Abdominal Wall

Top PDF Abdominal Wall:

Metastasis of Dermatofibrosarcoma from the Abdominal Wall to the Thyroid Gland: Case Report

Metastasis of Dermatofibrosarcoma from the Abdominal Wall to the Thyroid Gland: Case Report

Metastases in the thyroid gland are very rare. Even the rarer are sarcoma metastases. A 52-year-old woman was referred to our department for evaluation of a nodule in the right lobe of the thyroid gland. She had a history dermatosarcoma of the abdominal wall with known metastasis in the lung. Clinically she had neck pain and worsened swallowing. Objective assessment (ultrasound, computed tomography, and magnetic resonance) indicated a voluminous right lobe nodule with mechanical syndrome, and a fine-needle aspiration biopsy revealed a very suspicious malignant finding. After surgery, the diagnosis was metastasis of dermatofibrosarcoma protuberans. Subsequent treatment was radio- and chemotherapy.
Show more

5 Read more

Biologic mesh for abdominal wall reconstruction

Biologic mesh for abdominal wall reconstruction

breadth of clinical entities ranging from small, clean fascial separations to complete loss of abdominal domain. The surgical approach to abdominal wall reconstruction (AWR) must take into account many variables including defect size, location, etiology, as well as the overall clinical picture in order to develop an appropriate treatment algorithm. These hernias pose difficult reconstructive challenges, often fraught with high recurrence rates and postoperative complications. There is a substantial recur- rence rate after ventral herniorrhaphy as well as a high incidence of surgical site occurrences (seroma, hematoma formation) and surgical-site infections. While there is not a successful “one size fits all” approach to AWR, there are treatment modalities, which significantly improve these outcomes.
Show more

9 Read more

WSES guidelines for emergency repair of complicated abdominal wall hernias

WSES guidelines for emergency repair of complicated abdominal wall hernias

A recent study performed by Martínez-Serrano et al. prospectively analyzed morbidity and mortality rates fol- lowing emergency hernia repair [12]. The study popula- tion included 244 patients with complicated abdominal wall hernias requiring surgical repair. In this study, the patients were treated according to standardized proto- cols with detailed actions to be taken during the pre-, intra-, and post-operative periods. Clinical outcomes were compared retroactively to that of 402 patients who had undergone similar procedures before the develop- ment and implementation of the protocols outlined in the study. Results showed higher rates of mortality in patients with acute complication as their first hernia- related symptom and whose treatment was delayed for more than 24 hours. Thus, the authors concluded that early detection of complicated abdominal hernias may be the best means of reducing the rate of mortality [12].
Show more

11 Read more

Phosphoglyceride crystal deposition disease in the abdominal wall: a case report

Phosphoglyceride crystal deposition disease in the abdominal wall: a case report

To our knowledge, only 10 cases of PGDD have been reported previously, including our case. The available clinical information on these cases is sum- marized in Table 1 [1–7]. The mean age of patients is 57 (range, 37–76) years. There appears to be no gen- der predilection. No congenital abnormalities or fam- ily history of metabolic disorders have been found. Deposition was characteristically noted at intramuscu- lar injection sites or postoperative sites like the glu- teal muscles and the deltoid, abdominal wall soft tissue, scapula, spine, myocardium, and pelvic soft tis- sue. The size of the tumors reported is highly vari- able, from 3.5 cm to the size of an infant ’ s head, but in general it is a relatively large tumor with a mean size of 8.9 cm. The time from the initial invasion to confirmation of the tumor was at least 20 years and was 45 years in the longest case. About half of the cases had multiple lesions. In most cases, excisional surgery was performed due to local tumor formation without apparent symptoms of inflammation. Tumors that occurred at postoperative sites were suspected to be true malignant neoplasms or recurrent tumors. In one case, intraoperative rapid pathological diagnosis revealed PGDD, so complete resection was not per- formed and the patient was observed clinically.
Show more

