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At least 433 records · Page 24Linked to original sources
PubMed2004

Traumatic abdominal wall hernia: a reappraisal.

Traumatic abdominal wall hernia, a rare cause of hernia, has a confusing clinical picture and requires a high index of suspicion for prompt diagnosis and management. Such hernias, if missed, can result in high morbidity and may prove fatal. Distinction from a pre-existing hernia is important as well. We report our experience in two such cases, which had presented in a span of 9 months, and submit a brief analysis of 50 reviewed cases.

Abdominal Injuries↗
PubMed2004

[Midgut malrotation risk in abdominal wall defect].

BACKGROUND: Midgut malrotation has a low incidence (0.5-1% at necropsies) and it is a rare symptomatic condition. Nevertheless it is often associated to clinical situations with a high morbility and mortality and it could complicate them. Our aim is to study the patients treated for abdominal wall defects and who have suffered complications due to non-treated malrotation at first surgery. METHODS: We retrospectively studied the charts of patients diagnosed of abdominal wall defects in our hospital from 1993 to 2002. We reviewed the initial treatment, the associated morbility and any new surgical treatment needed. RESULTS: During this 10-year period, 110 abdominal wall defects were managed: 56 congenital diaphragmatic hernias, 30 onphaloceles and 14 gastroschisis; overall 79 of these 100 patients survived and were included in this study. Eleven patients had symptoms due to bowel malrotation during the follow-up period. In 1 case the clinical picture had an acute onset as a volvulus that required extensive gut resection; another patient presented as a persistent gastrocutaneous fistula after removal of a gastrostomy tube; in the remaining 9, symptoms were always of classical intestinal obstruction. The malrotation was never treated during the initial surgical procedure for abdominal wall defect; later on, Ladd procedure was always the definitive treatment. CONCLUSIONS: Due to local conditions during first abdominal wall surgery that limit the evaluation of the malrotation, we must think about it when we find obstructive symptoms any time during life.

Child, Preschool↗
PubMed1977

Management of enterocutaneous fistulas and problem stomas with silicone casting of the abdominal wall defect.

Silicone casting of abdominal wall defects around enteric fistulas in six patients and problem stomas in three patients proved to be an effective means of controlling the output of the fistulas, reducing wound care time, and reducing or eliminating parenteral nutrition needs. Outpatient management was possible in seven of the nine patients. It is observed that the wounds healed rapidly with this method of fistula control. Epithelialization occurred more rapidly than expected. This method of management may tend to make the fistulas remain open longer than by other means of care, but the significant increase in patient comfort, the financial savings, and the relative safety warrant continued utilization and observation of this method of management.

Abdominal Muscles↗
PubMed1995

[Large eventrations: deep extensive cleavage of the abdominal wall and prosthetic repair].

The objective for surgical repair of major defects of the abdominal wall is an anatomical reconstruction and reinforcement with a support prosthesis. Wall reconstruction should be obtained without tension. This requires deep extensive cleavage so the deep musculo-aponevrosis can be advanced approximately 10 cm. This manoeuvre is anatomic and preserves vascularization and innervation. A prosthesis covers the orificies and reinforces the anatomic construction. In peripheral defects, cleavage is necessary for closure. The prosthesis is anchored on deep solid structures (ribs, iliac crests) guaranteeing solidity. In a series of 252 operated patients, abdominal wall solidity was achieved in 91% of the cases with a mean follow-up of 2 to 13 years. Mortality was 1.2% and morbidity 8%, emphasizing the importance of rigorous indications. Intensive preparation including the Goni Moreno pneumoperitoneum is required for surgery in all major abdominal wall defects.

Abdominal Muscles↗
PubMed1993

Rectus repair for midline ventral abdominal wall hernia.

Recurrence-free repair of midline ventral abdominal wall hernia continues to elude surgeons, despite the abundance of described techniques. Based on the observation that spontaneous herniation through the rectus abdominis muscles is unknown, a new technique of repair was devised. The rectus muscles and their sheaths on either side of the hernial defect are directly brought together to obliterate the hernia, the intervening linea alba and intact hernia sac being 'keeled' into the abdominal cavity. Using this technique, 85 consecutive midline abdominal hernias were repaired over an 11-year period. Follow-up was from 18 months to 12 years; there was one recurrence. The rectus repair is recommended as an effective method of dealing with ventral midline abdominal wall hernia.

