Abdominal Wall Research Articles

Comparison of gauze packing, sponge-based, and hemostatic Surgicel wound stasis dressings to treat hemorrhages from grade IV liver injuries: An experimental study

BackgroundUncontrolled bleeding is still the major factor leading to preventable deaths following trauma. This study sought to assess the effectiveness of mini sponge-based wound stasis, cellulose-based local hemostatic, and traditional gauze dressings for the control of hemorrhages resulting from grade 4 liver injuries in rats. MethodsThirty Sprague-Dawley rats were divided into three equal groups. In the first group, a liver laceration was treated with gauze packing. The second group received XStat minisponge dressing (MDS), and the third group was administered a combination of MDS dressing and Surgicel hemostatic agent. After gaining access to the intra-abdominal cavity, a liver laceration measuring 10 mm in length, 5 mm in depth, and extending to the middle lobe was created. The dressings were removed after 2 and 10 minutes to assess the amount of bleeding, and any bleeding was documented again after 48 hours. Intraperitoneal adhesions were evaluated during euthanasia. ResultsAt 2 minutes post-injury, the gauze packing group had an average bleeding volume of 0.97±0.15 mL, compared to 1.08±0.25 mL in the MDS group (P=0.26) and 1.02±0.18 mL in the MDS+Surgicel group (P=0.69). At 10 minutes, the bleeding volumes were 0.13±0.05 mL, 0.22±0.01 mL (P=0.09), and 0.14±0.05 mL (P=0.19), respectively. At 48 hours, significant differences were observed in bleeding volumes (gauze: 0.55±0.18 mL, MDS: 1.15±0.21 mL, MDS+Surgicel: 0.82±0.06 mL, P<0.001). Mortality rates after 14 days were 0% in the gauze packing group, 60% in the MDS group (P=0.001), and 60% in the MDS+Surgicel group (P=0.001). The gauze packing group displayed no adhesions, while the other groups exhibited adhesions in the liver, bowel, omentum, and abdominal wall. ConclusionOur results indicate that, when it comes to managing bleeding in severe liver injuries, traditional gauze packing remains the tried-and-true method, showing superior effectiveness in terms of blood loss and mortality when compared to XStat minisponge dressings and the fibrillar Surgicel hemostatic agents.

Results From Complex Abdominal Reconstruction at Non-Academic Institution can Favorably Compare to Major Academic Centers: An Abdominal Core Health Quality Collaborative Database Review.

Many complex abdominal hernias are referred to tertiary academic institutions for evaluation and treatment. The purpose of this study was to compare clinical outcomes from complex abdominal hernia repairs and abdominal wall reconstructions at a community hospital vs high volume academic centers participating in Abdominal Core Health Quality Collaborative (ACHQC). Patients undergoing elective complex abdominal hernia repair were identified in our community setting and treated between 2016 and 2019. These results were then compared to Academic centers in the ACHQC database. Complex hernia definition was limited to those who have undergone any myofascial advancement procedure for homogeneity. Informed consent was obtained, and study was IRB approved. All data was de-identified. A total of 180 patients underwent complex abdominal hernia repair at our community hospital. The ACHQC database identified 6299 patients meeting criteria at participating academic centers. Demographics were similar between the two groups including hernia grade, size and wound class. Academic centers tended to have patients with previous component separations (25.7% vs 10.6%) and immunosuppressed (7.2% vs 2.8%), while the community hospital patients included more patients with tobacco use (18.9% vs 12.1%) and hypertension (65% vs 54.9%). Operative times were significantly less at the community hospital, patients requiring >240 minutes of time for repair at academic centers (39.6% vs 5%). Postoperatively length of stay was significantly shorter at the community hospital group averaging 3.7days vs academic centers of 6days (P < .05). Although overall complications were less in the community hospital group (26.5% vs 19.4%). Readmission within 30days was nearly twice as frequent in the community hospital group (14.4% vs 7.7%). Community hospitals can provide comparable care and surgical expertise as major academic centers in regard to complex hernias in a large majority of cases. There is a need for dedicated care coordination and continuous review of supporting staff and outcomes is necessary to assure quality care. There is still a need to identify which patients would benefit from treatment at an academic center as opposed to a community hospital in order to maximize patient access and outcomes at both types of hospital setting. Further investigation needs to be performed regarding criteria for which patients should be transferred to academic centers for their complex hernia care. Identifying patients who would benefit from treatment at Academic Centers as opposed to Community hospitals should continue to be investigated.