5 Read more

Abdominal wall procedures: the benefits of prehabilitation

Abdominal wall procedures: the benefits of prehabilitation

Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical complications. It includes interventions that optimize nutrition, glycemic control, functional status, and utilization of the patient’s microbiome pre-, intra-, and postoperatively. Through a multidisciplinary and anticipatory approach to patients’ existing co-morbidities, the physiological stress of surgery may be attenuated to ultimately minimize perioperative morbidity in the elective setting. With increasing data to support the efficacy of prehabilitation in optimizing surgical outcomes and decreasing hospital length of stay, it is incumbent on the surgeon to employ these practices in elective abdominal wall reconstruction. Further research on the effects of prehabilitation interventions will help to shape and inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best practices in surgical care.
Show more

14 Read more

SUBFASCIAL ABSCESSES OF THE ABDOMINAL WALL IN CHILDREN

SUBFASCIAL ABSCESSES OF THE ABDOMINAL WALL IN CHILDREN

Roentgenogram of the abdomen revealed a poorly defined mass in the right upper quadrant involving either the abdominal wall or lying just beneath it.. Preoperative diagnoses considered w[r]

10 Read more

Successful laparoscopic management of combined traumatic diaphragmatic rupture and abdominal wall hernia: a case report

Successful laparoscopic management of combined traumatic diaphragmatic rupture and abdominal wall hernia: a case report

the lungs. The Redivac drain was maintained, and he was managed expectantly with intravenous antibiotics and analgesics. Unfortunately, 2 weeks after the accident, the patient developed temperature spikes with purulent discharge from the drain. The initial concern was that the mesh had become infected with possible empyema thoracis. However, there was no evidence on repeated CT scanning of the thorax and abdomen to suggest such findings. In addition, CT showed continuity of the left hemidiaphragm reinforced with mesh and ProTack (Fig. 4). Nevertheless, there was extensive fat stranding in the previous abdominal wall fluid collections, along with presence of some air locules, suggestive of superim- posed infection (Fig. 2b). Pus culture from the abdom- inal wall drain isolated Hafnia alvei sensitive to amoxicillin/clavulanic acid, and the patient’s antibiotic was downgraded from the initial intravenous merope- nem 500 mg three times daily to intravenous amoxicil- lin/clavulanic acid 1.2 g three times daily for 1 week. The Redivac drain was removed on postoperative day 23, when the purulent discharge had become minimal. A few days after removal of the drain, the patient devel- oped spikes of temperature. Ultrasound (US) examin- ation of the abdomen showed two collections: one at the right anterior abdominal wall, measuring 2.8 × 12.1 cm and another at the left anterior abdominal wall measur- ing 5.7 × 14.6 cm. US-guided percutaneous drainage was performed with insertion of two 8-French pigtail cathe- ters. The aspirated pus grew Yokenella regensburgei, for which the patient was treated with appropriate antibi- otics. The drainage gradually settled over the next 2 weeks, with repeat abdominal US showing resolution of
Show more

6 Read more

Abdominal Wall Endometriosis as  Endometrioma Cutaneous Fistula:  A Case Report

Abdominal Wall Endometriosis as Endometrioma Cutaneous Fistula: A Case Report

A 46-year-old woman, gravida 3 para 3, was referred to clinic for a pelvic mass and a mass in her abdominal wall. The patient had a previous cesarean delivery for breech presentation complicated by a superficial post- operative wound infection 7 years prior. The abdominal wall mass was included in her CD scar and produced cyclic bleeding and increased pain with menstruation that had been going on for 2.5 years. Review of symptoms revealed a history of chronic pelvic pain, dyspareunia, increasing abdominal girth, urinary splinting, and drib- bling. Pelvic ultrasound 7 months prior to clinic visit revealed a 2.5-cm complex, left ovarian cyst and a 3.7-cm left ovarian heterogeneous structure likely representing a dermoid and a 5.8 cm complex right adnexal mass.
Show more

