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PubMed2006

Abdominal wall injuries: rectus abdominis strains, oblique strains, rectus sheath hematoma.

Abdominal wall injuries are reported to be less common than actually perceived by sports medicine practitioners. National Collegiate Athletic Association injury statistics for 2004-2005 cite a high of 0.71 abdominal muscle injuries per 1000 player-hours in wrestling competition to a low of 0.01 injuries per 1000 player-hours in autumn football practices. British professional soccer clubs reported an incidence of "torso" injuries of up to 7% of all injuries over the course of several seasons. Injury definition is most likely the explanation for this discrepancy. The abdominal wall muscles (rectus abdominis, external and internal obliques, and transverse abdominis) are injured by direct blows to the abdomen or by sudden or repetitive trunk movement, either rotation or flexion/extension. With the exception of the rare rectus sheath hematoma that does not self-tamponade, the treatment for these problems is nonoperative with symptoms guiding rehabilitation and return to play decisions.

Abdominal Muscles↗

PubMed1992

Human in situ dosimetry: differential insertion loss during passage through abdominal wall and myometrium.

We constructed a specialized in vivo exposimetry system and determined selected ultrasonic field quantities. We examined two groups of non-pregnant women (nulliparas = 14, multiparas = 9) under conditions of full and empty bladder. A calibrated 7-element linear array hydrophone was placed in the anterior fornix of the vagina in each subject. In the full bladder condition, the sound beam traversed the anterior abdominal wall and full bladder, whereas after voiding, the sound beam traversed the abdominal wall and anteverted uterine fundus. Each study was conducted using a 3.5 MHz mechanical sector transducer. Calibration data were recorded after completion of each in vivo experiment. Data from both groups were pooled for analysis. Assuming (1) the sound path through the full bladder is loss less, the insertion loss (ILFULL) should represent the insertion loss for the abdominal wall (ILABD WALL) 8.2 +/- 5.6 dB; whereas (2) for the empty bladder condition, (ILEMPTY) represents (ILABD WALL+ILUTERUS). Subtracting ILFULL from ILEMPTY yields ILUTERUS = 5.8 +/- 6.8 dB. Therefore, knowing the respective path lengths and normalizing for frequency, the mean tissue attenuation coefficients (A) are estimated to be AABD WALL = 1.39 dB/cm-MHz and AUTERUS = 0.14 dB/cm-MHz. These attenuation data suggest that the abdominal wall is the principal source of ultrasonic energy loss.

Abdominal Muscles↗

PubMed2003

Abdominal wall and surgical scar endometriosis: results of magnetic resonance imaging.

Scar endometriosis is a rare disease which is difficult to diagnose. The symptoms are nonspecific, typically involving abdominal wall pain at the time of menstruation. Clinical examination may reveal a painful nodule, if the scar involved is located on the abdominal wall, but is normal, when the lesion is located on the uterine scar. Other means of investigation (transvaginal ultrasonography, computed tomography) may be useful in case of lesions on the abdominal wall, or if the nodule is large, but give no specific results. The diagnosis is frequently made only after excision of the lesion. We report here 4 patients operated for scar endometriosis (two abdominal and two uterine scars) for whom MRI had suggested the diagnosis. Thanks to its very high spatial resolution, MRI enables very small lesions to be detected and can distinguish the hemorrhagic signal of endometriotic lesions. Furthermore, it performs better than the CT scan in detecting the limits between muscles and abdominal subcutaneous tissues.

Abdominal Wall↗

PubMed2006

Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia.

