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PubMed1998

A gastroschisis-like abdominal wall defect in the left hypochondrium. Case report and literature review.

Congenital abdominal wall defects are exceedingly rare on the left side. The presented patient had an upper abdominal wall defect located just lateral to the left rectus muscle. Additionally, upper parts of the abdominal flat muscles were defective on that side. Because no report was found in the literature about the defect described here, both its terminological and embryological backgrounds are discussed.

Abdominal Muscles↗
PubMed2003

Ultrasonographic projection of a pathologic site on the anterior abdominal wall. Our own experience.

INTRODUCTION: The success of any operation depends to a great extent on how well the optimal surgical approach is chosen. The purpose of the present study was to propose a method of sonographic projection of an abdominal pathologic site on the anterior abdominal wall which can facilitate the selection of an optimal surgical approach. MATERIAL AND METHODS: The study included 26 patients aged 20 to 65 years operated on in the Clinic of Thoracic and Abdominal Surgery in the Medical University, Plovdiv between January 1996 and December 2001. Using ultrasonography we projected a pathologic site located in the abdomen on the anterior abdominal wall. A strip of adhesive band was placed on the scanning surface of a 3.5 MHz linear transducer to cast an acoustic shadow and thus draw the outlines of the site on to the anterior abdominal wall. RESULTS: Patients with liver hydatid cysts (primary and recurrent) and with recurrent calculous cholecystitis were predominant (20/26, 76.9%). The surgical approach in the cases of primary liver hydatid cysts was in the right hypochondriac region; after laparotomy it was extended in both directions. In the patients with recurrent liver hydatid cysts (6/26, 23.07%) the incision was made on the projected image, directly over the site; it was less traumatic and associated with less blood loss. In eight patients with chronic calculous cholecystitis (30.7%) the projection was used for minilaparotomy (up to 6 cm); in two patients the projection suggested that we should use the transrectal approach as optimal instead of the subcostal approach. The right subcostal approach was used in one patient with chronic calculous cholecystitis and retroperitoneal cyst instead of median laparotomy. In patients with retroperitoneal tumours and intra-abdominal non-organ echinococcosis the projection had confirmatory character. According to the review of the literature we made, such sonographic projection of pathologic sites on the anterior front wall for the purpose of selecting an optimal surgical approach has been done for the first time. CONCLUSIONS: 1. The sonographic projection of a pathologic site located in the abdomen on the anterior abdominal wall creates a direct visual association between intra-abdominal lesions and superficial structures (body constitution, subcutaneous fat, operative cicatrices). 2. This direct visual association, as well as the information provided about the depth, size and relation to adjacent organs helps the surgeon to choose the most appropriate surgical approach.

Abdomen↗
PubMed1981

Congenital defects of the abdominal wall. A review of the experience in New Mexico.

Omphalocele, umbilical cord hernia, and gastroschisis are surgically correctable defects of the abdominal wall. Each of these defects has a distinct embryologic basis that results in a characteristic clinical picture. Twenty-five infants with congenital defects of the abdominal wall were treated at the University of New Mexico Hospital in the past four years. Six infants had omphalocele, one had umbilical cord hernia, and 18 had gastroschisis. Survival among infants who underwent a corrective operation was as follows: omphalocele, 50%; umbilical cord hernia, 100%; and gastroschisis, 82%. Long-term survival for the entire group was 72% (18/25). Gastroschisis, which had a lower incidence of major associated anomalies, had a better prognosis than omphalocele. The mortality of congenital abdominal wall defects was related to presence of severe associated anomalies and to poor clinical condition on admission. Prompt and informed initial care may increase the chance of survival.

Abdominal Muscles↗
PubMed2004

[Anterior abdominal wall defects--retrospective analysis of fetuses diagnosed in the Department of Obstetrics & Gynecology of the Postgraduate Center of Medical Education between 1997 & 2002].

