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The authors discuss the treatment of a desmoid tumour of the abdominal wall and propose an original technique of extensive parietal repair by epiplooplasty associated with inert prostheses.
OBJECTIVE: To assess the usefulness of the abdominal wall fat index (AFI) for predicting pulmonary embolism (PE) after gynecologic surgery. METHOD: The subjects were 115 female patients who underwent laparotomy for gynecologic disease. They were divided into low-dose heparin therapy (n=28) and control, without heparin (n=87) groups. The AFI ratio of the maximum preperitoneal fat thickness to the minimum subcutaneous fat thickness was determined using ultrasonography. RESULT: Post-operative PE occurred in four control patients. If the cut-off value of the AFI for predicting PE development was set at more than or equal to 0.85, the sensitivity was 1.00 and the specificity was 0.60 (P=0.03). If we restricted the criteria, and set the cut-off value of the AFI to more than or equal to 0.85 in patients with hypertension [systolic blood pressure (BP)>/=140 mmHg, diastolic BP>/=90 mmHg or patients were taking antihypertensive medication], the sensitivity and specificity were 0. 75 and 0.92, respectively (P=0.001). CONCLUSION: Visceral fat obesity is a risk factor for PE after gynecologic surgery, and the AFI is useful for predicting PE and for whom post-operative low-dose heparin therapy may be indicated.
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Carcinoma of the transverse colon presenting as an abscess of the anterior abdominal wall is a rare occurrence. Such a case is presented, where all investigations failed to show the nature of the lesion. The literature has been reviewed and the pathology that characterizes such lesions, and their management in the light of their favourable prognosis, is discussed. Occult colonic carcinoma should be considered in the differential diagnosis of such abscesses.
Radiologic studies were reviewed of three men (aged 25, 26, and 53 years) with angiomatosis of the abdominal wall. Studies included plain radiography (n = 2), computed tomography (n = 3), magnetic resonance imaging (n = 2), and ultrasonography (n = 1). Intraabdominal (n = 3), scrotal (n = 1), and intrathoracic (n = 1) extension of the fatty infiltrating process was seen, with multiple serpentine structures, some containing calcified phleboliths, representing proliferating vessels. Enlargement of muscles (n = 2), bone (n = 1), and kidney (n = 1) adjacent to the angiomatosis also occurred.
A case of migration of a gravid female roundworm into the peritoneal cavity is reported. The presenting feature, a lump in the anterior abdominal wall, has not previously been documented. Fertilized ova of the worm were found in miliary peritoneal granulomata, and showed development up to the eight-cell stage.
A 68-year-old man was admitted to our hospital complaining of a tumor of the left abdominal wall. Thirteen years previously, had undergone a nephrectomy of a right renal cell carcinoma with T2, N0, M0, manifestations stage I. Prior to his second operation, a parenchymal tumor was strongly suspected. The tumor, however, was finally diagnosed pathologically as being a metastatic renal cell carcinoma. Postoperatively, the patient has been well for 21 months without any evidence of recurrence at the time of this report. Long-term follow-up is thought to be essential for cases of renal cell carcinoma with a slow-growing type of metastasis.
BACKGROUND: Disadvantages related to CO2 pneumoperitoneum have led to development of the abdominal wall retractor (AWR), a device designed to facilitate laparoscopic surgery without conventional pneumoperitoneum (15 mmHg CO2). We investigated the effects of the AWR on hemodynamics and gas exchange in humans. We also investigated whether the use of an AWR imposed extra technical difficulties for the surgeon. A pilot study revealed that cholecystectomy without low-pressure pneumoperitoneum was technically impossible. METHODS: A prospective randomized controlled trial: Twenty patients undergoing laparoscopic cholecystectomy were randomly allocated into group 1: AWR with low-pressure pneumoperitoneum (5 mmHg), or group 2: conventional pneumoperitoneum (15 mmHg). RESULTS: Surgery using the AWR lasted longer, 72 +/- 16 min (mean +/- SD) vs 50 +/- 18 min compared with standard laparoscopic cholecystectomy. There were no differences between the groups with respect to hemodynamic parameters, although a small reduction of the cardiac output was observed using conventional pneumoperitoneum (from 3.9 +/- 0.7 to 3. 2 +/- 1.1 l/min) and an increase during AWR (from 4.2 +/- 0.9 to 5.2 +/- 1.5 l/min). Peak inspiratory pressures were significantly higher during conventional pneumoperitoneum compared to AWR. A slight decrease in pH accompanied by an increase in CO2 developed during pneumoperitoneum and during the use of the AWR. In both groups arterial PO2 decreased. CONCLUSIONS: The results indicate that the view was impaired during use of the AWR and therefore its use was difficult and time-consuming. Possible advantages of this devices' effects on hemodynamics and ventilatory parameters could not be confirmed in this study.
Diffuse retroperitoneal soilage following rectal laceration with a blunt object resulted in significant morbidity despite prompt recognition, parenteral antibiotic administration, and early surgical intervention. A septic postoperative course was complicated by perforation of the third portion of the duodenum and a diffuse suppurative peritonitis with multiple intra-abdominal abscesses. Closure of the incision at reexploration was facilitated by sewing Marlex to the fascia while a centrally located nylon zipper allowed access to the peritoneal cavity for further explorations and eventual ablation of the septic process.
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Explore the source record for details and available documents.
A new native synthetic absorbable antibacterial polyamide thread "Capromed DC" was used for liquidation of the abdominal wall defect in operation for postoperative recurrent hernia. The low incidence of complications caused by infection around the non-absorbable ligature was noted.
A case report is presented of intra-mural gallbladder carcinoma discovered incidentally after laparoscopic cholecystectomy who subsequently developed abdominal wall recurrence at the epigastric exit port, and axillary lymph node metastases. Possible preventative steps for tumour dissemination and a management plan if incidental carcinoma is diagnosed is discussed. The use of a non-porous retrieval bag, early recognition of the carcinoma and excision of the exit wound are advocated.
The aim of this study is experimental testing of various kinds of meshes. They are used for correction of abdominal wall defects during operations of hernias (especially by the laparoscopic technique). The following implants were tested: Goretex, Prolen, Mersilen and Vicryl. Each of them represents one group of artificial materials (nonabsorbable, monofilaments multifilament, absorbable) which are usually used. Semiabsorbable materials were not tested because they are not usually used. The objects of testing were firstly constant quality of implants lasting in the time and secondly the reaction of tissues after implantation of those materials.
Spillage of gallstones during laparoscopic cholecystectomy is not a rare event. We describe a patient who showed signs of an abdominal wall abscess 4 months postsurgery. The abscess was found to be due to gallstones trapped in the preperitoneal space behind the left rectus sheath.
A case of necrotizing fasciitis with full-thickness loss of the entire abdominal wall is reported after an uncomplicated sterilization by bilateral partial salpingectomy through a minilaparotomy incision in a healthy young patient. Salvage was accomplished by early wide surgical debridement and multiple reconstructive procedures.
Vesicoamniotic shunting for fetal obstructive uropathy is beneficial in selected cases. We report a new complication, fetal abdominal wall defect secondary to vesicoamniotic shunting. Placement of the shunt should be as low and as close to the fetal midline as possible in order to reduce the risk of this complication.