The Role of Tissue Expansion Before Baclofen Pump Insertion in the Pediatric Population.

Tissue expansion is a well-established technique for soft tissue reconstruction in the pediatric population. We present a case series of this technique to create a safe pocket for baclofen pump insertion to minimize risk of complications including pump migration, extrusion, wound dehiscence and infection. A case series of 3 pediatric patients undergoing tissue expansion prior to baclofen pump insertion at a single center in Melbourne. The expansion procedure was performed by senior surgeon N Low in all cases, and patients followed up 6 months after expander-pump exchange. The study was conducted over a 4-year period 2019 to 2023. We suffered 2 minor complications with the tissue expansion process including cellulitis and pump deflation. Neither complication precluded further tissue expansion nor led to premature removal of the expander. All patients proceeded to safely complete expander-pump exchange. One patient suffered a small (6 mL) abdominal seroma associated with pump insertion, which required no intervention. All patients have had a successful outcome 6 months after pump insertion. We describe a reliable and reproducible approach in creating a safe abdominal wall pocket to better accommodate baclofen pump insertion. Our series has overcome the imbalance between device size and abdominal wall pocket, now offering an alternative approach to achieve the safe delivery of intrathecal baclofen in the pediatric population.

Traumatic Abdominal Wall Hernia, often missed diagnosis in blunt trauma and delayed elective repair: A Case Report

Background: Traumatic Abdominal Wall Hernia (TAWH) is a rare type of hernia following blunt abdominal trauma that can easily missed. Always have high clinical suspicion following blunt trauma. Ultrasound scans and CT scans are particularly useful investigation to diagnose TAWH and associated abdominal injuries. Surgical repair is the definitive management of TAWH. Case description: This report presents a case of a 57-year-old male who presented abdominal wall hernia following blunt trauma to the abdomen and the diagnosis and management of TAWH. Conclusion: The timing of surgery depends on the concomitant injury. Delayed elective repair may be safe and cause less postoperative complications in stable patients. Delayed repair carries the risk of bowel incarceration and strangulation.

Sudden onset abdominal wall leakages of inguinal hernia in patients undergoing peritoneal dialysis: report of two cases with literature review

BackgroundIn this report, we presented two cases of sudden onset abdominal wall leakages of inguinal hernia in patients undergoing peritoneal dialysis (PD).Case presentationA total of 519 patients with end-stage kidney disease underwent PD at our hospital between March 2006 and March 2023. Among them, 39 patients [7.5%; 36 men (92%); mean age, 66 years; median PD duration, 1.7 years] developed inguinal hernias, with an incidence rate of 0.85 per 100 dialysis patient-years. Two patients (0.4%; both men; age/PD duration, 65/4.6 years and 74/1.7 years) experienced sudden onset abdominal wall leakages of inguinal hernia, with a rupture rate of 0.04 per 100 dialysis patient-years. In these cases of sudden onset abdominal wall leakages, both patients underwent tension-free hernioplasty; one patient was shifted to hemodialysis due to discomfort experienced from the right groin to the thigh area, while the other patient remained on PD.ConclusionsClinicians should consider the possibility of sudden onset abdominal wall leakages of inguinal hernia in PD patients.

An anatomical and histological narrative of a subcutaneous muscle of the anterior abdominal wall in human cadavers: a case report

This report investigates a subcutaneous muscle layer found during routine dissections in four formalin embalmed human cadavers donated for medical training. The gross and microscopic morphology is described and potential implications in humans are raised. Tissue samples were taken from representative regions of the anterior abdominal wall and stained using Haematoxylin & Eosin followed by Masson’s Trichrome. The muscle tissue was seen in the deepest layers of the hypodermis of the anterior abdominal wall, with variable presentation between cadavers. Visually, it appeared as a thin greyish-pink or brown layer with variable morphology based on location, namely, sheet like, discontinuous, and enmeshed within fascial layers, with a thickness ranging from 1 to 5 mm. Tissue staining revealed muscle fibres in all samples. Our incidental findings add gross and histological evidence for the presence of a subcutaneous muscle layer found in the anterior abdominal wall of humans.