OBJECTIVES: Our objectives were to determine the risk of aneuploidy and anatomic anomalies in fetuses with different kinds of abdominal wall defects. DESIGN: We retrospectively studied ultrasound reports of the fetuses with abdominal wall defects. MATERIALS AND METHODS: We analyzed 108 cases diagnosed during the last five years in our center. All fetuses underwent a detailed ultrasonographic survey and in majority of cases (78.8%) antenatal karyotyping was performed. We also analyzed gestational age at the first examination. RESULTS: 35 cases presented gastroschisis, 60 omphalocele, 7 ectopia cordis and 6 limb-body wall complex. Associated anomalies were detected in 48.1% of all cases. It was 22.9% in gastroschisis group, 58.3% in omphalocele group, 42.9% in ectopia cordis group and in all fetuses with limb-body wall complex. Chromosomal abnormalities were present in 13% of all cases; in 2.9% of gastroschisis group, 20% of omphalocele group, 16.7% of limb-body wall complex group and none of the fetuses with ectopia cordis. The median gestational age at the first examination was 24 weeks. CONCLUSIONS: In fetuses with abdominal wall defects detailed ultrasonographic survey and in majority of cases prenatal karyotyping should be done. Furthermore patients with fetus with such a defect should be diagnosed as early as possible in the referral center.

Abdominal Wall↗
PubMed1997

CT in the diagnosis of abdominal wall hernias: a preliminary study.

The aim of the study was to estimate the value of CT in the diagnosis of abdominal wall hernias and at the same time to create a standard for this CT investigation. Twenty-four patients with suspected hernia of the abdominal wall were examined. All were operated on. The CT scans were assessed by two radiologists to estimate the interobserver variation. The CT diagnoses made by the two radiologists were correct in 83 % and 79 % of cases, respectively. The sensitivity was 0.83 in both CT evaluations and the specificity was 0.83 and 0.67, respectively. The predictive value of a positive CT finding was 0.94 and 0.88, while the predictive value of a negative CT finding was 0.63 and 0.57, respectively. The interobserver variation (kappa) was 0.87. The study therefore indicates that a positive CT finding of abdominal wall hernia is reliable, while a negative finding does not exclude the diagnosis. The interobserver variation of the CT diagnoses is acceptable. To achieve the highest diagnostic accuracy, it is recommended to always use the Valsalva manoeuvre, oral intake of contrast and 10/10 mm CT slices.

Adult↗
PubMed2006

Innervation of the rat anterior abdominal wall as shown by modified Sihler's stain.

OBJECTIVE: The purpose of this study was to use the modified Sihler's staining technique to demonstrate detailed distribution of the rat anterior abdominal wall nerves and test the value of Sihler's technique in demonstrating such a complex muscle-nerve relationship. MATERIALS AND METHODS: The anterior abdominal walls of 5 Wistar rats were isolated by making a deep incision from the costal arches on each side down to the inguinal region and processed using a modified Sihler's stain technique. RESULTS: This technique was successfully applied to visualize the innervation of the anterior abdominal wall muscles of the rat. The segmental nerves of T6-L1 and their terminal branches were shown and possible motor and sensory fibers identified. CONCLUSIONS: This technique is valuable in understanding the complex nature of final branching of the nerve endings, and it may be useful for studying experimental nerve models.

Abdominal Wall↗
PubMed2003

Abdominal wall defects.

The frequent use of prenatal diagnostic techniques including ultrasound and maternal serum alpha-fetoprotein has increasingly led to detection of abdominal wall defects before birth. This prenatal detection creates the opportunity to influence neonatal outcome by alteration in management of pregnancy or delivery. The optimal management of an individual fetus depends on careful prenatal assessment of the abdominal wall defect, combined with experience and knowledge of the natural history for that particular lesion. A multidisciplinary approach to the fetus can improve neonatal outcome. Careful assessment for other structural anomalies and karyotype analysis should be performed. Delivery at a high-risk perinatal center should be encouraged. Currently, there is no convincing evidence to support routine cesarean section for most abdominal wall defects.

Abdominal Muscles↗
PubMed1997

Use of nonporous polytetrafluoroethylene prosthesis in combination with polypropylene prosthetic abdominal wall implants in prevention of peritoneal adhesions.

