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Laparoscopists consider the umbilical and ventral midline area to be "vascular safe." On occasion, however, the insertion of the first trocar at the umbilical port may result in severe abdominal wall hematoma.
Omphalocele and gastroschisis involve protrusion of intestine through a defect in the abdominal wall. It is important to differentiate between the two because of a difference in the incidence of associated anomalies and of chromosomal abnormalities. The distinguishing characteristics are the location of umbilical cord insertion, the echogenicity of the contents of the protruding mass and, usually, the presence or absence of a sac surrounding the mass. Early detection is critical so that decisions can be made about the possibility of surgical correction and the outcome of the pregnancy. We describe an omphalocele detected by ultrasonography in the 20th week of gestation during a routine prenatal check-up.
A surgeon has many options available to aid in the closure of abdominal wall defects in the elective setting. In the emergent setting, active infection or contamination increases the likelihood of infection of permanent prosthetic material and limits the surgical options. In such settings, we have used absorbable mesh (Dexon) as an adjunct to fascial closure until the acute complications resolve. To evaluate the effectiveness of this technique, we reviewed the outcome of such closures in 26 critically ill patients. Between July 1987 and June 1993, 26 patients were identified who had placement of absorbable mesh as part of an emergent laparotomy at a major urban trauma center. Through a retrospective chart review, the incidence of complications and outcome of the closure were tabulated. Seven patients were initially operated on for trauma. Two of the patients had mesh placement at their initial procedure secondary to fascial loss from trauma. The remainder of the patients hd mesh placement during a subsequent laparotomy for complications related to their initial procedure. Indications for these laparotomies included combinations of wound dehiscence, intra-abdominal abscess, anastomotic disruption, and perforation. Mesh placement in patients with intra-abdominal infection created effectively open abdominal wounds that allowed continued abdominal drainage, but required extensive wound care. Despite the absorbable nature of the mesh and often prolonged hospital stay in these ill patients, none of them required reoperation for dehiscence, recurrence of intra-abdominal abscess, or infection of the mesh.(ABSTRACT TRUNCATED AT 250 WORDS)
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A new method of vaginal reconstruction is reported. In the procedure, the left inferior abdominal wall flap with the subcutaneous pedicle containing epigastric superficial blood vessels and/or the circumflex iliac superficial vessel and the external pudendal vessel and their branches is raised and passed through an immediate extraperitoneal tunnel to be the artificial vagina. The operation is straightforward, quick, and safe. Thirty consecutive patients suffering from congenital absence of vagina have been treated. All flaps in the group, which were less bulky, survived completely. The follow-up survey was carried out from 6 months to more than 4 years postoperatively. There was no occurrence of hernia after surgery. The reconstructed vaginas in all patients were clean, soft, elastic, and expansible. Married patients indicated satisfaction with their sexual life.
Extraskeletal myxoid chondrosarcoma is a rare soft tissue tumor. Most of the reported cases that were diagnosed by fine-needle aspiration were taken from the extremities, where the tumor is often found. Problems can occur when the site is unusual and cellular differentiation is not distinct. We present a case in which the tumor was located in the intra-abdominal wall, an unusual location. Cytologic features and immunocytochemistry are helpful in distinguishing this tumor from others that share similar myxoid background.
Seromuscular spiral cuff perineal colostomy may be an alternative to abdominal wall colostomy after abdomino-perineal excision. We present our initial experience with the procedure in 13 patients operated upon between March 1993 and December 1997. Patients undergoing abdomino-perineal excision for rectal cancer, under 65 years of age, without severe concomitant disease, and strongly motivated to comply with an intensive postoperative physiotherapy were selected. The neosphincter procedure comprised a pull-through of a sufficient length of well-vascularized colon, 12 cm of which was then cleared of fat. In this segment, the seromuscular layer was separated from the mucosa, cut into a longitudinal sheet and wrapped in spirals around the colon at its perineal insertion. One patient died from pulmonary embolism. A second patient suffered from ischemic necrosis of the distal colon and lost his neosphincter. Minor complications included one stenosis, corrected by surgery, and one iatrogenic lesion on rectoscopy at another institution. No patients experienced local recurrence, while four patients presented distant metastases. Initially, all patients suffered from incontinence. After 6 months, 6 of 11 evaluable patients showed total and 5 showed partial continence.
We reviewed a 22 year experience with 138 newborn infants with congenital evisceration through defects of the abdominal wall. Omphalocele is a large defect which always has a sac, in which the rectus muscles insert laterally on the costal margins and which usually has associated anomalies. Cord hernia is a small defect which always has a sac, in which the rectus muscles insert at the xiphoid and which commonly has associated anomalies. Gastroschisis is a small defect which never has a sac, in which the rectus muscles insert at the xiphoid and has few associated anomalies, though prematurity is frequent. We hypothesize that gastroschisis develops because the umbilical coelom fails to form, which forces the elongating midgut to rupture into the amniotic cavity. This differs from the embryogenesis of omphalocele, which is failure of closure of a primary body fold, and from that of cord hernia, which is failure of the midgut to return from the umbilical coelom. The number of infants in this series who survived after surgical repair of an omphalocele was 31 of 51 patients; of a cord hernia, 22 of 28 patients, and of gastroschisis, 40 of 59 patients. Factors contributing to mortality were associated anomalies, low birthweight and surgical closure under excessive tension.