5 Read more

Abdominal wall implantation of hepatocellular carcinoma

Abdominal wall implantation of hepatocellular carcinoma

In Oct. 2004, three years following her original surgery, she was referred to the Liver Unit, Mubarak Al-Kabeer Hospital with an abdominal wall mass of one-year dura- tion. On physical examination an obvious 7 × 5 cm smooth oval mass was seen in the right upper quadrant at the lateral border of her previous right subcostal scar. Clinically the mass seemed to be within the abdominal wall and the skin over it was free. CT scan of the abdomen showed a round well defined enhancing soft tissue den- sity mass measuring 11 × 5 × 5 cm within the anterior abdominal wall with no intra-abdominal extension or skin infiltration (Figure 1). The liver was free except from signs of previous surgery in segment VII. Tumor markers were: AFP 6.23 ng/ml (normal < 5.6 ng/ml), CEA 1.5 ng/ ml (normal < 6.9 ng/ml) and CA19-9 15.9 (normal < 43 ng/dl). FNAC from this mass, was consistent with meta- static HCC (Figure 2). En-bloc resection of the mass (including the mass, overlying skin, abdominal wall mus-
Show more

5 Read more

Abdominal Wall Endometriomas at Cesarean Section Scars: A Case Series

Abdominal Wall Endometriomas at Cesarean Section Scars: A Case Series

The most common extrapelvic location for endometriosis is the abdominal wall, typically presenting within scars following gynecological or obstetric sur- gery [1]. Surgical scar endometriomas following a cesarean delivery are rare, with a prevalence estimated to be between 0.03% and 1% [1]. The rare presence of an abdominal wall endometrioma within a cesarean section scar may pose a diagnostic dilemma both clinically and with diagnostic imaging. Abdominal wall endometriosis is often misdiagnosed and the cause of surgery referrals for treat- ment [3]. Cesarean section scar endometriomas are often mistaken for pathologies such as an incisional hernia, lipoma, hematoma, abscess, or suture granuloma [5]. In conjunction with a clinical history, diagnosis of an abdominal wall endo- metrioma may be aided by utilization of diagnostic imaging modalities, includ- ing sonography, computed tomography (CT), and magnetic resonance imaging (MRI). Definitive diagnosis is usually made with histologic examination. The clinical symptoms and sonographic appearance of three cesarean section endo- metriomas occurring at the same institution are highlighted in this case series.
Show more

9 Read more

Endometrioma of the Abdominal Wall after Caesarean Section

Endometrioma of the Abdominal Wall after Caesarean Section

Background: Endometrial cell implantation after abdominal surgery, mainly after caesarean section, may result in formation of endometrioma, which is usually described to be of various sizes, and adjacent to the surgical scar. Case: A 36-year old woman complaining of a mass of the abdominal wall with pain during the menstrual period, with a caesarean section 5 years earlier, presented a rounded tumour not contiguous to the Pfannenstiel’s laparotomy scar, of hard consistence, fixed and adherent to the deep abdominal wall structures, located on the left paramedian epigastric region. Magnetic Resonance imaging showed the nodule, involving the deep layers of the abdominal wall and the distance from the laparotomic scar. Surgical removal was performed with wide excision of the lesion, causing a large wall defect. After histological con- firmation (endometriosis) by frozen section, reconstruction of the abdominal wall required prolene mesh grafting. After twelve months the patient is healthy. Conclusion: When abdominal wall endometrioma is located distant from the scar, perhaps more frequently after Pfannenstiel’s laparotomic inci- sion, the differential diagnosis may be more difficult and MRI can help diffe- rentiating many of these lesions, and histological confirmation should be ob- tained intraoperatively, by frozen section, to allow an oncological resection if required.
Show more

8 Read more

Desmoid tumors of the abdominal wall: A case report

Desmoid tumors of the abdominal wall: A case report

A 37-year-old female recognized an initially painless tumor in the right lower abdominal wall. In her history, the patient reported on a laparoscopic resection of an ovarian-cyst in 1993 and two pregnancies (1995 and 1997) with caesarean section. On admission, a palpable demarcated fixed tumor in the right lower third of the lat- eral abdominal wall was investigated. Analysed blood parameters were within normal range and tumor markers negative.

