Abdominal Wall Sinus Research Articles

Imaging of the Abdominal Wall Sinus Tract: Comparison of Computed Tomography Sinography and X-Ray Sinography.

The study aims to clarify the comparative benefits of X-ray sinography and computed tomography (CT) sinography in assessing the abdominal wall sinus tract. In this cross-sectional study, patients in our hospital with an abdominal wall sinus tract who had received both X-ray sinography and CT sinography from January 2018 to January 2021 were enrolled. The intraoperative findings were used as the gold standard to calculate the accuracy of the two methods. Kappa statistic was employed to evaluate the concordance between the two methods and the intraoperative findings. Differences in diameters measured on X-ray sinography and CT sinography images were analyzed using the Wilcoxon signed rank test. The study sample consisted of 74 patients. The accuracy of the CT sinography in diagnosing the extent of the sinus invasion was 85.1%, while the accuracy of the X-ray sinography was 59.5%. For the sinus confined to the abdominal wall (Kappa: 0.783 VS 0.248), the sinus extending into the abdominal cavity (Kappa: 0.734 VS 0.339), and the sinus with fistula formation (Kappa: 0788 VS 0.496), the consistency of the CT sinography and surgery were significantly better than that of the X-ray sinography. Diameters of the sinus tract measured on CT images were statistically larger than the diameters measured on X-ray sinography (P<0.001). CT sinography has significant advantages to X-ray sinography in depicting the extent of the abdominal wall sinus tract and the presence of a fistula.

Value of CT sinography and analysis of missed diagnosis and misdiagnosis for abdominal wall sinus

BackgroundThe value of CT (computed tomography) sinography in evaluating abdominal wall sinus tracts is currently unclear. The present study aims to investigate the accuracy of CT sinography in diagnosing the extent of abdominal sinus and analyze the reasons for misdiagnosis.Materials and methods64 patients with abdominal sinus tract formation (including fistula) undergoing CT sinography in our hospital from January 2018 to November 2020 were retrospectively analyzed. The CT images were blindly and independently re-assessed by two radiologists with 5- and 18-years work experience, respectively. Whether the sinus tract was confined to the abdominal wall or had invaded the abdominal cavity, and whether there was fistula formation were evaluated. The accuracy of CT sinography in diagnosing sinus invasion in the abdominal cavity and fistula formation was calculated. The agreements of CT sinography-surgical results and inter-observer were assessed using weighted-kappa statistics.ResultsThe weighted- Kappa of inter-observer agreement (0.825, P < 0.001) and CT sinography—surgical results (0.828, P < 0.001) were both perfect. The diagnostic accuracy, sensibility, and specificity of sinus tract confined to the abdominal wall were 90.6% (95% CI: 80.7–96.5), 85.7% (95% CI: 67.3–96.0), and 94.4% (95% CI: 81.3–99.3), respectively. The diagnostic accuracy, sensibility, and specificity of fistula formation were 93.8% (95% CI: 84.8–98.3), 89.5% (95% CI: 66.9–98.7), and 95.6% (95% CI: 84.9–99.5), respectively. A total of 4 cases of sinus tract confined to the abdominal wall were misdiagnosed as invading the abdominal cavity, 2 cases of sinus tract invading the abdominal cavity were misdiagnosed as confined to the abdominal wall, 2 cases of enterocutaneous fistula were missed, 1 case of enterocutaneous fistula was misdiagnosed, 1 case of vesico-cutaneous fistula was misdiagnosed, and no cases of vesico-cutaneous fistula were missed.ConclusionsCT sinography can accurately assess the extent of an abdominal sinus tract and reveal fistula formation, despite some inevitable misdiagnosis and missed diagnosis. Radiologists should find more clues to improve the diagnostic accuracy.

Clinical improvement of encapsulating peritoneal sclerosis after challenging course and 6\xa0months of total parenteral nutrition in child with nephronophthisis: a case report