The investigation of ultrasound to assess lateral abdominal wall activation with different types of core exercises

BackgroundCore training is the foundation of physical exercise. The activation of the lateral abdominal wall (LAW) muscles in the core muscles, particularly the transversus abdominal (TrA) muscles, has a stabilizing effect on the chest and abdomen. Therefore, we need to focus on the training effect of the TrA. There are many ways to measure the LAW. Ultrasound can assess the effect of training in real time and intuitively. Therefore, we intend to evaluate the activation of the LAW in different types of core training using ultrasound, to determine the best movements that can activate the TrA and train the core muscles.Methods22 healthy subjects (male 10, female 12, age 22.82 ± 0.98, BMI 20.78 ± 2.27) were included. The subjects were given the following instructions to perform breathing exercises at different positions: calm breathing and deep breathing at 0° hip flexion and 0° knee flexion; calm breathing, deep breathing, abdominal crunches and ball crunches at 45° hip flexion and 90° knee flexion; and calm breathing, deep breathing, abdominal crunches and ball crunches at 90° hip flexion and 90° knee flexion. The muscle thicknesses of the bilateral transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and LAW muscles were measured using ultrasonography at the end of expiration during the above movements.Results(1) The action with the greatest contraction ratio of the TrA was deep exhalation, which was significantly greater than crunch and ball crunch; (2) During deep exhalation, the TrA had the greatest contraction ratio, significantly greater than the IO and EO. (3) The TrA was thinnest during deep exhalation at 90°, followed by 45° and 0°.ConclusionIn healthy young people, deep expiration with 90° hip flexion and 90° knee flexion was the optimal action for activating the LAW, especially the TrA.

On the Relative Effects of Wall and Intraluminal Thrombus Constitutive Material Properties in Abdominal Aortic Aneurysm Wall Stress.

An abdominal aortic aneurysm (AAA) is a dilation localized in the infrarenal segment of the abdominal aorta that can expand continuously and rupture if left untreated. Computational methods such as finite element analysis (FEA) are widely used with in silico models to calculate biomechanical predictors of rupture risk while choosing constitutive material properties for the AAA wall and intraluminal thrombus (ILT). In the present work, we investigated the effect of different constitutive material properties for the wall and ILT on 21 idealized and 10 unruptured patient-specific AAA geometries. Three material properties were used to characterize the wall and two for the ILT, leading to six material model combinations for each AAA geometry subject to appropriate boundary conditions. The results of the FEA simulations indicate significant differences in the average peak wall stress (PWS), 99th percentile wall stress (99th WS), and spatially averaged wall stress (SAWS) for all AAA geometries subject to the choice of a material model combination. Specifically, using a material model combination with a compliant ILT yielded statistically higher wall stresses compared to using a stiff ILT, irrespective of the constitutive equation used to model the AAA wall. This work provides quantitative insight into the variability of the wall stress distributions ensuing from AAA FEA modeling due to its strong dependency on population-averaged soft tissue material characterizations. This dependency leads to uncertainty about the true biomechanical state of stress of an individual AAA and the subsequent assessment of its rupture risk.

Inguinal hernia: a view from the 21st century (a review)

The proposed review is a look at the pathogenesis of inguinal hernia from the standpoint of molecular biology, as well as an attempt to understand the problems that are a consequence of explantation: issues of male fertility, chronic inflammation, carcinogenesis. It is proven that the pathogenesis of inguinal hernia is not reduced to a defect of the anterior abdominal wall. Moreover, the formation of this defect is preceded by a complex of modification of connective tissue components, which is based on the separation of the processes of extracellular matrix synthesis and matrix degradation with the predominance of the latter that disrupts the rotation of structures responsible for mechanical strength and elasticity. From this point of view, inguinal hernia is a multifactorial and heterogeneous disease.