Abdominal Muscles↗
PubMed1984

Gastric involvement in abdominal wall hernias.

Six cases of abdominal wall hernias involving the stomach are reported. Three of the hernias were incisional, 2 were epigastric, and 1 was umbilical. All the patients were middle-aged or elderly women. In 2 cases, the gastric herniation produced gastric outlet obstruction with resulting severe dehydration and electrolyte disturbances. Radiographically, the abnormality involved deformity of the stomach with shortening in the frontal views. Lateral profile views were essential in demonstrating the cause of this deformity. In 5 cases, there was mesenteroaxial torsion of the herniated stomach so that the efferent limb of the hernia was superior to the afferent limb. Two of these were associated with obstruction which developed at the neck of the efferent limb.

Aged↗
PubMed1998

Understanding gastroschisis: an abdominal wall defect.

Gastroschisis is an abdominal wall defect found in the newborn that requires immediate interventions in the delivery room. To provide appropriate management, clinicians must have a clear understanding of the etiology and pathophysiology of gastroschisis. Stabilization in the delivery room is important and begins with establishing an airway, preventing hypothermia, and protecting the exposed bowel from the environment. Surgical treatment is required in the early neonatal period. Adequate preparation prior to repair is essential to ensure optimal outcomes.

Diagnosis, Differential↗
PubMed2001

Fascial incisions heal faster than skin: a new model of abdominal wall repair.

BACKGROUND: Optimal healing of the fascial layer is a necessary component of complete abdominal wall repair. The majority of acute wound healing studies have focused on the dermis. We designed a model of abdominal wall repair that, to our knowledge, for the first time simultaneously characterizes differences in the wound healing trajectories of the fascia and skin. METHODS: Full-thickness dermal flaps were raised on the ventral abdominal walls of rats, and midline fascial celiotomies were completed. The dimensions of the flap were developed so as to have no detrimental effect on skin healing. The dermal flaps were replaced so that the fascial incisions would heal separately from the overlying skin incisions. Animals were killed 7, 14, and 21 days after operation and fascial and dermal wounds were harvested and tested for breaking strength. Fascial and dermal wounds were also compared histologically for inflammatory response, fibroplasia, and collagen staining. RESULTS: Fascial wound breaking strength exceeded dermal wound breaking strength at all time points (9.16 +/- 2.17 vs 3.51 +/- 0.49 N at 7 days, P <.05). Fascial wounds also developed greater fibroblast cellularity and greater collagen staining 7 days after the incision. There was no difference in wound inflammatory response. CONCLUSIONS: Fascial incisions regain breaking strength faster than simultaneous dermal incisions. The mechanism for this appears to involve increased fascial fibroplasia and collagen production after acute injury.

Abdominal Muscles↗
PubMed1992

Intraregional differences in the absorption of unmodified insulin from the abdominal wall.

Absorption of subcutaneously injected unmodified human 125I-insulin (5 U; 100 U ml-1) was studied concurrently from three areas of the abdominal wall (120 mm above, 120 mm lateral to, and 40 mm below the umbilicus), and one area of the thigh (upper midline), in nine Type 1 diabetic patients of normal body weight, and from deep (2 mm above muscle fascia) and superficial (3 mm beneath skin surface) sites in abdominal wall and thigh in 11 Type 1 diabetic patients. The absorption rates were followed continuously for 3 h with the patient in the supine position. Whereas 125I-insulin disappeared considerably faster from the site above the umbilicus than from sites below or lateral to the umbilicus or from the thigh (residual radioactivities after 175 min: 36 +/- 4 vs 49 +/- 5, 54 +/- 2, and 62 +/- 4 (+/- SE)%, respectively; p less than 0.05 or better), no significant differences were found between deep and superficial sites in either abdominal wall or thigh. The results suggest that insulin absorption rates from subcutaneous injection sites within the abdominal wall differ sufficiently for this to be of clinical importance.

Abdominal Muscles↗
PubMed1995

[Abdominal wall endometriosis imitating incisional hernia].

