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Fifty-one cases of burst abdomen occurred following 1 988 cesarean sections performed at the University of Nigeria Teaching Hospital over a 5-year period. The incidence of this occurrence was 2.6% (2.3% if all laparotomies in both obstetrics and gynecology are combined). The risk was three times as great for "unbooked" patients, who were first seen in labor. Possible etiologic factors and preventive measures are discussed.
Gray scale ultrasonography has made it possible to identify the major systemic arteries and veins in the upper abdomen. Identification of these vascular structures is discussed as well as their value as anatomic landmarks.
Magnetic resonance (MR) imaging of the abdomen and pelvis with use of gastrointestinal (GI) contrast agents is slowly emerging as a valuable diagnostic tool. In the past few years, considerable effort has been expended on developing an oral contrast agent to serve as a bowel marker during abdominal and pelvic imaging. Four major categories of agents have been studied: compounds with positive contrast-enhancing characteristics (ie, which increase signal intensity), which may be either miscible or immiscible with bowel contents, and compounds with negative contrast-enhancing characteristics (ie, which decrease signal intensity), which also may be miscible or immiscible. Compared with precontrast images, MR images acquired after administration of GI contrast agents have shown increased anatomic delineation of the bowel lumen, pancreas, and paraaortic nodes, allowing increased detection of pancreatic lesions, improved assessment of bowel wall lesions, and distinction between intrahepatic and extrahepatic lesions. This review focuses on the general physics and requirements for intraluminal GI contrast media for MR imaging, the currently used intraluminal agents and their regulatory status, current and near-future availability, and cost considerations.
Fourteen patients with focal or segmental involuntary movements affecting the ears, back, shoulder girdle, and upper extremity, as well as the abdomen and pelvic girdle, are presented. The unusual locations and appearance of these dyskinesias distinguishes them from recognized movement disorder syndromes. It is argued that the slow, sinuous, and semirhythmic character of the movements and the variable long-duration bursts of motor unit activity responsible for them most closely fit into the spectrum of dystonia. A history of pain in the affected region and/or peripheral trauma in some cases also suggests that peripheral factors may play a role in their pathogenesis.
Changes in the relative contribution of ribcage and abdomen during augmented breaths were assessed in two groups of infants (less than 2 weeks and 4-12 weeks old). In both groups ribcage and abdominal movements increased during augmented breaths in quiet sleep. In the older infants the relative increase was greater for the ribcage (P less than 0.05) when expressed either as a ribcage to abdominal movement ratio or as a percent of the respective movements during control breaths. In contrast, no significant change of the relative contribution was observed in the younger age group. During active sleep paradoxical movement of the ribcage, observed during tidal breaths, continued during the first phase of the augmented breath; however, during the second phase of inspiration, the ribcage moved outward in all but one infant. Our results show that marked increases in tidal volume are associated with greater increases in ribcage contribution in infants beyond the neonatal period. This may reflect differences in recruitment patterns of intercostal muscles during development.
A retrospective review of 75 spiral CT examinations of the abdomen was performed to assess: (1) patient's ability to sustain a 24-s breath-hold, and (2) the proportion of targeted regions or organs that were completely imaged at different table feed speeds. Seventy of 72 patients sustained a 24-s breath-hold without motion artifact. Region coverage depended on the prescribed table feed speed and length of exposure. With a fixed exposure time, there was a tradeoff between the volume of tissue that could be imaged and the slice colimation.
Forty-three patients with ovarian carcinoma were treated with whole-abdomen radiation (moving strip +/- pelvic radiation), 15 patients had not received prior chemotherapy, and 28 patients were irradiated following chemotherapy and second-look laparotomy. Ten of these had been treated with a variety of chemotherapy regimens (L-PAM, CHAD, Hexa-CAF). Eighteen patients were treated in an ongoing prospective trial with combination chemotherapy consisting of melphalan, cis-platinum, and hexamethylmelamine++ (HexaPAMP). Thrombocytopenia was the limiting toxicity. A temporary pause in the radiation schedule allowing platelets to recover made it possible to complete treatment in 80% of the patients. The acute toxic effects, which included the expected side effects of radiation therapy on intestine, liver and lung, were not more frequent or more severe in the patients who had received prior chemotherapy than in those who had radiation therapy alone. Thirty-four of 43 patients (stage I, seven patients; stage II, seven patients; stage III, 27 patients; stage IV, two patients) are alive and without evidence of disease 26 + months (range 7 to 64 months) after entering the postsurgical treatment program.
