of the most common complications after abdominal surgery, secondary to postoperative infection and intraabdominal hyperpressure. The chronicity with gradual increase in size of some of these hernias is such that the hernial ring enlarges resulting in a real parietal defect, the herniated organs can be strangulated and the poor abdominal motility alters the respiratory function. All incisional hernias require surgical repair, except small asymptomatic hernias. Surgical treatment depends on several factors, especially the size of the defect: Simple hernioplasty can be recommended for small hernias (ring < 5 cm); for large hernias, the reinforcement of the abdominal wall with a prosthesis is mandatory for long term successful repair. The type and the site of the prosthesis depend on the surgical technique.

Hernia, Ventral↗
PubMed2006

Rippled mesh: a CT sign of abdominal wall ePTFE prosthesis infection.

BACKGROUND: Infection of polytetrafluoroethylene (ePTFE) prostheses for abdominal incisional hernia is a rare but serious complication that often makes meshes removal necessary. Instead serous collections (seromas) without signs of infection don't require surgical removal. Differential diagnosis between infected and non-infected fluid collections is difficult and sometimes impossible before surgical exploration. METHODS: We describe a new sign observed in two patients who underwent abdominal computed tomography for evaluation of a fluid collection without clear signs of prosthesis infection, complicating abdominal wall repair for incisional hernia in which an ePTFE mesh was used. In both patients an alteration of the mesh profile was demonstrated on imaging, and in both patients prostheses resulted infected at surgical exploration and at microbiological examination after removal. The sign we observed is not evident in computed tomography images performed in cases of seromas. CONCLUSIONS: We discuss the possible mechanism of this finding and propose that this sign may be due to a "rejection" of the infected prosthesis from the surrounding neo-formed fibrous and inflammatory tissue.

Adult↗
PubMed1988

Strangulated external abdominal wall hernia: experience with 53 cases in Port Harcourt, Nigeria.

External abdominal wall hernias located in the groin commonly affect the male population, and are the most frequent cause of mechanical small-and large-bowel obstructions seen in Port Harcourt, Nigeria. The mortality associated with gangrenous strangulations of these hernias is quite high (29.4 percent), as revealed by this report. Early surgical intervention for strangulated hernias reduced this mortality to 0 percent for 34 patients who had ischemic, but viable, bowels at surgery.

Adolescent↗
PubMed1997

Laparoscopic Hill's vagotomy by the abdominal wall lifting method.

We performed laparoscopic Hill's vagotomy by the abdominal wall lifting method in nine patients with intractable duodenal ulcer. Our original I-type lifting bar is a curved stainless-steel rod 5 mm in diameter. One I-type lifting bar is inserted intraperitoneally into each of the right and left hypochondrial regions. An incision is made in the lesser omentum near the gastroesophageal junction, and the right esophageal wall and right crus of the diaphragm are dissected and exposed. The posterior trunk of the vagus nerve is identified and divided. Then the neurovascular bundle is dissected and divided repeatedly along the lesser curvature of the stomach from the first branch of the crow's foot to the gastroesophageal junction. The mean operating time was 163 min, with little blood loss. The reduction rate of basal acid output and maximal acid output was, respectively, 73.7 +/- 0.1 and 63.7 +/- 0.1%. Four weeks after surgery, gastroduodenoscopy revealed ulcer healing to a scar.

Adult↗