BackgroundEncapsulating peritoneal sclerosis is a rare but potentially lethal complication of long-term peritoneal dialysis that is associated with significant morbidity and mortality. The occurrence of encapsulating peritoneal sclerosis varies worldwide, but is increased in patients maintained on peritoneal dialysis for 5–8 years. The etiology of encapsulating peritoneal sclerosis remains unidentified, and a high index of clinical suspicion is required for diagnosis.Case presentationWe report a 5-year-old Saudi female with end-stage renal disease secondary to nephronophthisis type 2. She underwent peritoneal dialysis for 30 months, with four episodes of peritonitis. She presented with clinical signs of peritonitis. Three days later, she developed septic shock, which required pediatric intensive care unit admission. The peritoneal dialysis catheter was removed because of refractory peritonitis. Her course was complicated by small bowel perforation, and severe adhesions were revealed on abdominal ultrasound and computed tomography, consistent with a diagnosis of EPS. This finding was later confirmed by diagnostic laparotomy performed twice and complicated by recurrent abdominal wall fistula. She received total parenteral nutrition for 6 months and several courses of antibiotics. The patient received supportive treatment including nutritional optimization and treatment for infection. No other treatments, such as immunosuppression, were administered to avoid risk of infection. Following a complicated hospital course, the patient restarted oral intake after 6 months of total parenteral nutrition dependency. Her abdominal fistula resolved completely, and she was maintained on hemodialysis for few years before she received a kidney transplant.ConclusionWhen treating patients using peritoneal dialysis, it is important to consider encapsulating peritoneal sclerosis with refractory peritonitis, which is not always easy to identify, particularly if the patient has been maintained on peritoneal dialysis for less than 3 years. Early identification of encapsulating peritoneal sclerosis and appropriate conservative treatment, including nutritional optimization and treatment of infections, are essential to achieve a better prognosis.

Robotic management of complicated jejunal diverticulitis causing iliac bone osteomyelitis and abdominal wall fistula – a video vignette

There have been six reported cases of jejunoileal diverticulitis causing an abdominal wall abscess. To the best of our knowledge, this is the first case of jejunal diverticulitis complicated with abdominal wall fistula and iliac bone osteomyelitis. In this video, we present robotic management of a complicated case of jejunal diverticulitis complicated with abdominal wall fistula and iliac bone osteomyelitis.

545P - Feasibility of chemoradiotherapy in rectal cancer patients with peritumoral abscesses and fistulas: A case-control non-inferiority trial

BackgroundNeoadjuvant chemoradiotherapy (CRT) is a standard treatment for patients with locally advanced rectal cancer and is effective as a palliative care in patients with nonresectable tumors. Unfortunately CRT is often being withheld for patients with tumor-associated complications due to safety concerns. Literature search reveals only case reports and neither supports nor declines additional risks of CRT in this patient group. The aim of this study was to determine feasibility of CRT in rectal cancer with peritumoral abscesses and fistulas. MethodsPatients with locally advanced or recurrent rectal cancer with peritumoral abscesses and fistulas were included in the study group. The control group consisted of T4 locally advanced or recurrent rectal cancer patients without complications, both groups received long-course neoadjuvant CRT. Groups were matched by age, previous treatment, treatment year. The primary endpoint was CRT toxicity. Secondary endpoints included postoperative morbidity (Clavien-Dindo), pathologic complete response (pCR) and 2year PFS. Results30 patients were included in each group. Patients in the main group had following tumor-associated complications: perianal fistula (n=11), abdominal wall fistula (n=1), rectovaginal fistula (n=9), rectovesical fistula (n=4), peritumoral abscess (n=17). Grade 3-4 toxicity was observed in 2 (6.66%) vs 3 (10%) patients, non-inferiority was confirmed (p=0.0326). Grade 3-4 postoperative complications were observed in 2 (7.14%) patients in the main group and in 3 (10.7%) patients in the control group (p=0.639) with no cases of mortality. pCR was achieved in 2 (7.14%) and 5 (17.8%) patients accordingly (p=0.225). Median follow-up was 25.2 months in the main group and 27.4 months in the control group. Two-year OS was 69% vs 100% (p=0.11), 2-year PFS was 65% vs 78% (p=0.434). ConclusionsPeritumoral abscesses and fistulas should not be considered as contraindication to neoadjuvant chemoradiotherapy. CRT is feasible and safe in patients with tumor-associated complications. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Nephrocutaneous fistula due to renal stone disease presenting as non-healing abdominal wall sinus: lessons from two cases

Nephrocutaneous fistula due to renal stone disease presenting as non-healing abdominal wall sinus: lessons from two cases

Gossypiboma in the urinary bladder: Time to make new surgical guidelines

The actual incidence of gossypiboma is difficult to determine possibly due to reluctance to report occurrence arising from fear of legal repercussion, but retained surgical sponge is reported to occur one in every 3000-5000 abdominal operations and is most frequently discovered in abdomen. Here, we report a case of 69-year-old male patient who suffered from severe irritative voiding symptoms with abdominal wall fistula at the incision site due to accidently left surgical sponge in bladder following suprapubic cystolithotomy surgery for bladder stone at some other hospital.