7 Read more

Sirenomelia associated with an anterior abdominal wall defect: a case report

Sirenomelia associated with an anterior abdominal wall defect: a case report

Multiple abnormalities highlighted in our patient ’ s case showed a complete anterior abdominal wall agenesis with most of the exposed viscera, fusion of lower limbs, fusion of the lower spine, Potter syndrome, left upper limb amelia, and anencephalia. None of the cases de- scribed in the literature has described the severity of the highlighted clinical features in our case report. Only a few rare noteworthy papers have reported sirenomelia associated with abdominal wall defect [12]. The possible pathophysiology of abdominal wall defect in sirenomelia may be the vascular steal theory [10] and failure of the development of ventral mesoderm [17]. In fact, the sin- gle artery present (steal vessel) diverts the flow of blood that normally circulates from the aorta to the lower parts of the embryo and to the placenta. Thus, the steal vessel redirects the blood flow to the placenta without ever reaching the tail end (caudal) of the embryo. As a result of this rerouted blood flow, the steal vessel also di- verts nutrients away from the blood-deprived portion of the embryo. Arteries in this caudal area are underdevel- oped, and tissues dependent on them for nutrient supply fail to develop, are malformed, or arrest their growth in some incomplete stage. The ventral mesoderm may also be affected with this phenomenon; thus, a failure in its development causes an abdominal wall defect.
Show more

5 Read more

Original Article Serous adenocarcinoma arising from endometriosis in cesarean section abdominal wall scar: a case report and literature review

Original Article Serous adenocarcinoma arising from endometriosis in cesarean section abdominal wall scar: a case report and literature review

Immunohistochemistry sh- owed the cancer was ER(-), PR(-), Vim(-), CK7(+), CA125 (+), p16(+), p53(+), NapsinA (-), WT1(+), Ki67(70%+) (Fi- gure 2). Post-operative path- ological examination revea- led an abdominal wall adeno- carcinoma without evident evidence of malignancy in the ovaries, fallopian tubes and uterus. Thus, the conclu- sion was malignant transfor- mation from the abdominal wall endometriosis. There were 11/18 positive pelvic lymph nodes, 1/9 positive para-aortic lymph nodes and 2/5 positive bilateral ingui- nal lymph nodes. Therefore, adenocarcinoma mass of the abdominal wall perhaps arising from endometriosis after cesarean section was diagnosed.
Show more

8 Read more

A study of abdominal wall hernias

A study of abdominal wall hernias

Once inside the abdominal cavity, the mesh is unrolled and positioned. A transfascial suture passer can be introduced through small stab incisions placed around the marked border of the defect. The suture passer retrieves the long ends of the suture that has been previously placed in the mesh, and the ends are tied at the skin level at 4 to 6 points around the repair and buried with the subcutaneous tissue in the stab incision. This affixes the mesh patch to the fascia layers around the circumference of the patch. After all sutures have been tied and cut, laparoscopically placed tacks or staples can be used to further fasten the mesh to the anterior abdominal wall. Whether the strength of the repair is imported by the trans fascial sutures or the tacks or both remains controversial.
Show more

125 Read more

Benign Ancient Schwannoma of the abdominal wall: An unwanted birthday present

Benign Ancient Schwannoma of the abdominal wall: An unwanted birthday present

In this study we have presented the first reported case in the English literature of an abdominal wall ancient schwannoma and discussed the key clinical, radiological and pathological features of the condition. As this was picked up asymptomatically on a private health whole body CT screen given to the patient as a birthday pre- sent, we have extolled the pitfalls of such tests as well as offered an insight into the clinical, ethical and health economic issues that they raise. Wider marketing and availability of these services may lead to increased non evidence based patient-led screening in the private sec- tor. Unfortunately, this may add an unnecessary burden to public health resources.
Show more

5 Read more

Current practice of abdominal wall closure in elective surgery – Is there any consensus?

Current practice of abdominal wall closure in elective surgery – Is there any consensus?