Sonographic anatomy of surgically acquired abdominal pseudohernia—A guide to the documentation of anterolateral integument denervation with ultrasound

AbstractIncisional hernia is a common clinical diagnosis when a patient presents with a post‐surgical abdominal wall bulge. Herniation is a complication that can result from a disruption to the anterior abdominal wall, however other differentials need to be considered to account for a localized prominence of the abdominal integument. One such differential is a pseudohernia; a bulging of an intact abdominal integument without protrusion of abdominal contents. This can occur as a direct consequence of operative trauma and subsequent denervation injury to abdominal wall musculature. Although surgical techniques have been refined to reduce the potential of segmental neuropathy, atrophy of the abdominal wall can be a long term sequalae that clinically mimics that of a hernia. Such an outcome can result from surgical approaches with a particular location and orientation leaving little option to avoid damage to nerves inherent to the area. Damage to these nerves can not only result in abdominal wall laxity but also to the development of further complications that can affect a patient's quality of life. The aim of this article is to increase sonographer awareness of postsurgical pseudohernia of the anterolateral abdominal wall as a differential to incisional hernia, and as such provide guidance on how to demonstrate this anomaly. Considering that pseudohernia and incisional hernia have differing management techniques, the sonographer can play a pivotal role in influencing patient management, negating the need for surgical hernia repair and advocate for a conservative management pathway.

The Analysis of the Fetal Abdominal Wall and Gastrointestinal Tract Abnormalities in a Single Tertiary Center

OBJECTIVE: We aimed to evaluate the fetuses with gastrointestinal anomalies and anterior abdominal wall defects detected in the prenatal period in our clinic and to analyze their perinatal outcomes. STUDY DESIGN: This retrospective study analyzed the data of 67 cases evaluated by the perinatology department of the Basaksehir Cam and Sakura City Hospital between January 2021 and May 2023 with a diagnosis of fetal anterior abdominal wall and gastrointestinal tract abnormalities. RESULTS: A total of 67 cases were included in our study with a mean maternal age of 26.4 ± 3.1 years and a median gestational week of first assessment at our center of 22 weeks (12-39 weeks). The most common anterior abdominal wall malformations were omphalocele (n=29, 43.3%) and gastroschisis (6 cases, 9.0%), and the most common fetal gastrointestinal tract anomalies were duodenal atresia (n=10, 14.9%), dilated bowel (n=5, 7.4%), and intestinal atresia (n=4, 5.9%). While genetic testing was carried out in 18 cases (27%), chromosomal abnormality was found in 6 (9.0%) cases. Termination of pregnancy was performed in 6 cases (9.0%). Postnatally, surgery was performed in 49 cases (73.1%) with a diagnosis of postpartum omphalocele, duodenal atresia, gastroschisis, intestinal and anal atresia. An uneventful surgical course was recorded for 47 cases that underwent surgery. CONCLUSION: The most common abdominal wall defects are omphalocele and gastroschisis, and the most frequent gastrointestinal anomalies are small bowel abnormalities (duodenal atresia, dilated bowel, intestinal atresia) in our study cohort. These abnormalities might be an isolated anomaly or part of a syndrome or associated with chromosomal abnormalities. The prognosis for infants with gastrointestinal malformation depends on the presence of associated anomalies or karyotype anomalies.

Comparison of the clinical efficacy on chronic abdominal wall pain between trigger-point electroacupuncture and transversus abdominis plane block

To compare the clinical efficacy between trigger-point (TrP) electroacupuncture and transversus abdominis plane (TAP) block in treatment of chronic abdominal wall pain (CAWP). A total of 62 CAWP patients were randomly divided into a TrP electroacupuncture group (31 cases, 1 case dropped off) and a TAP block group (31 cases, 1 case dropped off). Electroacupuncture at trigger points was delivered in the TrP electroacupuncture group, and TAP block was administered under ultrasonic guidance in the TAP block group. Separately, the score of the numerical pain rating scale (NRS) was observed before treatment and in 1 week, 1 month and 3 months after treatment；the scores of the self-rating anxiety scale (SAS) and the self-rating depressive scale (SDS) observed before treatment and in 1 week and 3 months after treatment；and the score of the short form 36 questionnaire (SF-36) was observed before treatment and in 3 months after treatment. The utilization rate of remedial drugs was recorded during follow-up visit. The clinical efficacy was compared. At each time point after treatment, NRS score decreased in comparison with that before treatment (P<0.05), the scores of SAS and SDS 1 week and 3 months after treatment were reduced (P<0.05) and the each item score of SF-36 increased (P<0.05) 3 months after treatment of each group. Compared with the outcomes in the TAP block group, NRS scores were reduced 1 month and 3 months after treatment respectively (P<0.05), the scores of SAS and SDS decreased (P<0.05) and SF-36 score was elevated (P<0.05) 3 months after treatment in the TrP electroacupuncture group. There was no significant difference in the utilization rate of remedial drugs between the two groups. The clinical efficacy of the TrP electroacupuncture group (96.7%) was superior to that of the TAP block group (83.3%, P<0.05). Both TrP electroacupuncture and TAP block can markedly relieve pain, attenuate the emotional symptoms of anxiety and depression and improve the quality of life in the patients with chronic abdominal wall pain. The clinical efficacy of TrP electroacupuncture is better than that of TAP block 3 months after treatment.