BACKGROUND: The aim was to determine whether systemic antibiotic prophylaxis prevented wound infection after repair of abdominal wall hernia with mesh. METHODS: This was a systematic review of the available literature identified from multiple databases using the terms 'hernia' and 'antibiotic prophylaxis'. Randomized placebo-controlled trials of antibiotic prophylaxis in abdominal wall mesh hernia repair with explicitly defined wound infection criteria and a minimum follow-up of 1 month were included. After independent quality assessment and data extraction, data were pooled for meta-analysis using a random-effects model. RESULTS: The search process identified eight relevant trials. Two papers on umbilical, incisional or laparoscopic hernias, and six concerning inguinal and femoral (groin) hernias were suitable for meta-analysis. The incidence of infection after groin hernia repair was 38 (3.0 per cent) of 1277 in the placebo group and 18 (1.5 per cent) of 1230 in the antibiotic group. Antibiotic prophylaxis did not significantly reduce the incidence of infection: odds ratio 0.54 (95 per cent confidence interval 0.24 to 1.21); number needed to treat was 74. The number of deep infections was six (0.6 per cent) in the placebo group and three (0.3 per cent) in the antibiotic prophylaxis group: odds ratio 0.50 (95 per cent c.i. 0.12 to 2.09). CONCLUSION: Antibiotic prophylaxis did not prevent the occurrence of wound infection after groin hernia surgery. More trials are needed for complete evidence in other areas of abdominal wall hernia.

Antibiotic Prophylaxis↗

PubMed2002

The spinal needle test effectively measures abdominal wall thickness before cannula placement at laparoscopy.

STUDY OBJECTIVE: To demonstrate the usefulness of the spinal needle test at laparoscopy to correlate abdominal wall thickness at initial entry sites with body mass index (BMI). DESIGN: Prospective cohort study (Canadian Task Force classification). SETTING: University-affiliated hospital. PATIENTS: One hundred thirty-eight women. INTERVENTION: Diagnostic laparoscopy. MEASUREMENTS AND MAIN RESULTS: After CO(2) insufflation, the spinal needle test was performed by inserting a spinal needle attached to a partially filled syringe and advancing it perpendicular to the skin until the gas pocket was reached. To improve precision, the distance was measured 3 times at two sites, the umbilicus and Palmer's point (left upper quadrant). Patients' mean BMI was 25.8 kg/m(2) (range 17.2-60.0 kg/m(2)), with 24 (17%) considered clinically obese (BMI > or =30 kg/m(2)). A significant correlation was noted between BMI and abdominal wall thickness at the umbilicus (R = 0.69) and left upper quadrant (R = 0.81). Excellent correlation was also noted between body weight and thickness at the two points (R = 0.72 and R = 0.78, respectively). The mean thickness at the umbilicus differed significantly between obese (3.0 +/- 1.2 cm) and nonobese women (1.7 +/- 0.7 cm, p <0.001); as did mean thickness at the left upper quadrant (4.4 +/- 1.0 vs 2.0 +/- 0.7 cm, p <0.001). CONCLUSION: Thickness of the abdominal wall at umbilical and left upper quadrant entry sites correlates well with weight and BMI. Even among obese women, the distance to the pocket of gas after insufflation at either entry site is remarkably small.

Abdominal Wall↗

PubMed2005

Metastasis of transitional cell carcinoma to the lower abdominal wall 20 years after cystectomy.

Iatrogenic implantation has been the main cause in the majority of cases of transitional call carcinoma (TCC) with metastasis to the abdominal wall. A 66-year-old woman had undergone radical cystectomy 20 years prior to presenting. Radiological investigations revealed one mass in the left lower abdominal wall and one mass in the right inguinal area. She underwent wide excision of the lesions that revealed metastasis of TCC. This report describes this case of a woman with bladder carcinoma who developed a metastasis in the anterior abdominal wall following an apparent disease-free interval of 20 years.

Abdominal Wall↗

PubMed1986

[Synovial sarcoma of the abdominal wall].

A case of a synovial sarcoma arising in the abdominal wall in a 60-year-old man is reported. Histologically, a characteristic biphasic cellular pattern with epithelium-like cell complex and fibrosarcomatous spindle cell area was found. Mucinous materials within the epithelium-like cells, intercellular clefts and pseudoglandular spaces stained positively with PAS, alcian blue, colloid iron and mucicarmine stain. The staining characteristics of these materials remained unchanged after treatment with diastase and hyaluronidase. This histochemical finding makes the diagnosis of a peritoneal mesothelioma unlikely. A brief review of previously reported cases of synovial sarcoma arising in the abdominal wall is also presented.

