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Among 23 cases of obscure masses in the abdominal wall or groin examined by ultrasound, 91% had clinical confirmation of the ultrasonic findings, and in 39% of the cases, unsuspected conditions were diagnosed. All of the unconfirmed findings occurred through inability to distinguish inguinal adenopathy from inguinal abscesses.
BACKGROUND: Recently there has been interest in performing laparoscopic herniorrhaphies without the use of staples or tacks to fix the mesh. Although mesh fixation has been linked to an increased incidence of nerve injury and involves increased operative costs, many surgeons feel that fixation is necessary to reduce the risk of hernia recurrence. This study evaluates the outcomes of laparoscopic herniorrhapies performed with and without mesh fixation at our institution. METHODS: We retrospectively evaluated our last 172 laparoscopic herniorrhaphies, which span a period of conversion from staple fixation to nonfixation of total extraperitoneal herniorrhaphies using systematic chart review and follow-up self-administered questionnaires. The outcomes assessed were the incidences of postoperative neuralgia and hernia recurrence. Adjustment for important prognostic factors was achieved using Cox regression for estimating the risk of recurrence, and multiple logistic regression for estimating the risk of neuropathic complications. RESULTS: Of 172 laparoscopic herniorrhaphies performed in 129 patients since July 1993, 105 were accomplished without mesh fixation, and 67 were performed with fixation of mesh to the abdominal wall. There were no significant differences in demographics between the two groups. A trend toward a higher incidence of neuropathic complications was observed in the mesh-fixation group (risk ratio [RR], 2.2; 95% CI, 0.5-10). A nonsignificant increased risk of hernia recurrence with fixation of mesh was observed (4.2 vs 1.6 per 100 hernia-years at risk; RR, 2.3; 95% CI, 0.4-13.10), but this finding may be associated with a selection bias with regard to giant hernia defects. CONCLUSIONS: Our data suggest that mesh fixation to the abdominal wall may be avoided in total extraperitoneal repairs without increasing the risk of hernia recurrence and neuropathic complications. The increased risk of recurrence observed with mesh fixation possibly results from selection bias. Large randomized controlled studies are needed to determine whether mesh fixation is truly related to neuropathic complications and the incidence of recurrence.
We describe the case of a 56 years old man, who was operated on with abdominal wall skin malignant melanoma 5 years ago. He received postoperative DTIC + Intron A treatment. Five years later he presented with complaints of epigastric pain, melena, hematochezia, anorexia and fatigue. Upper gastrointestinal tract endoscopy showed a tumour mass in the duodeno-jejunal flexure and colonoscopy showed a tumour in the large bowel. Histology verified anaplastic carcinoma. The patient was operated on. We found metastases in the small and the large bowel The patient underwent resection of the jejunum and right hemicolectomy. We describe the different types of metastases of malignant melanomas symptoms, therapies and prognosis.
Presented is a case of abdominal wall hematoma following a fall from a height of 20 feet. This emergency department course illustrates the diagnostic dilemma that frequently accompanies this entity. The patient was discharged from the hospital without further complication following an extensive workup and 48 hours of observation. Pathophysiology, evaluation, and treatment are then discussed in detail.
Patients with acute losses of large portions of the anterior abdominal wall are discussed. Management is divided into the acute or immediate phase in which initial wound control is paramount, and then a subacute period in which coverage with skin is accomplished. Many weeks later during the chronic phase, reconstructive procedures are done if needed. Methods of handling these defects are presented.
An abdominal wall Actinomyces abscess occurred in a woman with an intrauterine device. Contributing factors were local trauma, spread from surrounding colonized body sites and symbiotic growth of other anaerobes. The diagnosis was based on the histologic finding of the sulfur granule. Special studies may be needed to distinguish this condition from other, similar ones (Nocardia, botryomycosis).
We report three cases of abdominal wall metastases from ovarian cancer after laparoscopy. The implants occurred at the site of insertion of laparoscopy trocars. One patient had an implant of serous papillary carcinoma of low malignant potential at the trocar sites after laparoscopic oophorectomy. Laparoscopic surgery is inappropriate in patients with malignant ascites or when preoperative or intraoperative findings are suggestive of ovarian cancer.
A case is presented of subcutaneous fat necrosis manifested as an abdominal wall mass, a finding reported only rarely with acute pancreatitis. It should be considered a possibility in the differential diagnosis of a palpable abdominal mass in acute pancreatitis.