Clinical and Cost-Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta-Analysis.

Indocyanine green fluorescence angiography (ICGFA) is gaining popularity for the assessment of reconstructive flap perfusion intraoperatively. This study analyses the literature with a focus on its clinical efficacy and cost-effectiveness across various plastic and reconstructive surgery procedures. A systematic review was conducted in accordance with PRISMA guidelines on published studies in English comparing ICGFA with standard clinical assessment for flap perfusion. Meta-analysis concerned perfusion-related complications and cost data. Twenty-five studies met the inclusion criteria, of which two were randomized controlled trials (RCTs) and four were prospective cohort studies. Twenty-one studies were AHRQ Standard 'Good'; however, the overall level of evidence remains low. ICGFA was predominantly performed in breast surgeries (n = 3310) and head and neck reconstruction (n = 701) albeit with inconsistency in protocols and predominantly subjective interpretations (only five studies utilized objective thresholds). In breast surgery, meta-analysis demonstrated significant reductions in mastectomy skin flap necrosis (odds ratio (OR) 0.58, p < 0.0001), fat necrosis (OR 0.31, p < 0.001), infection (OR 0.66, p = 0.02), and re-operation (OR 0.40, p < 0.0001), but no significant decrease in total or partial flap loss (OR 0.78, p = 0.57/OR 0.87, p = 0.56, respectively) or increase in dehiscence (OR 1.55, p = 0.11). In head and neck surgery, ICGFA significantly decreased total flap loss (OR 0.47, p = 0.04), although not partial flap loss (OR 0.37, p = 0.13) and reoperation (OR 0.92, p = 0.73). Lower limb (n = 104) and abdominal wall (n = 95) reconstructive surgeries were much less studied with no significant ICGFA impact. Seven studies reported cost savings with flap surgeries and breast reconstructions, although study heterogeneity precluded meta-analysis. ICGFA appears to be a useful, cost-effective tool to identify otherwise unsuspected hypoperfusion in breast and head and neck reconstruction. There is a clear need for standardization, however, to avoid bias. Further RCTs are necessary to solidify these promising clinical findings.

Influence of Loading Density and Gender on the Welfare and Meat Quality of Horses During Transport for Slaughter

The aim of this study was to determine the effects of loading density and gender on blood welfare indicators, carcass bruises and horsemeat quality. Data were collected from twelve transports of 89 slaughter horses originating from the same collection centre. The transportation of slaughter horses at high loading densities (&gt;200 kg/m2), especially stallions, resulted in increased levels of lactate (p = 0.021), glucose (p &lt; 0.0001), ceruloplasmin (p &lt; 0.0001) and AOPP (p &lt; 0.0001), but lower GSH levels (p &lt; 0.0001). Compared to stallions and mares, geldings subjected to high loading density (&gt;200 kg/m2) during transport had lower levels of the aforementioned blood metabolites. In addition, stallions exposed to a high load density (&gt;200 kg/m2) had the highest frequency of severe (p = 0.0002), large (p &lt; 0.0001) and circular (p = 0.0001) carcass bruises, which were predominantly located on the abdominal (p = 0.0056) and thoracic (p = 0.0004) wall. In contrast, a higher percentage (p &lt; 0.0001) of undamaged carcasses was found in slaughter horses exposed to a low loading density (≤200 kg/m2) during transport. Stallions exposed to high loading densities (&gt;200 kg/m2) during transport had the highest initial pH (p &lt; 0.0001) and ultimate pH (p = 0.005) in terms of m. longissimus lumborum and redness (p = 0.017), but the lowest drip loss (p = 0.050) and lightness (p &lt; 0.0001), which, consequently, led to the highest (p = 0.0045) proportion of DFD-like defects in the meat quality. In conclusion, the results of this study showed that high loading densities (&gt;200 kg/m2), regardless of gender, negatively affect horse welfare during transport. In addition, stallions were more sensitive to poor pre-slaughter conditions and produced the lowest meat quality, while geldings were the most resistant. To determine the optimal transport density, further research is needed to determine the effects of different loading densities on the behaviour, physiology, carcass and meat quality of slaughter horses.