Our finding that midline incisions are the most frequently applied access in open abdominal surgery is in accordance with previous reports [15]. While the abdominal access may to some degree depend on the target organ it was our aim to assess the overall frequency of midline incisions that would support the rationale of the INSECT-Trial. However, it appears valuable to perform further studies to evaluate the relative frequency of midline and transverse incisions in well-defined patient populations. The urgency of the intervention (i.e. elective vs. emergency laparotomy) as well as the target organ are critical factors to be considered for determination of the population under study. A recent Cochrane review indicated that transverse incisions are potentially less painful and less frequently associated with pulmonary complications, but failed to show a clear advantage for a reduction of inci- sional hernias [16] when compared to midline incisions. Further data analyzing the patient's perspective (i.e. post- operative pain) in a blinded randomized fashion are needed for evidence-based surgical decision making. Cur- rently, both incision types may be used in daily practice of elective surgery depending on the surgeons preference. The lack of consensus for abdominal wall closure strate- gies after midline incisions demonstrates persistent uncer- tainty within the surgical community. Several RCTs [4-8] and meta-analyses [9-12] were published comparing dif- ferent closure methods of midline abdominal incisions. In a critical appraisal of meta-analyses in the surgical liter- ature [17] two of these meta-analyses have been found to
Show more

8 Read more

Original Article Effect of high-intensity focused ultrasound ablation on endometriosis of the abdominal wall

Original Article Effect of high-intensity focused ultrasound ablation on endometriosis of the abdominal wall

Abdominal wall endometriosis is one of the most common extrapelvic endometriosis. It often occurs in the incision scar of a cesarean operation, and indicates that active endome- trial tissue is present in the abdominal wall. The incidence is rapidly rising with the increasing of trend of cesarean section in recent years [20, 23, 24]. Ultrasound ablation is a non-invasive procedure that involves increasing temperature of a lesion to 65°C, and induces coagulative necrosis; it is currently widely used in the treat- ment of benign and malignant tumors of the uterus [25-27], breast [28, 29], pancreas [29- 31], liver [8, 32], and others, and has become an indispensable therapeutic approach in the clinical setting.
Show more

7 Read more

Malignant Triton Tumor in the Abdominal Wall: A Case Report

Malignant Triton Tumor in the Abdominal Wall: A Case Report

Malignant triton tumor (MTT) is a rare variant of malignant peripheral nerve sheath tumor (MPNST) with rhabdomyo- sarcomatous differentiation. We report the case of a 54-year-old male without a history of neurofibromatosis type 1 (NF1) who had a growing abdominal wall tumor diagnosed as MTT. Computed tomography (CT), magnetic resonance imaging (MRI) and 2-[F-18]-fluoro-2-deoxy- D -glucose positron emission tomography/CT (FDG-PET/CT) were per-

5 Read more

Is abdominal wall contraction important for normal voiding in the female rat?

Is abdominal wall contraction important for normal voiding in the female rat?

begins, possibly in response to urine being forced into the proximal urethra at a threshold bladder pressure against the closed rhabdosphincter. This timing suggests that abdominal pressure due to the voiding-associated abdominal response may thus play a part in initiating and supporting the IPHFO/flow phase of micturition. It has been demonstrated that the voiding-associated EMG activity depends upon pelvic nerve afferents [1]. Bladder pelvic nerve activity decreases during the IPHFO phase, possibly in response to decreasing volume, with a change in efferent activity to a bursting pattern [14], and thus detrusor-generated bladder pressure may decrease. The persistence of the abdominal activity throughout the IPHFO/flow phase despite decreasing bladder afferent activity is consistent with afferent signalling leading to the abdominal response arising in the urethra rather than the bladder. The voiding-associated abdominal wall response may therefore provide an important self-sustaining quan- tum of driving pressure at a moment when detrusor-gen- erated pressure is declining, and thus maintain urine flow during EUS relaxation. According to this hypothesis, fail- ure of abdominal pressurization (as in the BTX group) results in a degradation of the IPHFO phase as the bladder empties, decreasing per-void volume and impairing flow. Our findings are consistent with such a functional role of abdominal wall contraction as part of normal voiding. Removing the supplemental pressure supplied by the abdominal wall without disturbing the rhabdosphincter activity decreased voiding efficiency as evidenced by a decreased per-void volume and flow rate.
Show more

7 Read more

Show all 9986 documents...