We quantified the tissue response, tissue organization and patency of biodegradable patches for the repair of abdominal wall defects. We used dermal sheep collagen, cross-linked with hexamethylenediisocyanate in a model. The collagen patches were implanted either untreated or plasma polymerized with tetrafluoroethylene (TFE), to improve the properties of the patch for bowel adhesion and rate of degradation. The implants with surrounding tissue were retrieved after 3 d, 1, 2, 4, 6 and 8 wk, then sectioned and stained specifically for macrophages, neutrophils, T-lymphocytes and endothelium. Only macrophages and neutrophils were observed in the implant and surrounding tissue, with different antigen expression in the macrophages. This was found to be dependent on whether the macrophages were found within the implant or in the surrounding tissue. The neutrophils and macrophages were assessed using image analysis techniques to quantify the tissue responses to treated and untreated collagen, enabling comparison of the respective tissue responses. No significant differences were found between the two forms of this collagen. Infection played a key role in the severity of the tissue response around both types of implants, resulting in large variations in cell counts at each time period. Treating the collagen with TFE did not significantly improve its performance in this application.
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INTRODUCTION: A simple technique is presented here for temporarily covering massive, full-thickness, abdominal-wall defects, when they cannot be closed directly. METHODS: The exposed viscera can be covered with a meshed split-thickness skin graft to close the wound and seal off the abdominal cavity from the outside. Once the patient's general condition improves, the epidermal layer of the mesh graft should be removed by dermabrasion to minimize the risk of epidermal cysts, and the defect should be closed either by primary closure or by a local or free flap, depending on the defect size.
The results of explantation of synthetic netted materials in 82 patients with vast and giant postoperative abdominal wall hernia were analyzed. Physical and biological properties of netted explants made from polypropylene permit to apply them while infectioning of the operative field occurs and providing measures of complex prophylaxis for purulent-inflammatory, broncho-pulmonary and cardio-vascular complications. The method of plasty choice depends on clinical situation present, the operative risk degree, the hernial defect size and magnitude and on the stage of prognosticated intraabdominal pressure raising. An early postoperative complications were noted in 14 (17%) of patients. Hernial recurrency had occurred in 3 patients in terms of follow-up from 1 to 5 years.
Described in this paper is a modified method to open the abdominal wall for gynaecological operations, and it is compared for postoperative formation of haematoma with the two most common conventional methods. The modified method and lower median incision so far have been performed on a comparatively small group of patients, when compared to Pfannenstiel's incision. Therefore, no unambiguous conclusion can be drawn as yet. The validity of the method should be confirmed by a larger number of operations. The method should be tried by more hospitals to enable large-scale comparison with other techniques.
Surgical repair of major incisional hernia of the abdominal wall is a technically challenging operation. It is not exceptional to be faced with major loss of parietal tissue requiring associated aponevrosis plasty and prosthesis implantation. We report a new technique involving transposition of the aponevrosis sheaths of the rectus abdominis creating a new muscular sheath. The prosthesis thus becomes extra-peritoneal and is inserted deep into the new muscular sheath thus protecting both the intestine and the skin. This technique can be used as an alternative when the size of the defect makes it impossible to bring the two borders of the rectus sheath together. Due to the transposition of the aponevroses, the sutures are placed laterally to the rectus abdominis so the plasty can also be applied when prosthesis implantation is contraindicated.
We report a case of urachus carcinoma in which the resulting abdominal wall defect was reconstructed during surgery with an artificial polypropylene mesh. The use of the mesh made it easier to resect the tumor more radically, even in an advanced case.
Using a hand-held infrared temperature sensor, temperatures were recorded from the abdominal wall in antenatal patients at 35+ weeks' gestation. The inguinal and periumbilical areas appeared to be relative "hot spots" in normal pregnancy. This noninvasive technique may be useful in confirming the diagnosis of chorioamnionitis.
Gastrointestinal (GI) bleeding is not uncommon and responsible for considerable morbidity and mortality. Radionuclide red blood cell scintigraphy (RBCS) is a well established imaging modality for identifying patients with ongoing active GI bleeding. However, false positive RBCS are known to occur. The authors report the findings of a RBCS in an elderly female, who developed GI bleeding following the commencement of anticoagulant therapy. Although active GI bleeding was not identified, two abdominal wall hematomata and a cecal adenocarcinoma were detected. Distinguishing features of these lesions are described.