盲腸腹壁瘻をきたした単純性潰瘍穿孔の1例

症例は46歳男性で，42歳から盲腸炎を繰り返していたが確定診断がつかず，43歳から通院していなかった．二日前からの発熱と右下腹部痛で来院した．CT画像で右下腹部の腹壁と皮下に液体の貯留を認め，盲腸が変形していた．右下腹部皮膚を切開すると膿瘍と腸液が排出された．何らかの盲腸穿通と考え試験開腹術を行った．盲腸腸間膜対側に穿孔を認めたが他の小腸や大腸に異常は認めず，右半結腸切除術と腹壁皮下膿瘍ドレナージを施行した．摘出標本の菌培養で結核菌や特殊な菌は認めなかった．穿孔部の病理像は潰瘍に非特異的な炎症を認めるのみで，単純性潰瘍が進行した穿孔と診断された．術後2週間で退院，術20カ月後現在再燃を認めていない．盲腸穿孔の報告は左側大腸好発の特発性大腸穿孔と違い，単純性潰瘍やその他まれな原因でも穿孔をきたす．報告例はまれであるが壮年の盲腸穿孔は単純性潰瘍も念頭に置く必要があると考えられた．

Large neomucosal space 25 years after mesh repair of ventral hernia

A 64-year-old, otherwise healthy, male patient presented with a malodorous abdominal wall fistula of recent onset. He gave a history of mesh repair of ventral hernia 25 years ago. Computed tomography scan of the abdomen revealed a 15 cm × 15 cm thick-walled cavity inside the abdomen adjacent to bowel loops and the prosthetic mesh. Resection of the mass included a 25-cm segment of small bowel. Histopathology revealed a thick-walled large cavity lined with mucosa, surrounding a large wrinkled sheet of permanent mesh.

Seat belt injury causing delayed sigmoid colon fistula

Seat belt use can decrease the mortality rate associated with road traffic accidents (RTA). However, there is an increased risk of bowel perforations among seat belt wearers, possibly as a...

Abdominal Wall Sinus: An Unusual Presentation of Spilled Gallstone

Gallbladder perforation and spillage of bile is common during laparoscopic cholecystectomy. We report a case of an abdominal wall sinus due to a spilled gallstone presenting 10 years after laparoscopic cholecystectomy.

Mesh Migration Into the Bladder After TEP Repair: A Rare Case Report

Mesh migration after laparoscopic inguinal hernia repair is an unusual complication. We report a case of a 45-year-old man with persistent discharging of abdominal wall sinus after total extraperitoneal inguinal hernia repair. The patient underwent exploration and excision of the sinus tract with removal of the embedded mesh. A part of the mesh had migrated into the urinary bladder. Partial cystectomy with excision of wall containing the mesh was performed.

Chronic abdominal wall sinus and recurrent abscesses caused by a foreign body after laparotomy

The prolonged failure of a wound to heal due to the existence of a foreign body can result in chronic sinuses and fistulae and is a situation that should be avoided through thorough assessment of the wound in the first instance.

Risk factors associated with ileal pouch-related fistula following restorative proctocolectomy

Pouch-related fistula occurs in 5-10 per cent of patients after restorative proctocolectomy. The present study identified risk factors associated with the development of such fistulas. Data on preoperative and postoperative risk factors were recorded from 1965 patients who underwent restorative proctocolectomy in a single tertiary centre between 1983 and 2001. Cox regression analysis was used to identify independent predictors of pouch-perineal, pouch-abdominal wall and pouch-vaginal fistula during follow-up. Median patient follow-up was 4.1 (range 0-19) years. By 15 years' follow-up, pouch-vaginal fistulas had occurred in 44 women (5.2 per cent). The prevalence of ileal pouch-perineal and pouch-abdominal wall fistula was 3.6 per cent (70 patients) and 1.5 per cent (30 patients) respectively. Independent predictors of pouch-related fistula identified by multivariate analysis were diagnosis of indeterminate colitis or Crohn's disease (hazard ratio (HR) 1.28 (95 per cent confidence interval (c.i.) 1.00 to 1.65) and 1.73 (95 per cent c.i. 1.07 to 3.48) respectively versus ulcerative colitis or familial adenomatous polyposis), previous anal pathology (HR 3.43 (95 per cent c.i. 2.43 to 4.84) and 4.02 (95 per cent c.i. 1.27 to 12.77) respectively for perineal abscess and fistula in ano versus no previous anal pathology), abnormal anal manometry (HR 4.29 (95 per cent c.i. 2.33 to 7.91)), patient sex (HR 0.74 (95 per cent c.i. 0.58 to 0.95) for men versus women) and pelvic sepsis (HR 3.79 (95 per cent c.i. 2.48 to 5.79)). This study suggests that Crohn's disease and the clinical signs that favour the diagnosis of Crohn's disease may contribute to the development of pouch-related fistula.