Laparoscopic-Assisted, Percutaneous Cryoablation: A Novel Technique for the Treatment of Abdominal Wall Soft Tissue Tumors.

Percutaneous cryoablation is a first-line therapeutic option for primary neoplasms and metastatic lesions of the musculoskeletal system. Treatment of abdominal wall tumors is challenging as surgical resection can be highly morbid and necessitate complex reconstructive surgery; the efficacy of cryoablation for abdominal wall tumors may be limited by inadequate posterior margins owing to the proximity of intra-abdominal organs. With laparoscopy and insufflation, peritoneal structures can be safely mobilized away from the abdominal wall, allowing for adequate deep margin freeze and visualization of the ice ball. We present two patients with abdominal wall soft tissue tumors treated with a novel approach of laparoscopic-assisted, percutaneous ultrasound-guided cryoablation. Patient 1 is a 65-year-old female with metastatic extraskeletal myxoid chondrosarcoma, stable on systemic therapy, who presented with a new soft tissue metastasis to the abdominal wall. Resection would have necessitated a highly morbid complex abdominal wall reconstruction with mesh. Patient 2 is a 35-year-old female with a large abdominal wall desmoid tumor, diagnosed after miscarriage. Resection was relatively contraindicated owing to the morbidity of a complex abdominal wall reconstruction and concerns regarding potential future pregnancies after surgery. Both patients underwent procedures in the outpatient setting after discussion at multidisciplinary sarcoma tumor board. Laparoscopic enterolysis was performed to mobilize the bowel away from the abdominal wall, to allow direct visualization of the peritoneal aspect of the tumor, and to confirm adequacy of the posterior margin freeze of the lesion. Laparoscopic transversus abdominus preperitoneal (TAPP) blocks with local anesthetic were performed for postoperative pain control. Interventional radiology performed an ultrasound-guided cryoablation consisting of two freeze and thaw cycles. Both patients recovered well without complications and were without radiographic evidence of persistent or recurrent disease at 12 and 18 months postoperatively, respectively. We report a novel approach of laparoscopic-assisted cryoablation for the treatment of abdominal wall soft tissue tumors. This allowed for successful minimally invasive local control of these large tumors that would have otherwise required highly morbid resections with complex abdominal wall reconstruction and mesh repair.

Feculent Drainage from Percutaneous Endoscopic Gastrostomy Tube due to Gastrocolocutaneous Fistula Found in Emergency Department: A Case Report

Introduction Percutaneous endoscopic gastrostomy (PEG) placement is a common procedure for patients requiring non-oral feeding. One rare complication of PEG placement is the formation of a gastrocolocutaneous fistula that develops when bowel is caught between the stomach and abdominal wall during placement. This report explores an elderly patient's gastrocolocutaneous fistula development months post-PEG placement who presented with malodorous leakage from the gastrostomy tube to the Emergency Department (ED). Case Report A 73-year-old male on hospice presented to the ED with malodorous leakage from his PEG tube. He had received the PEG tube four months prior to this presentation and had it replaced once at an outside hospital due to blockages. In the ED, his PEG tube was found to have a deflated balloon stopper. The PEG tube was replaced, but the feculent discharge persisted. Imaging showed the tube's position in the transverse colon. The patient underwent non-surgical management, with PEG tube removal and nutritional support via nasogastric tube. He was discharged with improvement of PEG site. Conclusion Gastrocolocutaneous fistula should be considered in patients experiencing unexpected PEG tube drainage or feeding-related complications such as diarrhea. Careful replacement techniques after dislodgement or blockage are important. Radiologic confirmation should be considered after replacement of tubes with feculent drainage. The rarity of gastrocolocutaneous fistula cases in literature explains the lack of standardized management approaches. Clinical signs such as feculent leakage through PEG tube site should prompt recognition and diagnosis by the ED clinician.