One of the drawbacks of using macroporous polypropylene prostheses in the repair of the abdominal wall is the formation of adhesions with the viscera. However, polytetrafluoroethylene (PTFE) has low adhesion formation, although it provides less resistance to traction in the repaired zone. The aim of the present study was to reduce the formation of adhesions to a polypropylene implant Prolene (PL) by introducing a nonporous expanded PTFE layer (Preclude Dura-Substitute) (PR) between the polypropylene prosthesis and the abdominal viscera. The scarring process and resistance to traction in the repaired zone were also evaluated. Thirty-six rabbits were divided into three groups and were treated as follows: group I, a PR patch (7 x 5 cm) was secured to the parietal peritoneum; group II, an abdominal wall defect (7 x 5 cm) was created and repaired using a PL patch; group III, an abdominal wall defect was as in group II and was repaired using a combined PR/PL prosthesis. Specimens were evaluated at 14, 30, 60, and 90 days postimplant for extent of adhesion formation and morphological analysis was performed using light and scanning electron microscopy. Biomechanical resistance of the implant was evaluated using strips comprising prosthetic material and anchorage tissue. Group I and group III prostheses showed loose adhesions only, but group II adhesions were firmly attached. The mean surface areas covered by adhesions were 0.08 cm2 (group I), 7.67 cm2 (group II), and 0.1 cm2 (group III). PR implants (group I) were encapsulated by organized tissue. In group II the formation of disorganized tissue invading the prosthesis was observed. In group III the PR impeded the growth of disorganized scar tissue and the lower surface of the implant was covered by an orderly neoperitoneum. Resistance to traction of the double implants (group III) (mean +/- SD, 33.32 +/- 0.9 N) was similar to that of the Prolene implants (group II) (33.76 +/- 0.46 N) (Mann-Whitney U test, p < 0.05). We concluded the presence of a PR layer between the PL implant and viscera greatly reduced the incidence of adhesion formation without affecting the high resistance to traction provided by the PL implant or the evolution of the scarring process.

Abdominal Muscles↗
PubMedDate not supplied

Severe abdominal wall necrosis after ultrasound-assisted liposuction.

The complicated case of a 44-year-old white female following ultrasound-assisted liposuction of the entire abdomen is presented. In this case the postoperative course was complicated by hematoma, treated conservatively. During following weeks extensive cutaneous necrosis over the abdomen developed. After four weeks the patient presented to our institution with purulent discharge. After surgical revision, requiring excision of the abdominal wall necrosis, a significant residual abdominal wall defect remained. After three further revisions, removal of residual necrotic fat, irrigation, and temporary coverage with a synthetic dressing, infection cleared. At this point, split thickness skin grafting was possible. The healing in of the skin grafts was complete, eventually enabling wound closure and successful reconstruction of the abdominal wall.

Abdomen↗
PubMed1995

Prenatal detection of anterior abdominal wall defects with US.

The size and position of an anterior abdominal wall defect, its contents, and its association with other anomalies are features that can be diagnosed in utero with ultrasound and that allow a differential diagnosis to be made. The correct prenatal diagnosis is extremely important for patient management. The key feature for sonographically distinguishing these conditions is the position of the defect in relation to the umbilical cord insertion. Omphaloceles and pentalogy of Cantrell usually involve a midline defect at the umbilical cord insertion. Gastroschisis most frequently consists of a small, right-sided paraumbilical defect. Eccentric, large lateral defects are typically present in limb-body wall complex or amniotic band syndrome. Bladder and cloacal exstrophy involve the infraumbilical region. In addition, the size of the defect, the organs eviscerated, the presence of membranes or bands, and any associated abnormalities help determine the correct diagnosis. Increased knowledge of these uncommon fetal conditions should result in better detection, more accurate diagnosis, and improved management of anterior abdominal wall defects.

Abdominal Muscles↗
PubMedDate not supplied

Abdominal wall actinomycosis associated with prolonged use of an intrauterine device: a case report and review of the literature.

The relationship between pelvic actinomycosis and the presence of an intrauterine device is well known. Abdominal wall actinomycosis with no involvement of pelvic organs in the presence of an intrauterine device is extremely rare. We report a case of a 32-year-old woman with a long-standing intrauterine device who developed abdominal wall actinomycosis. The diagnosis was established late by histopathological examination after an initial surgical procedure during which the abscess was evacuated and all the necrotic tissue was excised. Postoperatively, the patient developed two intra-abdominal abscesses, which were treated by surgical drainage. The combination of long-term high-dose antibiotic therapy with surgery led to successful management of the condition. We highlight the difficulty in diagnosis, necessity for an early postoperative diagnosis, and the importance of high-dose intravenous antibiotic therapy to prevent recurrence. Abdominal wall actinomycosis should be considered in intrauterine device users who present with abdominal abscesses of unknown origin.

