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PubMed2006

PET/CT detects abdominal wall and port site metastases of colorectal carcinoma.

Abdominal wall metastases from colorectal cancer (CRC) may be resected with curative results. Such lesions, often indicators of additional intra-abdominal lesions, may appear in surgical scars, stomas and port site metastases after laparoscope-assisted surgery (LAS). Post-operative changes, primarily surgical scars, alter local physical findings making early detection of small lesions challenging. The purpose of this study was to retrospectively evaluate the contribution of PET/CT to the diagnosis of recurrent colorectal cancer in the post-operative abdominal wall. 120 patients were referred for PET/CT with suspected recurrent CRC based on clinical, radiological or laboratory findings. All underwent whole body PET/CT imaging. 12 of these 120 (10%), were found to have abdominal wall lesions. A total of 16 abdominal wall lesions were detected, located to surgical scars, stomas, drain and laparoscope ports. Additional findings on PET/CT in this group included liver metastases, intra-abdominal lesions and retroperitoneal lymph node involvement. In general, the patients in this small group were young with high grade tumours presenting in advanced stages. In conclusion, PET/CT appears to be a sensitive tool for the diagnosis of abdominal wall recurrence of CRC. The accuracy of localization afforded by the fused functional and anatomic images makes PET/CT a likely tool for diagnosing abdominal wall lesions, including port site metastases of other aetiologies.

Abdominal Wall↗

PubMedDate not supplied

Fascial fibroblast kinetic activity is increased during abdominal wall repair compared to dermal fibroblasts.

Abdominal wall fascial wound healing failure is a common clinical problem for general surgeons, manifesting in early postoperative fascial dehiscence as well as delayed development of incisional hernias. We previously reported that abdominal wall fascial incisions normally recover breaking strength faster than simultaneous dermal incisions in a rodent model. The accelerated fascial repair was associated with greater fibroblast cellularity within fascial wounds and increased wound collagen deposition. The current study was designed to determine whether accelerated fascial healing is the result of increased fascial fibroblast kinetic activity as measured by a more efficient fibroblast phenotype for binding to and remodeling a collagen matrix. Using a new model of abdominal wall repair, fibroblast cell cultures were developed from uninjured and wounded fascia and compared to dermal fibroblasts in order to define the fibroproliferative kinetic properties of abdominal wall fibroblasts. Fascial wound fibroblasts produced a more efficient and greater overall collagen lattice compaction compared to dermal fibroblasts. Acute fascial wound fibroblasts also showed enhanced cell proliferation compared to dermal fibroblasts but no significant differences in collagen production when normalized to cell number. These results suggest that fascial fibroblasts express distinct acute repair phenotypes and therefore a specific mechanism for fascial repair following injury.

Abdominal Wall↗

PubMed2006

Elasticity of the living abdominal wall in laparoscopic surgery.

Laparoscopic surgery requires inflation of the abdominal cavity and this offers a unique opportunity to measure the mechanical properties of the living abdominal wall. We used a motion analysis system to study the abdominal wall motion of 18 patients undergoing laparoscopic surgery, and found that the mean Young's modulus was 27.7+/-4.5 and 21.0+/-3.7 kPa for male and female, respectively. During inflation, the abdominal wall changed from a cylinder to a dome shape. The average expansion in the abdominal wall surface was 20%, and a working space of 1.27 x 10(-3)m(3) was created by expansion, reshaping of the abdominal wall and diaphragmatic movement. For the first time, the elasticity of human abdominal wall was obtained from the patients undergoing laparoscopic surgery, and a 3D simulation model of human abdominal wall has been developed to analyse the motion pattern in laparoscopic surgery. Based on this study, a mechanical abdominal wall lift and a surgical simulator for safe/ergonomic port placements are under development.

Abdominal Wall↗

PubMed2002

The management of the postoperative disrupted abdominal wall.

BACKGROUND: Dehisced abdominal wounds are common. Their management is generally difficult and often prolonged, with incisional hernias a common occurrence. A new technique is presented that results in accelerated delayed primary healing with full thickness skin and subcutaneous tissue coverage. METHODS: The technique involves a combination of vigorous wound toilette, the judicious use of sutures and tissue expansion produced by the application of specially designed external tissue expanders. Gradual approximation of the wound edges is achieved and final suture allows closure by full thickness skin and subcutaneous tissue. RESULTS: Sixteen patients, 10 with one or more intestinal fistula, developed abdominal wall dehiscences. At discharge all wounds were closed, from 2 days in wounds averaging 12 x 5 cm to 18 days in a 29 x 24 cm wound. The follow-up, both in numbers and length, was limited for various reasons. CONCLUSIONS: The technique appears to be generally successful. The simplicity allows easy learning and may avoid a major operative procedure. Accelerated delayed primary closure by full thickness skin and subcutaneous tissue has considerable economic benefits for the patient and the health service.