Pain and swelling in abdominal wall scars that become more severe on coughing and straining, are typical symptoms of postoperative ventral hernias. Other abdominal wall lesions, such as hematomas, granulomas and neoplasms, can evoke similar symptoms. Usually the diagnosis can be made by physical examination, but occasionally only at operation. Endometriosis in a postoperative scar is rare, and the symptoms are usually associated with the menstrual cycle. We describe a 40-year-old woman who suffered from pain and swelling in a cesarean section scar of 8 years duration. The symptoms worsened on coughing and during exercise. At operation, a 3 x 5 cm nodule was excised from the depths of the scar; endometriosis was found on histopathological examination. Endometriosis should be included in the differential diagnosis of abdominal scar lesions following gynecological operations.

Abdominal Muscles↗
PubMed1995

[Plastic surgery of the anterior abdominal wall in children using synthetic resolving materials].

The data on the first experience in the use of synthetic resolvable materials in plasty of the anterior abdominal wall in children are reported. Tissue glue compositions based on alpha-cyanoacrylates as well as connective biocompatible elements (CBE) developed at the SRIIMT were used. An aponeurotic suture-glue duplication was utilized for plastic enforcement of the anterior abdominal wall; individual methods were developed for each concrete localization of the defects. Operations were carried out on 201 children with congenital abnormality of the anterior abdominal wall: inguinal hernias, hernias of the linea alba, ventral hernias. Ninety-six (47.8%) children were examined in late postoperative periods of 2 to 9 years. Recurrences were not encountered. No inflammatory complications were found. It is concluded that the use of Russian synthetic resolvable materials for surgical treatment of pathological conditions of the abdominal wall in children is effective and safe.

Abdominal Muscles↗
PubMedDate not supplied

Gastric ulcer penetrating the anterior abdominal wall: ultrasound diagnosis.

We report two rare cases of penetration of the anterior abdominal wall by gastric peptic ulcers. The full diagnosis was made by ultrasound, which showed similar findings: sharply delineated, hyperechoic craters clearly traversing the gastric wall and covered by hypoechoic inflammatory components of the abdominal wall. Because ultrasound is increasingly used as a primary procedure for evaluation of abdominal complaints, efforts should be directed toward exploring the accessible portions of the gastric and duodenal walls to detect peptic ulcer disease and its complications.

Abdominal Wall↗
PubMed1994

Planned ventral hernia. Staged management for acute abdominal wall defects.

OBJECTIVE: Analysis of a staged management scheme for initial and definitive management of acute abdominal wall defects is provided. METHODS: A four-staged scheme for managing acute abdominal wall defects consists of the following stages: stage I--prosthetic insertion; stage II--2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage III--2 to 3 days later, planned ventral hernia (split thickness skin graft [STSG] or full-thickness skin and subcutaneous fat); stage IV--6 to 12 months later, definitive reconstruction. Cases were evaluated retrospectively for benefits and risks of the techniques employed. RESULTS: Eighty-eight cases (39 visceral edema, 27 abdominal sepsis, 22 abdominal wall resection) were managed during 8.5 years. Prostheses included polypropylene mesh in 45 cases, polyglactin 910 mesh in 27, polytetrafluorethylene in 10, and plastic in 6. Twenty-four patients died from their initial disease. The fistula rates associated with prosthetic management was 9%; no wound-related mortality occurred. Most wounds had split thickness skin graft applied after prosthetic removal. Definitive reconstruction was undertaken in 21 patients in the authors' institution (prosthetic mesh in 12 and modified components separation in 9). Recurrent hernias developed in 33% of mesh reconstructions and 11% of the components separation technique. CONCLUSIONS: The authors concluded that 1) this staged approach was associated with low morbidity and no technique-related mortality; 2) prostheses placed for edema were removed with fascial approximation accomplished in half of those cases; 3) absorbable mesh provided the advantages of reasonable durability, ease of removal, and relatively low cost--it has become the prosthesis of choice; and 4) the modified components separation technique of reconstruction provided good results in patients with moderate sized defects.

Abdominal Muscles↗
PubMed1998

Abdominal wall plasty for a premature infant with congenital diaphragmatic hernia.