Abdominal Abscess↗
PubMed2006

Improved abdominal wall wound healing by helium pneumoperitoneum.

BACKGROUND: Despite widespread use of the endoscopic technique in the treatment of inguinal and incisional hernias, knowledge about its impact on abdominal wall wound healing is rare. Questions remain regarding the risk of port-site hernias and hernia recurrence. The current study investigated the gas-dependent effects of pneumoperitoneum on laparotomy wound healing. METHODS: Laparotomy was performed in 54 male Sprague-Dawley rats. A carbon dioxide (n = 18) or helium (n = 18) pneumoperitoneum of 3 mmHg was maintained before and after laparotomy, with an overall duration of 30 min. The rats in the control group (n = 18) received no pneumoperitoneum. The animals were killed after 5 and 10 days, and the abdominal wall was explanted for subsequent histopathologic examinations of the laparotomy wound. The granuloma formation in hematoxylin and eosin-stained sections was analyzed. Infiltration of macrophages (CD68) and expression of matrix metalloproteinases (MMP-8 and MMP-13) were examined by immunohistochemistry. The collagen type 1 to type 3 ratio was investigated by cross-polarization microscopy after Sirius Red staining. RESULTS: After 5 and 10 days, the percentages of CD68-positive cells, granuloma formation, and expression of MMP-8 did not differ between the groups. In contrast, after both 5 and 10 days, the expression of MMP-13 and the collagen 1 to 3 ratio were significantly higher after helium pneumoperitoneum than in the control animals. CONCLUSION: The results suggest that helium pneumoperitoneum may ameliorate wound healing within the abdominal wall and could therefore represent a beneficial gas for endoscopic hernia repair.

Abdominal Wall↗
PubMed2000

Hand assisted laparoscopic radical nephrectomy for renal carcinoma using a new abdominal wall sealing device.

PURPOSE: We report our initial experience with a hand assisted laparoscopic radical nephrectomy for patients with renal carcinoma, and compare our results to those of conventional open radical nephrectomy. MATERIALS AND METHODS: The clinical data on 6 consecutive patients who underwent hand assisted laparoscopic radical nephrectomy for stage T1N0M0 renal cell carcinoma were reviewed. We performed hand assisted laparoscopic surgery using the new LAP DISC* abdominal wall sealing device. We compared the results of this procedure with those of conventional open radical nephrectomy in 12 patients with stage T1N0M0 renal cell carcinoma. RESULTS: The hand assisted laparoscopic radical nephrectomy for renal carcinoma was successfully performed without any major or minor complications in all 6 patients. Mean operation time for the laparoscopic group was significantly longer than that for the open surgery group (303 minutes versus 224 minutes, p = 0.0042). However, no significant difference was observed in mean estimated blood loss for the 2 groups (264 ml. in the laparoscopic group versus 341 ml. in the open surgery group). The frequency of parenteral analgesia postoperatively in the laparoscopic group was significantly lower than that in the open surgery group (16.7% versus 75.0%, p = 0.043). In addition, the laparoscopic group seemed to recover more rapidly than the open surgery group. The abdominal wall sealing device was easy to attach to the abdominal wall, and allowed rapid hand removal and reinsertion. CONCLUSIONS: Our preliminary results indicate that a hand assisted laparoscopic radical nephrectomy with the abdominal wall sealing device is an effective and safe surgical procedure, and is less invasive than open radical nephrectomy.

Adult↗
PubMed2004

The arterial vascularisation of the abdominal wall with special regard to the umbilicus.