Abdominoplasty is a common procedure in plastic surgery. Reviewing 150 patients who underwent abdominoplasty, it has been observed that 72% of the patients already had an abdominal scar. How to deal with abdominoplasty in an abdomen with a previous scar is discussed in this article.
The role of laparoscopy in the selective management of gunshot wounds (GSW) of the abdomen was prospectively investigated in 38 patients. All the patients were hemodynamically stable and had equivocal evidence of intraabdominal penetration. Laparoscopy was performed in the operating room under anesthesia. The site of penetration was in the thoracoabdominal area in 13, epigastrium in 7, and lower quadrants in 18. Twenty-three (60.5%) had nonpenetration on laparoscopy and a laparotomy was avoided. The remaining patients had injuries to the liver (4 patients), spleen (two patients), diaphragm (3 patients), hemoperitoneum or retroperitoneal hematoma (6 patients), and hollow viscus injuries (5 patients). Laparoscopy was also helpful in determining the need for laparotomy vs thoracotomy in lower chest wounds. The negative laparoscopy group (no penetration) had a significantly lower hospital stay compared to hemodynamically stable patients who had negative laparotomy without laparoscopy for nonpenetrating GSW. There were no complications related to laparoscopy. Laparoscopy is a useful modality in the evaluation of hemodynamically stable patients with abdominal missile wounds.
It is proposed to use information on the direction of reflector movement and extensive filtering in the detection of fetal breathing and cardiac movements in the ultrasonic Doppler signal recorded on the surface of the material abdomen. The method appears fairly insensitive to spurious signals and allows those of interest to be distinguished without any reference technique. A decision rule for breathing and cardiac rhythm detection, incorporating movement direction, amplitude, shape and periodicity criteria, is also proposed.
Appearances simulating neoplastic masses were found in five patients undergoing computed tomographic (CT) scanning of the chest and abdomen for a variety of indications. In each case the appearance was shown to be due to dilated collateral venous channels in association with portal hypertension or interruption of the inferior vena cava. The vascular origin of the masses was confirmed by CT scanning during intravenous bolus injection of contrast. Angiographic confirmation was obtained in three subjects. Enlarged collateral veins should be considered in the differential diagnosis of appearances suggesting mediastinal or abdominal lymphadenopathy at CT scanning.
15 patients with left/right intrahepatic bile-duct calculi received ultrasonic lithotresis via abdomen by using the percutaneous cholecystoscope and ultrasonic lithotresis apparatus. The results indicated that all the surgical manipulations were successful with a residual rate of 6.7%, compared with a residual rate of 78.2% in 23 cases of left/right intrahepatic bile-duct lithiasis treated simultaneously by lithotomy apparatus. The differences between them were statistically significant (u = 4.29, P < 0.01). Among 12 cases undergoing follow-up observation, no side effect due to ultrasonic lithotresis and no residual calculus after 2-4 check-ups with B-mode ultrasound diagnostic set were found and all of their symptoms disappeared except for 1 case.
Surgery for tumors in the abdomen, retroperitoneum, and pelvis requires technical skills and expertise sometimes beyond the capability of a single surgeon. This holds especially true if curative tumor resection involves replacement of arteries and veins, which needs careful planning to avoid long periods of ischemia, and the selection and provision of vascular substitutes according to anatomical position, postsurgical therapy, and adjuncts to avoid thrombosis and infection of vascular grafts. Since the works of Fortner, the value of close collaboration between general and vascular surgeons has been demonstrated, but many of the former even today continue to attempt the operation alone, although the result is not always a masterpiece. The authors refer to their experience in major tumor surgery in either the single management of vascular complications or collaboration. The potential value of close collaboration is presented by negative examples, and a plea is made for a less "eminence"-based management of these sometimes difficult cases, which is based on vast positive experience with vascular diseases of the aorta and the visceral and iliac arteries and veins, including safety measures and adjuncts.
Formation of enteric fistulas frequently complicates the open abdomen in patients who have sustained traumatic injury. The post-traumatic subset of patients with enterocutaneous fistula enjoy better than average recovery. To optimize this recovery, a systematic management approach is required. Patients must first be stabilized with nutritional support, control of sepsis, and special wound management systems to prevent further deterioration of the abdominal wall. Investigation of the origin, course, and characteristics of the fistula provides information about its likelihood to close without operation. Definitive operative therapy may be necessary to resolve the fistula and close the abdominal wall. Finally, healing support includes nutritional support and physical and occupational therapies to restore patients to pre-injury states.