This paper reports a premature infant with a congenital diaphragmatic hernia (CDH) who underwent an abdominal wall plasty to enlarge the abdominal cavity, one of twin infants born at 32 weeks weighing 1,255 g. After stabilization, the herniated viscera were reduced from the pleural cavity and the abdominal wall muscle and skin layers were replaced by a Gore-tex patch without closure of the diaphragmatic defect. Respiratory and circulatory conditions were stable during the perioperative period. Postoperatively, a roentogenogram showed expansion of the lung. However, his condition deteriorated 24 h after surgery, triggered by intratracheal suction, and he died on the 4th day of life despite the use of high-frequency oscillation, catecholamines, and vasodilators. Postmortem examination showed severely hypoplastic lungs. Abdominal wall plasty may be a less invasive initial procedure, however, further studies, such as comparison with the standard method or conservative management, are needed using a large clinical group or animal models to justify the usefulness of this procedure.

Abdominal Muscles↗
PubMed2004

Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen.

BACKGROUND: Inability to close the abdominal wall after laparotomy for trauma may occur as a result of visceral edema, retroperitoneal hematoma, use of packing, and traumatic loss of tissue. Often life-saving, decompressive laparotomy and temporary abdominal closure require later restoration of anatomic continuity of the abdominal wall. METHODS: The trauma registry, open abdomen database, and patient medical records at a level 1 university-based trauma center were reviewed from January 1988 to December 2001. RESULTS: During the study period, more than 15,000 trauma patients were admitted, with 88 patients (0.6%) requiring temporary abdominal closure (TAC). Patients ages ranged from 12 to 75 years with a mean injury severity score (ISS) of 28 (range 5 to 54). Forty-five patients (51%) suffered penetrating injuries, and 43 (49%) were victims of blunt trauma. Indications for TAC included visceral edema in 61 patients (70%), abdominal compartment syndrome in 10 patients (11%), traumatic tissue loss in 9 patients (10%), and wound sepsis and fascial necrosis in 8 patients (9%). Fifty-six patients (64%) underwent TAC at admission laparotomy, whereas 32 patients (36%) required TAC at reexploration. Seventy-one patients (81%) survived and 17 (19%) died. Of the survivors, 24 patients (34%) underwent same-admission direct fascial closure, and 47 patients (66%) required visceral skin grafting and readmission closure. Reconstructive procedures in the patients requiring skin graft excision included direct fascial repair (20 patients, 44%), components separation closure with or without subfascial tissue expansion (18 patients, 40%), pedicled or free-tissue flaps (4 patients, 8%), and mesh repair (4 patients, 8%). One patient refused closure. The mean follow-up was 48 months (range 6 to 144), with an overall recurrence rate of 15% (range 10% to 50%), highest in the mesh repair group. CONCLUSIONS: Silicone sheeting TAC provides a safe and reliable temporary abdominal closure allowing for later definitive reconstruction. Direct fascial repair or components separation closure with or without tissue expansion can be utilized in the majority of patients for definitive reconstruction with low recurrence rate.

Abdominal Injuries↗
PubMed1995

Jejunal diverticulitis manifesting with abdominal wall abscess.

Jejunal diverticulosis is generally considered to be an innocuous condition, but serious complications can arise and lead to acute or chronic syndromes. In this report, we describe a case of jejunal diverticulitis presenting with an abdominal wall abscess. To our knowledge, this is the first documented case of jejunal diverticulitis complicated by fistula formation leading to the development of an abdominal wall abscess. Because jejunal diverticula generally localize at the mesenteric border and their perforation tends to result in intra-abdominal abscess formation, we speculate that the abdominal wall abscess described in our case here was due to adhesions of jejunal loops to the abdominal wall secondary to previous abdominal surgeries.

Abdominal Abscess↗
PubMed1991

[Ultrasonic examination of the abdominal wall in surgery].

Ultrasonic (US) examination is a simple, effective and quick method of investigating the abdominal wall. We evaluated various cystic and solid lesions in 26 patients by US. In 24 the US diagnosis was correct and revealed pathologic conditions of the abdominal wall such as abscesses, cellulitis, metastatic tumors and hematomas. In 2 patients lesions of the abdominal wall were missed. All but 3 patients were treated surgically.

Abdominal Muscles↗