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The authors present a case report regarding abdominal wall gas gangrene and clostridial sepsis after laparoscopic cholecystectomy. Capacitive coupling was considered to be the most probable cause of small intestine perforation and further complications. Despite intensive treatment, the 69-year-old patient died.
In a 36-year old man a large recurrent sigmoid carcinoma, exophytically infiltrating the abdominal wall, was resected. The full-thickness defect in the middle and lower abdomen was reconstructed with a Vicryl-mesh and a combined tensor fasciae latae-rectus femoris flap.
A case report of necrotizing crepitant cellulitis of abdominal wall following caesarean section is presented. Because of intense haemorrhage it was namely necessary to perform additional hysterectomy and bilateral hypogastric artery ligation. Serious wound infection and sepsis were successfully treated by administration of antibiotics and repeated deep incisions.
The authors report an original case of large cutaneous necrosis of the abdominal wall following a first cesarean section in a patient with a background of pemphigoid gestationis. There was no direct skin burn nor infection of the dermis and this necrosis is typical of venous suffering. The mechanism is debated, probably the thrombosis of the superficial inferior epigastric vein due to the spreading out of a monopolar coagulation current. A one-step treatment was done using a wide excision and an abdominal advancement flap. This surgical technique allowed a fast cicatrisation and led to a very good long-term esthetical result.
The treatment of several cases of spontaneous haematomas of the abdominal wall triggers some remarks on clinical aspects of the condition.
To evaluate the effect of a delay in closure of the abdominal wall (AWC) on outcome in the management of gastroschisis, a retrospective analysis of 91 babies admitted over a 7-year period (1992-1998) to a single neonatal surgical unit with a diagnosis of gastroschisis was carried out. Antenatal diagnosis was made in 89 (98%) cases. Surgical intervention occurred in 90 babies at a median of 4 h (standard error 0.345, range 0.5-17) post-delivery. In 72 (80%) cases primary closure of the abdominal defect was achieved, with a silo fashioned in the remaining 18 (20%). One infant died prior to AWC. The median time to full oral feeding was 22 days (2.96, 5-160), and to discharge 28 days (4.03, 11-183). There was no correlation between time to AWC and any measured outcome parameter. There was no significant difference in mortality in those patients having closure before 6 h. Thus, no correlation between time to AWC and outcome was demonstrated. This would suggest that the time taken to optimally resuscitate a newborn infant prior to surgical closure does not have an adverse influence upon outcome and is to be recommended.
BACKGROUND: Aggressive fibromatosis (AF) is a rare soft-tissue tumour. It is histologically benign but locally aggressive and destructive. Surgery is the mainstay of treatment. This was a review of patients treated at the Royal Marsden Hospital between 1986 and 2003. METHODS: Records of patients with abdominal wall (23) and limb or limb girdle (86) AF were studied to determine patient, tumour and treatment characteristics and outcome. Children and patients with intra-abdominal AF were excluded. The data were analysed by Cox regression to calculate univariate hazard ratios. RESULTS: Twenty-one (19.3 per cent) of 109 patients developed recurrence after a median follow-up of 39 months. Recurrence did not correlate with surgical margin or any other variable. CONCLUSION: Wide excisional, function-preserving surgery is the goal in treatment of AF. Surgery for recurrent disease is often curative. Tumours are frequently irresectable at presentation and an initial period of expectant observation is advisable because growth arrest is a common feature of the disease.
Computed tomographic findings are reviewed in 25 patients with a palpable mass in the anterior abdominal wall. Computed tomography allowed a specific diagnosis when the mass was due to a hernia and hematoma. In the other cases a specific diagnosis could not be made but CT allowed a detailed evaluation of the extent of the disease.
Gastroesophageal reflux (GER), not yet described as a real complication, takes place very often in neonates with congenital abdominal wall defect. Our aim was to determine whether it is due to abdominal hyperpressure alone, or if another factor is involved in this occurrence. Thus we studied one group of 80 gastroschises and one of 67 omphaloceles, treated in our department between December 82 and December 92. Overall occurrence was found to be about 50% in both groups. The main feature is the particular severity of GER in neonates with wide omphalocele who required staged closure, leading to further surgical antireflux procedure. We suggest that this procedure could be performed earlier, at the time of closure, for these babies in whom moreover the anatomic approach is favorable.
The clinical experience with surgical reconstruction of the abdominal wall in vast defects in 172 cases of big and giant postoperative hernias by means of modified autoplasty methods with the formation of the doubling with a deep superposition of aponeurotic-muscular grafts is presented. Good results allow the author to recommend the described autoplasty methods to the use in surgical practice.
In the differential diagnosis of the acute abdomen, the possibility should be considered of a hematoma in the anterior abdominal wall, especially if the patient is a woman of advanced age with abdominal scars, with a chronic cough and on anticoagulant treatment. Cystography is valuable as a supplementary method of examination.
We described an unusual case of skin metastases of the uterine cervix in 63 year old woman. Previously, she was found having a Stage IIa squamous carcinoma of the cervix. She underwent bilateral salpingo-oophorectomy, total abdominal hysterectomy and pelvic node dissection. Then the patient was treated by external and intracavitary radiation. Within the next six months she was readmitted to the hospital because of abdominal pain and urinary stress incontinence after irradiation. The examination revealed three firm, freely-movable, solid subcutaneous nodules on the abdominal wall, umbilical site and urinary fistula. No other significant physical phenomena were noted. Radical excision of all the lesions was conducted and followed by four courses of adjuvant chemotherapy. Histopathological examination of the excised nodules revealed nests of squamous cell carcinoma, which were histologically identical to the previous carcinoma of the cervix. After successful treatment, the patient was continued for three months now, without any clinical evidence of recrudescence, and with good results from the urinary fistula treatment. Moreover, in these case-report we presented a review of current literature about new techniques and treatment methods of the cervical carcinomas.