Multi-detector-row computed tomography (MDCT) enables rapid, noninvasive, high-resolution, and three-dimensional imaging of pediatric vascular diseases. In this paper, we explore the adaptation of the MDCT angiographic principles to pediatric patients for vascular diseases of the abdomen, pelvis, and extremities. Special emphasis is placed on the practical aspects of how to perform these studies. Optimizations of scan parameters, contrast medium usage, radiation dose, and three-dimensional image processing are discussed in detail. We provide practical guidance on how to choose between MR angiography and CT angiography. Finally, we review important pediatric vascular diseases, categorized into traumatic injuries, inherited vascular diseases, congenital vascular diseases, vasculitides, and surgical planning and assessment. In each category, we discuss how CT angiography can be tailored to maximize its clinical benefits.
Carcinoid tumors are rare neuroendocrine neoplasms that belong to a more general category of tumor called the APUDomas. Ninety percent of carcinoid tumors are located in the gastrointestinal tract. Abdominal carcinoid tumors are categorized according to the division of the primitive gut from which they arise. Carcinoid tumors originating from the foregut develop in the gastric wall, duodenum, and pancreas; those originating from the midgut develop from the small bowel, appendix, and right colon; and those originating from the hindgut develop from the transverse or left colon or from the rectum. This report illustrates the computed tomographic appearance of primary and metastatic carcinoid tumors of the abdomen. Among the different organs that may be involved by metastases from carcinoid tumor, special emphasis is placed on the liver.
BACKGROUND: To determine the potential ability of diffusion-weighted magnetic resonance (MR) imaging with single-shot echo-planar imaging (DW imaging) in the upper abdomen by apparent diffusion coefficient (ADC) and signal:intensity ratio (SIR) measurements. METHODS: DW imaging was performed in 61 clinical patients. ADCs in the liver, pancreas, spleen, kidney, and different pathological conditions were calculated. Spleen-to-liver SIR and segmental intensity difference of the liver (SID) were also calculated. RESULTS: The mean ADCs (mm(2)/s) were 2.28 x 10(-3) +/- 0.07 in the liver, 1.44 x 10(-3) +/- 0.05 in the spleen, 1.94 x 10(-3) +/- 0.19 in the pancreas, and 5.76 x 10(-3) +/- 0.06 in the kidney. The mean ADC of cirrhotic liver was 1.96 x 10(-3) +/- 0.62, which was lower than that of normal liver. Other pathologic conditions also showed ADCs different from those of normal tissues. All DW images showed significantly higher spleen-to-liver SIRs and SIDs than did T2-weighted images (p < 0.05). CONCLUSION: The mean ADCs obtained with DW imaging were different in each upper abdominal organ and with each pathologic condition. DW images showed better soft tissue contrast than did T2-weighted images with regard to SIR and CNR in depicting and characterizing upper abdominal disorders.
We present patients treated for hydatid disease in our hospital (in northeastern Greece) over the last 20 years. In the period from 1984 to 2003, a total of 135 patients (54 male, 81 female) were treated for echinococcal disease (age 15-85 years). In 111 (82.2%) patients only the liver was affected; 9 (6.7%) patients had concomitant hepatic and extrahepatic hydatid disease; and 15 (11.1%) patients had only extrahepatic disease. Clinical symptoms in patients with hepatic locations of the disease included abdominal pain localized in the epigastrium or right upper quadrant of the abdomen, tenderness, hepatomegaly with palpable abdominal mass, jaundice, fever, and anaphylactic reaction. All the patients were treated surgically. Surgical techniques included partial cystectomy and drainage, cystectomy and capitonage, cystectomy and omentoplasty, only drainage, left lateral hepatectomy, total pericystectomy, and laparoscopic pericystectomy. Rupture into the bile duct was managed by T-tube drainage or biliodigestive anastomosis. Symptoms and surgical treatment for extrahepatic cysts varied according to the location of the cyst. The median cyst diameter of all patients was 11 cm. The postoperative complication rate was 17.0%. Two patients died (1.5%). The median hospital stay was 18 days. The recurrence rate was 6.7%. The study suggests that treatment of this benign disease should be the less radical surgical technique combined with pre- and postoperative anthelmintic administration. The surgical treatment should be combined with careful use of scolicidal fluids and aspiration of the cyst to avoid contamination and minimize the risk of recurrence.