Temporary loop end ileostomy reduces the risk of stoma outlet obstruction: a comparative clinical study in patients undergoing restorative proctocolectomy and ileal pouch-anal anastomosis.

Stoma outlet obstruction (SOO) is a serious complication of restorative proctocolectomy (RPC) and ileal pouch-anal anastomosis (IPAA). When the ileal mesentery to the pouch is under excessive tension, the ileum near the ileostomy twists easily, causing SOO. Loop-end ileostomy (EI) for fecal diversion was introduced in 2021 to prevent SOO, and we aimed to verify whether temporary EI reduces the incidence of SOO in RPC and IPAA patients relative to loop ileostomy (LI). This study included 106 consecutive RPC and IPAA patients with a diverting ileostomy and categorized them into LI (n = 75) or EI (n = 31) groups. The clinical characteristics of the patients were analyzed and compared. Patient characteristics were similar between the groups, except for higher preoperative steroid use in the LI group (38.7%; p = 0.0116). There were no significant differences between the groups in anatomical factors, such as abdominal wall thickness and the height-adjusted distance between the root of the superior mesenteric artery and the bottom of the external anal sphincter. There were no significant differences in surgery-related factors, with ≥ 90% of the patients in each group undergoing laparoscopic procedures. A multivariate logistic regression analysis revealed that EI significantly reduced the risk of SOO relative to LI (OR, 0.18; 95% CI 0.03-0.92; p = 0.0399). EI reduced SOO levels after RPC and IPAA and may be beneficial for cases in which anastomosis is challenging.

Comparative characteristics of separation plastics of the anterior abdominal wall in the prevention of compartment syndrome in herniology

Research Objective: To evaluate the effectiveness of separation plastic in reducing intra-abdominal hypertension in midline ventral hernia surgery in an experimental setting. Materials and Methods. Research Subjects: 15 pigs weighing 30-35 kg with an original model of midline ventral hernia. In the acute experiment, intra-abdominal hypertension was created at 40 mmHg and the aponeurosis tension was set at 3.6 N. A comparative analysis was conducted to assess the impact of separation plastics of the anterior abdominal wall by Ramirez, Carbonell, and Novitsky on intra-abdominal pressure and central hemodynamics. Results: A direct correlation was found between intra-abdominal pressure and aponeurosis tension. Ramirez separation plastic of the anterior abdominal wall reduced intra-abdominal pressure by 50.5±1.1%, Carbonell by 53.5±2.8%, and Novitsky by 59±3.3%. Conclusion: The original model of midline ventral hernia in the acute experiment can be used to study intra-abdominal hypertension and ways to reduce it. Separation plastics decrease intra-abdominal pressure, improve central hemodynamic parameters, and blood oxygen saturation. The most effective separation plastic of the anterior abdominal wall is the posterior component according to Novitsky.

Prevention of intrauterine balloon displacement in patients with postpartum hemorrhage: A narrative review.

Postpartum hemorrhage (PPH) remains a significant complication of pregnancy globally, with uterine atony accounting for the great majority of cases. Second-line hemostatic strategies such as uterine balloon tamponade play a crucial role in managing refractory hemorrhage. Despite its effectiveness, the phenomenon of balloon displacement poses a challenge to PPH management, often leading to treatment failure. Various techniques have been proposed to address this issue, including vaginal packing, cervical cerclage, fixation to the abdominal wall, holding the cervix with ring forceps, and suspending the balloon with cervical sutures. Each method has its advantages and limitations, influencing its suitability in different clinical scenarios. Understanding these techniques may be useful to optimize and improve the management of PPH and maternal outcomes. This review provides a comprehensive summary of these strategies, their mechanisms, and their clinical implications, aiming to guide healthcare providers in choosing the most appropriate approach for individual cases of PPH.

Anatomical &amp; Ayurvedic Changes in the Women's Body Resulting from Multiple Cesarean Sections

C-section is a common surgical delivery in cases where a vaginal delivery may pose a potential threat to the well-being of the child or mother. In most cases, C-section is normally safe, but undergoing several C-sections can cause enormous anatomical changes in a woman's body. These changes may affect the structure of the uterus, the abdominal wall, and tissues perforating in the area, thus presenting a possible health complication when pregnant.