Adult↗

PubMed1991

A comparison of polypropylene mesh and expanded polytetrafluoroethylene patch for the repair of contaminated abdominal wall defects--an experimental study.

Abdominal wall defects created in Sprague-Dawley rats were repaired with either polypropylene mesh (PPM) or expanded polytetrafluoroethylene patch (PTFE). Tensiometric studies of abdominal wall strength showed that PPM and expanded PTFE provided a strong repair in uninfected wounds. Wounds reconstructed with expanded PTFE and contaminated with Staphylococcus aureus had a weak interface between the patch and the abdominal wall fascia. The strength of the interface was inadequate because collagen ingrowth in the material was inhibited. In contrast, the wound strength of PPM was unaffected by the presence of bacterial contamination.

Abdominal Muscles↗

PubMed1988

Traumatic hernia of the abdominal wall.

Traumatic hernia of the abdominal wall is unusual and even more so the complete avulsion of muscles from the costal arch. While it is usual to search carefully for diaphragmatic hernia during laparotomy for blunt abdominal trauma, traumatic hernia of the abdominal wall of this nature can be easily overlooked. One such case in a child is presented where the diagnosis was not made at the initial laparotomy following blunt abdominal injury received in a road traffic accident. We believe bilateral avulsion of all the abdominal wall muscles from the costal arch has not been reported before.

Abdominal Injuries↗

PubMed2005

Laparoscopic assisted modification of the firlit abdominal wall plication.

PURPOSE: We describe a modification of the Firlit abdominal wall plication procedure for abdominal wall reconstruction in the prune-belly syndrome. MATERIALS AND METHODS: Five boys with the prune-belly syndrome and 1 with congenital atrophy or hypotrophy of the internal and external oblique muscles underwent laparoscopic assisted abdominal wall reconstruction. RESULTS: All 6 patients had excellent cosmetic results, with no weakness or sagging of the abdominal wall. CONCLUSIONS: Laparoscopy appears to add to the Firlit procedure an increased measure of safety and a possible decrease in morbidity associated with opening the abdomen, and improved precision that enhances the results achieved with the original procedure and other abdominal wall repairs.

Abdominal Wall↗

PubMed1999

Sonographic diagnosis of abdominal wall relaxation.

PURPOSE: We report our experience using sonography to diagnose abdominal wall relaxation. METHODS: All patients with abdominal wall abnormalities from 1996 through 1997 underwent clinical and sonographic examination. Sonographic criteria for abdominal wall relaxation were continuity of the fascia (no gap), identification of all muscle layers, and decreased muscle thickness on the affected side. Fifty controls with no abdominal wall abnormalities were also examined for comparison. RESULTS: We sonographically diagnosed 5 cases of abdominal wall relaxation in 625 patients examined. The diagnosis in these 5 cases was confirmed by MRI. Muscle thickness on the affected side decreased by a mean of 38%+/-6% compared with muscle thickness on the unaffected side and was significantly different (p< 0.0001) from the mean muscle thickness seen in the controls. CONCLUSIONS: Sonography enabled the diagnosis of abdominal wall relaxation with the advantages of saving time and money and not requiring use of a contrast medium. Based on our results, we recommend sonography as the first-line imaging modality in the diagnosis of abdominal wall relaxation.

Abdominal Muscles↗

PubMed2000

Abdominal wall recurrence after colorectal resection for cancer.