AIM: In order to prevent wound healing problems around the transposed umbilicus following abdominoplasty, we investigated the arterial vascularisation of the abdominal wall with special regard to the umbilicus. The aim was to optimise the planning of the umbilical stalk and flap design. METHOD: The inferior and superior epigastric arteries of 12 cadavers (mean age 83 years) were injected with barium-sulphate, lead-mennige and gelatine. The abdominal walls were resected en bloc and X-ray photographs were taken by conventional and mammographic technique. RESULTS: The radiographic examination showed that the main trunks of the epigastric vessels follow an "hour-glass" or "rhomboid" pattern around the centromedial umbilicus. Each main trunk splits into two obligate branches one medial and one lateral. The anastomosis between the inferior and superior epigastric artery is located above the umbilicus. The umbilicus is nourished by separate axial vessels originating from the inferior epigastric artery. It was also shown that the inferior intercostal arteries anastomose with the branches of the inferior and superior epigastric artery. CONCLUSION: Dividing the abdominal wall into four quadrants around the central umbilicus, the lateral areas of the lower quadrants show the weakest vascularisation by the inferior epigastric artery. This fact may cause healing problems after surgery in this area. The axial vascularisation of the umbilicus makes any torsion or traction a potential hazard to the umbilical flap during abdominoplasty especially by re-siting the umbilicus. The anatomical study showed clearly the benefit of preparing a broad base fat layer with a generous diameter of incision line around the umbilicus.

Abdominal Wall↗
PubMed1998

Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks.

PURPOSE: Since most previous reports of EMG activation profiles from psoas and the abdominal wall have been qualitative, the objective of this work was to document myoelectric activity from these deep muscles. This knowledge is required to assist in choosing specific training exercises and for making rehabilitation decisions that require knowledge of normalized and calibrated muscle activation levels in different tasks. METHODS: Intramuscular EMG was collected from five men and three women, in whom amplitudes were normalized to maximum contraction efforts and reported over a wide variety of clinical and rehabilitation tasks. Electrodes were inserted into vertebral portions of psoas and the three layers of the abdominal wall. Normalized signal amplitudes were reported as peak levels and time histories. RESULTS: All forms of sit-ups activated psoas (15-35% MVC) more than the curl-up (<10%); psoas was not highly activated during barbell lifting of loads up to 100 kg (< 16% MVC); psoas was most active during maximal hip flexion efforts; push-ups activated psoas up to 25% MVC. Several isometric abdominal exercises were evaluated using the criteria of maximizing abdominal activation while minimizing psoas activity: the side (bridge) support exercise proved the best training method for the abdominal wall. CONCLUSIONS: Consideration of deep muscle activity, provided in this report, is important for choosing the most appropriate rehabilitation and training program for an individual. Specific guidance is provided for choosing the best abdominal exercise, together with activation profiles during lifting, during twisting, and during hip rotation.

Abdominal Muscles↗
PubMed1982

Ultrasonography and computed tomography of inflammatory abdominal wall lesions.

Twenty-four patients with inflammatory lesions of the abdominal wall were examined by ultrasonography. Nine of these patients underwent computed tomographic (CT) scanning as well. Both ultrasonography and CT clearly delineated the exact location and extent of abdominal wall abscesses. Abscesses were easily differentiated from cellulitis or phlegmon with ultrasound. The peritoneal line was more clearly delineated on ultrasonograms than on CT scans; abscesses were also more distinct on the ultrasonograms because of their low echogenicity compared with the surrounding structures. Gas bubbles, fat density with specific low attenuation values, and underlying inflamed bowel loops in obese patients with Crohn's disease were better delineated by CT.

Abdominal Muscles↗
PubMed2005

Local administration of TGF-beta1 to reinforce the anterior abdominal wall in a rat model of incisional hernia.

The purpose of this study was to investigate different forms of the local application of TGF-beta(1) for augmentation of the anterior abdominal wall in an appropriate model of an incisional hernia. Sixty male Sprague-Dawley rats were divided into six groups. Artificial defects of the anterior abdominal wall were closed with one of the following methods: running Prolene suture, Vicryl mesh, prolene suture followed by an intramuscular injection of 1 mug TGF-beta(1), Vicryl mesh coated with 1 mug TGF-beta(1), and prolene suture coated with 1 mug TGF-beta(1). A control group did not receive any defect and treatment. Six weeks after operation, tensile strength, collagen content, gene expression of collagen I and III, blood vessels, and thickness of collagen fibres were evaluated. Tensile strength was strongest in the controls (14.2 (10.5-18 N)). There was no increase in tensile strength due to the administration of TGF-beta(1). On the contrary, bolus injection of the growth factor resulted in a significantly decreased strength of the wound tissue when compared to the groups 1, 4, 5, and 6 (9.1 (4.2-9.1 N)). These results correlated with the gene expression of collagen I and III. Local application of TGF-beta(1) did not augment the strength of the abdominal wall after 6 weeks.

Abdominal Wall↗