Crohn’s fistula: current concepts in management

Crohn’s disease was described in 1932 in the classic article by Crohn et al., and then subsequently the authors described one of the disease complications, namely perianal fistula. It was originally thought that the perianal disease originated in the inflamed terminal ileum, which extended internally down to the perianal area. In the last 70 years, we have learned much about this disease, as well as the complications of both perianal and internal fistula. Approximately 60%–70% of all patients with Crohn’s disease will eventually need to undergo surgery, which in many cases is related to the development of a perianal fistula, subsequent to an abscess.1 The purpose of this article is to review our current knowledge of Crohn’s fistula, focusing predominantly on the concepts in clinical management.

Abdominal wall sinus: unusual presentation of chronic cholecystitis

Abdominal wall sinus: unusual presentation of chronic cholecystitis

Infliximab for the treatment of abdominal wall fistulas in Crohn’s disease

The effects of some aromatic amines on the protein and ribonucleic acid metabolism in liver and kidney slices from rats and guinea pigs were investigated. 1.1. The incorporation of 14C-valine into protein by rat liver slices was markedly inhibited by 2-aminofluorene (AF) and 2-acetylaminofluorene (AAF), which have a carcinogenic effect on rat liver.2.2. The non-carcinogenic aromatic amines aniline and 1-aminonaphthalene (1-AN) did not inhibit the incorporation of 14C-valine into protein by rat liver slices under similar conditions.3.3. The bladder carcinogen 2-aminonaphthalene (2-AN), which like most other aromatic amines is metabolized by liver, inhibited the incorporation of 14C-valine into protein by rat liver slices at least as much as did AF and AAF.4.4. In slices from guinea pig, an animal which is refractory to the carcinogenic effect of AF and AAF, these compounds inhibited the incorporation of 14C-valine into protein even more than in rat liver slices.5.5. Substitution of fluorine in position 7 of the AF molecule, which increases the carcinogenicity of this compound in liver, rather decreased the inhibitory effect in rat liver slices. A similar picture was observed with guinea pig slices, although the difference in this case was less pronounced.6.6. A certain time of preincubation was needed for the inhibitory effects to become manifest. The incorporation of 14C-valine into protein by rat kidney slices was not inhibited by the above compounds. These facts suggest that the true inhibitors were metabolitic derivatives of the administered substances.7.7. The incorporation of 14C-adenine into ribonucleic acid by rat liver slices was inhibited by AF, FAF and 2-AN under the same conditions as the valine incorporation, although to a somewhat lesser extent.

Spontaneous enterourachocutaneous fistula in Crohn's disease: Sonographic diagnosis

Spontaneous abdominal wall fistulas are rare in Crohn's disease. We report a case of enterourachocutaneous fistula in a woman with Crohn's disease and present the sonographic, computed tomographic, and sinographic findings.

A Comparison of Budesonide with Prednisolone for Active Crohn's Disease

Patients with active Crohn's disease are often treated with corticosteroids, but the treatment has many side effects. Budesonide is a potent, well-absorbed corticosteroid, but because of a high rate of first-pass metabolism in the liver, its systemic bioavailability is low. We conducted a randomized, double-blind, 10-week trial comparing the efficacy and safety of an oral controlled-release form of budesonide with the efficacy and safety of prednisolone in 176 patients with active ileal or ileocecal Crohn's disease (88 patients in each treatment group). The dose of budesonide was 9 mg per day for eight weeks and then 6 mg per day for two weeks. The dose of prednisolone was 40 mg per day for two weeks, after which it was gradually reduced to 5 mg per day during the last week. At 10 weeks, 53 percent of the patients treated with budesonide were in remission (defined as a score < or = 150 on the Crohn's disease activity index), as compared with 66 percent of those treated with prednisolone (P = 0.12). The mean score on the Crohn's disease activity index decreased from 275 to 175 in the budesonide group and from 279 to 136 in the prednisolone group (P = 0.001). Corticosteroid-associated side effects were significantly less common in the budesonide group (29 vs. 48 patients, P = 0.003). Two patients in the prednisolone group had serious complications (one had intestinal perforation and one an abdominal-wall fistula). The mean morning plasma cortisol concentration was significantly lower in the prednisolone group than in the budesonide group after 4 weeks (P < 0.001) and 8 weeks (P = 0.02) of therapy, but not after 10 weeks. Among patients with active Crohn's disease, both controlled-release budesonide and prednisolone are effective in inducing remission. In this trial, prednisolone reduced scores on the Crohn's disease activity index more, whereas with budesonide there were fewer glucocorticoid-associated side effects and less suppression of pituitary-adrenal function.

Abdominal Wall Sinus Tract Secondary to Gallstones: A Complication of Laparoscopic Cholecystectomy

A persistent sinus tract of the abdominal wall caused by retained fragments of gallstones following laparoscopic cholecystectomy is reported. Review of the literature and suggested technique and methods to avoid this complication are described.