PURPOSE: Disease recurrence in the abdominal wall from a primary colorectal cancer is a poorly studied and little understood phenomenon that has received renewed attention after the recognition of port site metastases in patients after laparoscopic colorectal resections. The purpose of the present study was to define the clinical, pathologic, and management issues in patients with abdominal wall metastases from colorectal cancer. METHODS: Patients presenting to Memorial Sloan-Kettering Cancer Center with a diagnosis of colorectal cancer were entered into a prospective database beginning in 1986. Review of this database showed that 31 patients presenting with recurrent disease in the abdominal wall were managed surgically at the institution between 1986 and 1998. RESULTS: A total of 31 patients (19 males) with a median age of 67 (range, 45-86) years presented with recurrent disease between 7 and 183 (median, 24) months after primary surgery. Primary tumors were located in the right colon in 17 patients, left colon in 2 patients, sigmoid colon in 7 patients, and rectum in 3 patients. Nineteen percent of primary tumors were perforated, 45 percent were poorly differentiated, 92 percent were transmural (T3 or T4), and 51 percent had lymph node metastases at presentation. Twenty-two patients presented with a symptomatic abdominal wall mass, whereas recurrence in the abdominal wall was found incidentally in 9 patients undergoing laparotomy. Four patients had isolated abdominal wall disease, whereas the remaining 27 were found to have associated intra-abdominal disease. Six patients who were left with residual intra-abdominal cancer after abdominal wall resection had a median survival time of four months. Twenty-five patients underwent a histologically complete resection of recurrence restricted to the abdominal wall alone (n = 4; median survival time, 18 months), abdominal wall and in continuity resection of adherent viscera (n = 15; median survival time, 12.5 months), or resection of abdominal wall and intra-abdominal recurrence at a distant site (n = 6; median survival time, 22 months, although only 1 patient remained alive with disease). The actual two-year and five-year disease-free survival rates were 16 and 3 percent, respectively. CONCLUSION: Abdominal wall metastases are often indicators of recurrent intra-abdominal cancer; however, aggressive resection in patients with disease restricted to the abdominal wall and associated adherent viscera can result in local disease control with little morbidity and no mortality.

Abdominal Muscles↗

PubMedDate not supplied

[The abdominal wall: an overlooked cause of pain].

Abdominal wall pain is frequently misdiagnosed as arising from visceral source, often resulting in inappropriate diagnostic tests, unsatisfactory treatment and high costs. The Authors describe the various causes of abdominal wall pain with particular regard to abdominal cutaneous nerve entrapment syndrome. They analyze the main features of abdominal wall pain: a localized tender trigger point can be frequentely identified, the Carnett's sign is positive and the local injection of an anesthetic agent into the trigger point can be diagnostic and therapeutic, while image techniques are useful when the pain results from structural conditions. At last they describe the therapeutic options.

Abdominal Pain↗

PubMed1976

Desmoid tumors of the abdominal wall.

Four cases of desmiod tumors of the anterior abdominal wall recently treated at the University of Chicago Hospitals and Clinics are presented. From our experience we conclude: 1. Inadequate excision of desmoid tumors results in local recurrence. 2. Adequate excision of desmoid tumors ot the abdominal wall sometimes necessitates creation of an abdominal wall defect too large for primary closure. 3. Marlex mesh has been used successfully in reconstruction of the abdominal wall following adequate excision of desmoid tumors. 4. One patient (Case 4) with an abdominal wall desmoid tumor associated with familial polypisis and mesenteric fibromatosis has benefited greatly following wide excision of abdominal wall and reconstriction using Marlex mesh, despite the fact that the mesenteric fibrous tumor was unresectable.

Abdominal Neoplasms↗

PubMed2001

[Pedicle graft of intestine seromuscular layer and skin graft for repair of abdominal wall defect].

OBJECTIVE: To explore an effective method to repair the abdominal wall defect. METHODS: From July 1996 to December 2000, 7 cases with abdominal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fistulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumor in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscular layer was sutured to the margin of abdominal wall defect, and grafted by intermediate split thickness skin. RESULTS: The abdominal wall wound in 6 cases were healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all cases were improved remarkably. CONCLUSION: Pedicle graft of intestine seromuscular layer is a reliable method to repair abdominal wall defect with low regional tension, abundant blood supply and high successful rate.

Abdominal Muscles↗

PubMed2002

Temporary closure of the abdominal wall (laparostomy).

The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favorable in the treatment of numerous surgical conditions, e.g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is temporarily closed, and a laparostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome. Regarding the technique and material used for the temporary closure, no prospective randomized data exists, but mesh materials are commonly used. They provide drainage of infectious material, permit visual control of the underlying viscera, facilitate access to the abdominal wall, preserve the fascial margin, enable healing by secondary intention, and allow mobilization of the patient. In the case of decreasing intra-abdominal pressure, meshes can be trimmed to centralize the rectus muscle and to facilitate definitive closure. Non-absorbable meshes have been frequently reported to cause enteric fistulae and persistent infection necessitating mesh explantation. While these infectious complications appear to occur less frequently with the use of absorbable materials, these meshes will finally lead to an incisional hernia, requiring repair with non-absorbable mesh after a period of 6-12 months. Nevertheless, in the complex situation requiring a temporary abdominal wall closure, use of absorbable mesh material is common and represents the state of the art.

Abdominal Cavity↗

PubMed1985

Respiratory insufficiency in newborns with abdominal wall defects.