Tubal occlusion using Filshie clip is one of the most commonly performed operations for female sterilization. It is usually a simple and safe procedure, and operative complications are uncommon. We report a rare case of spontaneous expulsion of a Filshie clip through the anterior abdominal wall 5 years after sterilization. The management and possible underlying mechanisms are discussed and the related literature is reviewed.
INTRODUCTION: The aim of this study was to establish the efficacy and tolerability of human fibrin glue (Tissucol) for the nontraumatic fixation of a composite prosthesis (Parietex) in the laparoscopic repair of small to medium-sized incisional hernias and primary defects of the abdominal wall. MATERIALS AND METHODS: From October 2003 to October 2005, 40 patients underwent laparoscopic repair at the hands of one surgeon with expertise in laparoscopic surgery; all meshes were implanted in an intraperitoneal position. Follow-up visits were scheduled for 7 days and 1, 6, and 12 months. These included assessments for pain and postoperative complications. RESULTS: Forty patients (24 females, 16 males) with a mean age of 50 years (range, 26-65 years) and a mean Body Mass Index (BMI) of 27 (range 25 to 30) were included in the study. Sixteen patients had incisional hernias, and 24 had primary defects. The size of the defects varied from 2 to 7 cm. Adhesiolysis was necessary in 92.5% of cases (25/40). There were no intraoperative complications or conversions. After a mean follow-up of 16 months (range, 3-24 months), no postoperative complications were observed. The mean surgical intervention time was 36 min (range, 12-40 min), with an average hospitalization time of 1 day. CONCLUSIONS: The use of fibrin glue in the present study provided stable and uniform fixation of the prosthesis and minimized intraoperative and postoperative complications. Consequently, laparoscopic treatment of small to medium-sized abdominal defects using this approach is our therapeutic option of choice.
The ability of routine obstetric ultrasound to detect and accurately describe fetuses with anterior abdominal wall defects has been examined in an unselected population using data from a regional abnormality survey. Examination between 16 and 22 weeks gestation detected 60% of defects with a false positive rate of 5.3%. Fetuses with gastroschisis were incorrectly assigned as exomphalos in 14.7% of cases recognized before 22 weeks gestation. The diagnosis, including description of associated detectable anomalies, was completely accurate in 71.6% of cases. Some of the problems of diagnostic accuracy need to be considered when counselling couples with a fetal anomaly. Cross-referral between obstetric ultrasound units should be encouraged to improve diagnostic accuracy. These results form the basis for audit of obstetric ultrasound in the diagnosis of fetal abnormality within a geographically defined population.
Seven puppies with concomitant congenital cranioventral abdominal wall, caudal sternal, diaphragmatic, and pericardial defects were treated surgically when they were between 10 and 12 weeks old. Three pups had ventricular septal defects that were not corrected. Diaphragmatic herniorrhaphy without extension of the diaphragmatic defect was performed in 6 pups. In one pup, paracostal extension of the diaphragmatic defect was necessary to decrease tension on the diaphragmatic closure. All pups were healthy at 6-month follow-up examinations, but 2 of 3 pups with ventricular septal defects had moderate generalized cardiomegaly evident on thoracic radiography. Early surgical correction of the congenital defects in these pups was usually simple because there were few or no thoracic adhesions, the dogs were small, the defects were small in 6 of 7 dogs, and the costal arch was pliable in each dog.
Catamnestic investigations were performed in 288 children with malformations of the gastrointestinal tract and the abdominal wall, among them 41 with oesophageal atresia, 41 with stenosis/atresia of the small and large bowel, 78 with anorectal malformations, 75 with Hirschsprung's disease, 28 with omphalocele and 25 with gastroschisis. In atresias/stenoses of the gastrointestinal tract both sexes were equally affected whereas boys were significantly more often affected in both Hirschsprung's disease (p 0.0005) and omphalocele/gastroschisis (p 0.05). The babies were more frequently preterm (p 0.025) than it was the case in controls. Parental age was not higher than the average parental age at time of delivery. Incidence of malformations was significantly higher in the relatives of our patients than in the average population and reached 20% (p 0.0005) in relatives of children with omphalocele/gastroschisis. Teratogenic effects of alcohol, diseases, X-rays and drugs during pregnancy could be suspected in several instances, whereas adverse effects of smoking, previous abortions and cycle disorders before pregnancy could not be established.
The concentrations of piperacillin in serum, bile, gallbladder wall, abdominal skeletal muscle, and adipose tissue were measured simultaneously at various times after the intravenous administration of a single 5-g dose to each of 14 patients undergoing biliary tract surgery. Piperacillin concentrated in the bile with peak levels exceeding 4,000 micrograms/ml. In a single patient with cystic duct obstruction, trace gallbladder bile piperacillin levels were measured. Gallbladder wall concentrations of piperacillin tended to be higher than corresponding serum concentrations, with a correlation observed between tissue values and the degree of acute gallbladder inflammation and gallbladder bile piperacillin concentrations. Mean peak muscle and adipose tissue piperacillin concentrations of 31 and 27 micrograms/g, respectively, were reached at between 2 and 3 h after the start of infusion. These concentrations exceeded the minimum inhibitory concentration for a majority of susceptible organisms. A single 5-g dose of piperacillin achieved therapeutic levels in gallbladder wall, intraabdominal skeletal muscle, and adipose tissue and concentrated in the bile of patients with patent biliary tracts.