Only 38 cases of blunt traumatic rupture of the anterior abdominal wall musculature have been described in the literature to date. We describe a patient who sustained a complete transection of the right and a partial disruption of the left rectus abdominis muscle as well as multiple associated injuries secondary to blunt, crushing trauma. Postoperatively, he experienced several complications and developed a ventral and right flank hernia. The former was repaired with a rectus abdominis muscle flap and polypropylene mesh. The flank hernia was initially repaired with polypropylene mesh and a recurrence was repaired with latissimus dorsi fascia.
The rates of re-recurrent hernias after initial abdominal wall hernia repair are high. To reduce this intolerable high recurrence rate, 31 patients were treated by polypropylene-mesh implantation and followed up for about 3 years. Two new hernias could be diagnosed and were treated without problems by repeated implantation of Prolene-mesh. About 50% of patients complain of some pain at the edges of the implanted mesh--usually this makes only very few discomfort for the patients. The Polypropylene (Prolene) mesh implantation seems to reduce re-recurrence rates compared to published results of hernia repair without mesh implantation.
Experience of treatment of 975 patients with postoperative and recurrent abdominal wall hernia (AWH) and of 1473 patients with inguinal hernia was summarized. Intraoperative classification of Shevrel and Rets for AWH and of Gilbert and Rutkov for inguinal hernia were applied. The conventional methods of plasty, using local tissues, were performed up to 1998 in 648 patients with AWH and in 983--with inguinal hernia. Synthetic implants were used since 1999 in 327 patients with AWH and in 181--with inguinal hernia. In application of conventional methods recurrency had occurred after plasty for AWH in 26.6% and for inguinal hernia--in 5.8% of observations; hernial recurrency was not noted after usage of the modern plasty methods.
BACKGROUND: The usual methods of closure of major chest and abdominal wall defects have significant disadvantages. Skin grafts provide no structural support and result in incisional hernias. Synthetic mesh requires skin cover and is prone to infection and wound breakdown. The tensor fasciae latae (TFL) myocutaneous flap offers skin cover and a semi-rigid fascial layer. We document our unit's experience in pedicled and free TFL flaps. METHODS: The TFL flap closure of trunk defects was undertaken in 10 patients between August 1989 and April 1997. All cases were not amenable to primary closure and repair with synthetic mesh or skin grafts. RESULTS: The defect was satisfactorily repaired in all cases without subsequent herniation. The closure techniques using a pedicled TFL flap and a TFL flap for a free-tissue transfer are described. CONCLUSIONS: We conclude that the TFL flap is the method of choice for repairs of major truncal defects.
Ultrasound was used to diagnose and demonstrate an anterior abdominal wall abscess of unknown cause in a diabetic woman. This condition may mimic major abdominal disorders and, in our patient, appeared as acute cholecystitis. The use of ultrasound is simple, quick, painless, and without known adverse side effects. The diagnosis may be more easily and accurately established than by routine roentgenography.
After an accidental perforation by a wooden stake of the abdominal wall and distal ileum a 28-year-old man developed an aggressive granulomatous foreign body reaction of the greater omentum with high fever and abdominal pain. The patient was cured by omental resection and prednisone treatment.
INTRODUCTION: Hematomas of the abdominal and pelvic wall are frequent findings, particularly in the patients undergoing long-term anticoagulant therapy. MATERIALS AND METHODS: We reviewed a series of 9 cases of "spontaneous" hematomas of the rectus abdominis muscle (7 cases), of the obliquus internus muscle (one case) and of the gluteus muscles (one case) studied with US and CT. During the last 4 years, 9 patients complaining of the recent onset of a painful muscular swelling were examined: 8 of them were on anticoagulant therapy, while one was on long-term hemodialysis. They were examined with US (3.5 MHz, integrated with 7.5 MHz in 7 cases) and CT (contiguous 10-mm slices before and after i.v. contrast agent injection). Color Doppler was used in 3 cases. RESULTS: US showed different signs depending on hematoma onset and extent: the muscle was swollen, with an inhomogeneous structure with both coalescing liquid and echogenic areas in 2 cases, while the hematomas were bigger and appeared with mostly liquid areas and internal inhomogeneity due to blood clots in the remaining 7 cases. The evidence of pseudocystic areas with fluid blood levels (the so-called pseudohematocrit effect) was particularly specific of diffuse hematomas (4 patients). CT helped make the final diagnosis by showing the typical hyperdensity of fresh blood (at least 50 HU) in 9 cases and by defining the typical pattern of the pseudocysts with the hematocrit effect, but was useless in characterizing "pseudotumoral" lesions (3 cases), which were better defined by B-mode and color Doppler US. CONCLUSIONS: US is the examination of choice, even though it may misdiagnose small hematomas as muscular tumors or large hematomas as other diseases; color Doppler can be useful in the former case. CT usually permits the correct diagnosis by detecting fresh blood, which can however be found also in some muscular neoplasms.
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