Respiratory failure in newborns with abdominal wall defects has been attributed to increased intra-abdominal pressure and elevation of the diaphragm after closure. Despite surgical techniques designed to minimize intra-abdominal pressure, we have observed prolonged respiratory insufficiency in several such infants. We reviewed the charts of 108 infants from 1975 to 1982 who had abdominal wall defects: 53 with gastroschisis, 29 with small omphaloceles, 22 with liver-containing or giant omphaloceles (GO), and four with cloacal exstrophy. Nine infants with GO (41%) had prolonged respiratory insufficiency and five died. Infants with GO required longer periods of oxygenation and ventilation (P less than .001, ANOVA) than infants with other abdominal wall defects. Clinical observation suggested that infants with GO have a small, narrow thorax. We obtained detailed measurements from the chest radiographs of infants in all groups. After correction for birth weight, babies with GO had smaller chest widths (P less than .001) and lung areas (P less than .05) than infants with other abdominal wall defects. At autopsy, one newborn with GO was found to have severe pulmonary hypoplasia. Prolonged respiratory insufficiency in infants with GO may be explained by pulmonary hypoplasia and/or by a narrow chest deformity which limits lung expansion.

Abdominal Muscles↗

PubMed2006

Biphasic synovial sarcoma of the abdominal wall.

Synovial sarcoma arising in the abdominal wall is a rare tumor. We report a case of a 38-year-old man who complained of abdominal pain. Physical examination revealed a firm mobile mass, 25 cm in diameter, in the left lower abdominal wall. The tumor was first thought to be a sarcoma arising from the omentum or mesentery. During surgery, a large tumor was found attached to the inner surface of the abdominal wall and compressing the gastrointestinal tract. On microscopic examination the tumor corresponded to a biphasic synovial sarcoma immunoreactive for cytokeratins (AE1/AE3, 7 and 19), epithelial membrane antigen and carcinoembryonic antigen in the epithelial tumor cells, for E-cadherin especially in their glandular structure, vimentin, CD99, and CD56 in the spindle cell component and for bcl-2 protein. The tumor recurred at the same site, and clinical course progressed to death 3 months after the initial diagnosis.

12E7 Antigen↗

PubMed2004

[Abdominal wall reconstruction with pedicled rectus femoris muscle flap].

INTRODUCTION: Large abdominal hernias or abdominal wall defects often require the use of prosthetic mesh, local tissue transposition or even distant muscle flaps for proper reconstruction of the abdominal wall. The disadvantages of meshes are well known. The use of muscle flaps is an appreciated alternative. PATIENTS AND METHODS: We present 12 cases with reconstruction of the abdominal wall using pedicled rectus femoris muscle flaps after tumor resections, incisional hernias, and infection. Follow up time ranged from 6 months to 4 years. Abdominal wall stability was examined clinically. The aesthetic and the functional result were assessed using a standardized questionnaire. To objectively evaluate the loss of force in the quadriceps muscle the maximal voluntary knee extension torque was measured. RESULTS: In all patients except one a stable abdominal wall was achieved. No major complications occurred. The loss of torque in the operated leg was tolerable. DISCUSSION: The donor site morbidity is relatively low and the flap provides an easy and save possibility to reconstruct the abdominal wall. The rectus femoris muscle flap should be considered as an alternative for abdominal wall reconstruction.

Abdominal Wall↗

PubMed2006

[Endometriomas of the abdominal wall: Imaging findings].

Endometrioma of the abdominal wall is a not well-recognized disease and usually develops after pelvic surgery. The most common presentation is a mass of the abdominal wall associated with pain during menstruation. We report six cases of parietal endometriomas studied with ultrasonography, CT, and in one case with MRI. Our results are compared with recent findings in the literature. The purpose of this study was to describe the clinical and imaging findings in abdominal wall endometriomas that can help reach a presurgical diagnosis.

Abdominal Pain↗

PubMed2001

[Abdominal wall defects caused by postoperative infections].

Infectious defects of the abdominal wall often result from deeper subfascial infections of the abdominal wall caused by a persisting intraabdominal inflammation or the result of laparotomy in peritonitis. Therapies applied are first of all the removal of the sources of infection and a careful debridement of the abdominal wall. There are several ways of temporarily covering the abdominal wall, but there is no ingenious solution. In our own experience the application of zip fastening and PGS nets have proved successful. In case of deeper infections of the abdominal wall the most awkward situation is the laying open of small intestine loops in a granulating wound which may lead to a revitalization of chronic small intestine fistulae. In these cases a differentiated and repeated surgical approach and extensive resection of small intestine parts, and consequently a high rate of complications and lethality cannot be avoided. Extensive defects of the abdominal wall exposing parts of small intestines after such operations require temporary covering and in this case we use Vypro net which, under the most favourable circumstances, can represent a final solution.

Abdominal Muscles↗