Abdominal Muscles↗

PubMed1978

[Increased regional hepatic blood circulation and bile flow following application of peloid paraffin packs on rat abdominal wall].

In Sprague-Dawley rats anaesthetized with pentobarbital-Na and breathing spontaneously, regional hepatic blood flow (rHBF) is measured in the liver in situ and during application of peloid paraffin packs on the abdominal wall. Blood flow measurements are performed by means of the 85Kr(beta)-clearance technique after slug injection of the dissolved indicator into the thoracic aorta. Mean arterial blood pressure is monitored continuously. After exposing the liver surface by an incision at the right costal margin, rHBF is measured, 5, 15, 35 and 45 min later. The results of a control series clearly show that there exists a time-dependent decrease of rHBF at comparable M ABP values and normal respiratory gas parameters. If peloid paraffin packs are applied on the abdominal wall 25 min after the surgery, this time-dependent decrease of rHBF ceases and rHBF then increases to initial values. In comparison to the control series the application of peloid paraffin packs on the abdominal wall causes a significant increase in rHBF of about 20--39%. Experiments on bile flow of rats show that under normal conditions and after insertion of a cannula into the common hepatic duct, a time-independent mean flow of 0.053 ml bile/kg body weight/min occurs. The application of peloid paraffin packs 45 min after the suture of the abdominal wall yields a significant increase in bile flow of 18% within 15 min.

Animals↗

PubMed1976

Repair of incisional hernias and defects in the anterior abdominal wall using dermal grafts. Case report.

The technique and results of using autografts of dermis to repair defects in the anterior abdominal wall is shown. Dermal grafting was used in altogether 15 cases. 7 with extremely large incisional hernias, and 8 with defects after malignant abdominal wall tumours. The surgical method is described and the follow-up 1 to 4 years postoperatively has shown a very satisfactory result in 13 cases. In one case there was a postoperative haematoma with subsequent graft necrosis and in the other there was a residual hernial defect. We recommend this method as one of choice in cases with large abdominal wall defects.

Abdominal Muscles↗

PubMed2005

Incidence of abdominal wall metastasis complicating PEG tube placement in untreated head and neck cancer.

BACKGROUND: Abdominal wall metastasis after PEG tube placement has been reported in patients with head and neck cancer. The incidence of this occurrence is unknown. OBJECTIVE: Evaluation of the incidence of abdominal wall metastasis as a complication of PEG tube placement in patients with head and neck cancer. DESIGN: Retrospective chart review. SETTING: H. Lee Moffitt Cancer Center and Research Institute, Nutritional Support Services. SUBJECTS: Head and neck cancer patients requiring nutritional support with PEG tube placement. RESULTS: Of the 304 patients with head and neck cancer, 218 had active disease with a viable tumor in the oropharynx or hypopharynx at the time of PEG placement. Two of these patients, both with active disease (0.92%), developed a PEG site metastasis. CONCLUSION: There is a small but definite risk for tumor implantation in the gastrostomy site when using the pull technique in patients with active head and neck cancer. Careful assessment of the oropharynx and hypopharynx before PEG tube placement and the use of alternative techniques for enteral access in patients with untreated or residual malignancy are recommended to minimize this risk. Use of other percutaneous techniques that do not involve traversing the hypopharynx with the catheter may help to prevent tumor translocation. When head and neck cancers metastasize to the gastrostomy site, patient survival appears limited even with extensive resection.

Abdominal Wall↗

PubMed1997

[Morphologic correlation of functional abdominal wall mechanics after mesh implantation].

Modern surgical hernia repair depends increasingly on synthetic meshes for reconstruction of the abdominal wall. Despite the undisputed advantages of the synthetic meshes currently available, reports of late complications after implantation are accumulating. It is essential that the synthetic meshes be improved, but this makes a standardized animal model necessary for evaluation of their biocompatibility on both functional and morphological levels. In the present study, commercially available polypropylene and polyester meshes were implanted in a rat model, and detailed morphological and morphometric analysis were carried out. Correlations between the morphological and morphometric data and the function of the artificial abdominal wall were then sought. In summary, the data show that the mesh construction currently available are oversized and definitely restrict the function of the artificial abdominal wall. The degree of inflammation and fibrosis, the pattern of fibrosis, and the composition of the extracellular matrix exert decisive influences on the function. Fibrosis and inflammation are caused less by the material itself, however, than by its density, the way it is processed, and its surface. Future, that is to say second-generated, mesh constructions should be designed with the aims of reducing the amount of material used and finding material-specific processing methods in mind, to improve the functionally and morphologically defined biocompatibility.

Abdominal Muscles↗

PubMed1999

Reconstruction of disruption of the abdominal wall in burn patients.

Two patients with extensive destruction of the full thickness of the abdominal wall and associated intra-abdominal injuries were encountered. One case resulted from burns to a patient pinned under an automobile in contact with the muffler; the other was injured as a result of penetration of the abdominal wall by a railroad coupling and was also burned in an associated welding accident at the same time. Extensive staged debridement and repair of intra-abdominal injuries in several procedures were required in case 1. Closure was eventually achieved with serial applications of mesh and split-thickness autografting. In case 2, an initial attempt at flap closure failed. Coverage initially was obtained with silicone mesh followed by split-thickness grafting. We report successful management of two of these difficult reconstructive challenges.

Abdominal Injuries↗

PubMed1983

Total abdominal wall reconstruction.

A patient had full-thickness loss of abdominal wall from clostridial myonecrosis. Initial care consisted of resuscitation, debridement, and transfer to a hyperbaric chamber facility. After control of sepsis, multiple enteric fistulas were managed by enterotomies, gastric and duodenal defunctionalization with closed-loop gastrojejunostomy, gastrostomy, and end jejunostomy. Good nutritional status was maintained with total parenteral nutrition over a three-month period. Total abdominal wall reconstruction was accomplished by rotation of bilateral tensor fascia lata musculocutaneous flaps. Reconstruction was successful as the patient was able to return to an active life.

Abdominal Muscles↗

PubMed1996

[Changes in abdominal wall mechanics after mesh implantation. Experimental changes in mesh stability].

The use of biomaterials for incisional hernia markedly reduces the recurrence rates. Disadvantages are high rates of local wound complications and restriction of mobility by the rigid "shell". The abdominal wall mobility after mesh implantation is analysed for eight different mesh materials. The initial textile testing reveals relevant differences in structure with marked asymmetry in the different directions. The materials are implanted as inlay in rats for 3, 7, 14, 21 and 90 days. The deformation of the abdominal wall following intraabdominal pressure of 0-70 mmHg (0-9.81 kPa) is documented by 3D-photogrammetry, the tensile strength by tearing of excised strips of mesh. Three commercial available materials and two laboratory modifications lead independently of their textile characteristics to a marked restriction of the rounded configuration of the abdominal wall. The tensile strength exceeds by far the physiologically necessary value of 16 N/cm. Three newly developed meshes made of multifilament polypropylene with reduced amounts of material (21% and 28% relative to Marlex) lead to no restriction of the abdominal wall configuration yet have uncompromised stability. It might be possible to reduce the rate of local wound complications by the use of these newly developed meshes.

Abdominal Muscles↗

PubMed2003

Abdominal wall endometriomas near cesarean delivery scars: sonographic and color doppler findings in a series of 12 patients.

PURPOSE: To describe the sonographic and color Doppler features of endometriomas of the abdominal wall arising near cesarean delivery scars. METHODS: Twelve women (mean age, 31 years; range, 22-42 years) underwent sonographic and color Doppler examination of the abdominal wall with high-frequency probes for the presence of painful nodules near cesarean delivery scars, cyclic or continuous lower abdominal pain, or both. RESULTS: All patients had undergone at least 1 cesarean delivery before admission (mean, 4.1 years; range, 2-12 years). A typical clinical presentation (ie, mass and cyclic pain and swelling during menses) was recorded in 6 cases. Sonography disclosed all subcutaneous nodules (mean size, 28.1 mm; range, 7-50 mm). Common sonographic features included (1) a hypoechoic inhomogeneous echo texture with internal scattered hyperechoic echoes; (2) irregular margins, often spiculated, infiltrating the adjacent tissues; and (3) a hyperechoic ring of variable width and continuity. At color Doppler examination, a single vascular pedicle entering the mass at the periphery was shown in 7 cases. Abundant intralesional vascularization was shown in 3 cases with diameters of greater than 3 cm, whereas no vascular sign could be detected in 2 lesions smaller than 15 mm. All patients underwent wide surgical excision, and pathologic examination disclosed endometrial tissue in all of them. No relapses were recorded at clinical and sonographic follow-up (4-23 months). CONCLUSIONS: Sonographic and color Doppler findings, when properly combined with clinical data, may substantially contribute to the correct preoperative diagnosis of abdominal wall endometriomas.

Abdominal Wall↗

PubMed2003

Factors involved in abdominal wall closure and subsequent incisional hernia.

Incisional hernia is a frequent complication of abdominal wall closure with a reported incidence of between 5% and 15% following vertical midline incisions at one-year follow-up. Evidence from randomised clinical trials and meta-analysis indicate that a continuous running non-absorbable or slowly absorbed suture such as polydioxanone is the method of choice for abdominal wall closure. Continuous polydioxanone has a similar incisional hernia rate to its non-absorbable counterparts but causes less chronic pain and wound sinuses. Evidence from randomised clinical trials indicates that a lateral paramedian incision is associated with a lower incidence of incisional hernia when compared with other abdominal incisions. Transverse abdominal incisions have no advantage over midline incisions in reducing incisional hernia rate. Although experimental and clinical evidence indicate that a greater number of stitches with a suture length to wound ratio of at least 4:1 is associated with a lower incidence of incisional hernia, there is no evidence from randomised clinical trials to support this. Intuitively one may think that putting as little tension as possible on the closure is important, but there is no evidence for this. Clinical trials evaluating these factors would be difficult to undertake making it important that surgeons continue to audit incisional hernia rates following abdominal closure.

Abdominal Wall↗

PubMed1985

Cloacal exstrophy and related abdominal wall defects in Manitoba: incidence and demographic factors.

A retrospective descriptive study of omphalocele and exstrophic defects of the abdominal wall was carried out in Manitoba to determine the prevalence of these defects, changes in birth incidence with time and their etiologic heterogeneity. The incidence of isolated omphalocele was similar to that reported in other series but the overall incidence of other types of abdominal wall defects was high. Cloacal exstrophy, bladder exstrophy and amnion disruption defects contributed significantly to the number of cases ascertained and emphasized the heterogeneity of abdominal wall defects. There were fluctuations in birth incidence with time with cloacal exstrophy especially apparently being more common in 1980-81. No specific demographic or environmental factors were documented in the cases seen in 1980-81 which could explain the high incidence in these years. Cloacal exstrophy is, however, now appreciated to be much more common than first realized. Studied directed at elucidation of the causes of apparent changes in incidence of malformations such as omphalocele or exstrophic defects will have to take into account both the fluctuations in background incidence of these defects and the considerable diversity in their etiology.

Abdominal Muscles↗

PubMed2005

Malignant granular cell tumor of the abdominal wall.

The granular cell tumor is an uncommon tumor that usually appears as a solitary small nodular growth and runs a benign course. It occurs widely throughout the body, but is rarely described in the abdominal wall. The authors report a case of malignant granular cell tumor which was arising in anterior abdominal wall of a 67-year-old woman. Malignant variant is rare and the abdominal wall site is extremely uncommon. Regarding this clinical case and the literature the authors purpose to review the criteria of malignancy.

Abdominal Neoplasms↗