Herniation Of Organs Research Articles

Dogs and cats with prepubic hernia often have concurrent injuries and a good short-term outcome.

To describe clinical presentation, concurrent injuries, common imaging findings, and short-term outcome of dogs and cats diagnosed with prepubic hernia (PPH). 71 dogs and 16 cats. Medical records were searched at 2 academic referral institutions from August 1, 2008, to August 31, 2023, for dogs and cats diagnosed with PPH. Information regarding patient signalment, imaging, treatment(s) performed, and outcome was recorded. All imaging was reviewed by a board-certified radiologist. The majority of animals (77.5% of dogs, 87.5% of cats) presented within 24 hours of injury, most commonly secondary to vehicular trauma. Common concurrent injuries included pubic fractures (76.1% of dogs, 62.5% of cats), sacroiliac luxation (56.3% of dogs, 68.8% of cats), neurologic deficits (50.7% of dogs, 25% of cats), organ herniation (49.3% of dogs, 37.5% of cats), and urinary tract trauma (12.7% of dogs, 12.5% of cats). Most animals were diagnosed with radiographs (60.5% of dogs, 62.5% of cats), with the lateral projection proving most useful. Surgical treatment was pursued in 35 dogs and 7 cats, with muscular apposition being most common in dogs (54.3%) and use of pubic bone tunnels most common in cats (57.1%). Complications were uncommon, and PPH repair failure was reported in only 1 dog. Short-term outcome was good in both dogs and cats. Prepubic hernia should be suspected in patients that have sustained high-impact trauma and typically can be identified on lateral radiographs. For cases without organ herniation, conservative management may be a reasonable option.

Omental incarceration secondary to uterine perforation after dilatation curettage: Conservative approach in sub-saharan Africa.

Complications of uterine perforation and herniation of intra-abdominal organs into the perforated area may occur after gynecological operations. They can be treated with a conservative approach, especially in cases whose vital signs are stable, laboratory values are within normal limits and their general condition is suitable. We aim to present the conservative treatment without using surgical and medical methods as it is the first case in the literature. Uterine perforation is a rare but potentially serious complication of curettage for gynecologic or obstetric reasons especially during and after operative procedures and the application of intrauterine contraceptive devices. The incidence of uterine perforation during gynecological operations is between 0.002-1.7. A 30-year-old multiparous case with a 7-week 4-day pregnancy was diagnosed with incomplete abortion at an external center due to vaginal bleeding. The case underwent suction curettage. After 24 h, revision suction curettage was performed due to the finding of rest in the endometrium during the ultrasonographic control, and the case was diagnosed with uterine perforation and omental herniation due to this. We highlighted the importance of a thorough gynecological assessment following a dilated suction curettage (D&C) procedure that includes a careful clinical examination and a detailed ultrasound evaluation.

613. LAPAROSCOPIC MANAGEMENT OF TYPE IV HIATAL HERNIA WITH MESH AUGMENTATION CRUROPLASTY - EXPERIENCE AT A TERTIARY CARE CENTRE

Abstract Background Type IV para-esophageal hernias, which are characterized by herniation of other organs in addition to stomach, are rare - comprising only 2-5% of all para-esophageal hernias. They are associated with life-threatening complications such as strangulation or perforation of stomach. Laparoscopic treatment of these hernias requires excellent advanced laparoscopic suturing and dissecting skills. Although laparoscopic approach is now universally accepted, the role of mesh augmentation remains debated. Methods Case records of patients who underwent Laparoscopic mesh augmentation cruroplasty for Type IV hiatal hernia since 2012 were retrospectively analyzed. Results Out of 340 patients who underwent hiatal hernia repair, 7 patients (3males, 4females) fulfilled the selection criteria. Median age was 64(53-89) years. Median duration of symptoms was 2months (15days-6months). All patients complained of heartburn. Vomiting was present in 5(71%) patients; only 1(14%) patient had persistent vomiting with dysphagia. Respiratory symptoms were present in 2(29%) patients. No patient had features of peritonitis or sepsis. One patient had undergone laparoscopic heller’s cardiomyotomy twice before. All patients underwent MDCT which confirmed type IV paraesophageal hernia. Median operating time was 150(100-280) minutes. Median blood loss was 150(50-400) ml. 6(85%) patients had herniation of omentum in addition to stomach while 1 patient had herniation of omentum and transverse colon. No patient had ischemia/perforation of stomach. Median hiatal defect was 6(5-8) cm. Sac was excised completely in all cases following reduction of contents. Crural repair was done with1-0 polyester interrupted sutures. In some patients, anterior cruciate ligament repair was done to avoid tenting of esophagus. Rectangle shaped Composite mesh with key-hole slit in upper border was placed. Mesh was anchored with interrupted 1-0ethilon sutures. Fundoplication (Nissen’s/Toupet) was done in all patients, none required esophageal lengthening procedure. Median post-operative stay was 5(2-8) days, median ICU stay was 1(0-4) days. Oral liquids were started on 2 nd (1-3) post-op day and solids on 4 th (2-5) day. 2(29%) patients had post- operative complications - atrial fibrillation and transient respiratory failure respectively. Median follow-up was 14(1-40) months. No patient had symptomatic recurrence. OGDscopy at 6months was normal in 5 patients. No mesh related complication was observed. Discussion Wide hiatal defects were noted in all patients. This necessitated mesh augmentation of crural repair. Both short-term (morbidity, mortality) and long-term outcomes (recurrence, patient satisfaction) were excellent.

(Invited) 3D Printing for Tissue Scaffolds with Tunable Mechanical Durability and Sensing Capabilities

Pelvic organ prolapse (POP) is a prevalent condition among senior women, characterized by the descent or herniation of pelvic organs into the vaginal canal. It is a widespread issue, affecting a significant portion of the elderly female population, and yet, effective medical solutions for this condition remain elusive. This can be attributed to the complex nature of POP, where multiple factors, including tissue weakening and structural changes, contribute to its development. Despite the significant impact on women's quality of life, the absence of comprehensive treatment options underscores the urgency for innovative approaches to address this pressing health concern. In this context, 3D printing emerges as a valuable rapid prototyping tool, offering unique capabilities for designing and fabricating smart sensors and actuators. Its precision and versatility enable the creation of intricate devices that can be customized to specific medical applications. Moreover, 3D printing allows for the integration of sensors directly into biomedical devices, facilitating seamless monitoring and feedback mechanisms. Leveraging this technology, the research endeavors to harness the potential of 3D printing to develop advanced thermoelectric devices that can be seamlessly embedded within POP tissue scaffolds. These innovative devices will serve a dual purpose—detecting the health status of the tissue scaffolds and assessing their mechanical durability. In the realm of embedded medical devices, self-powered sensors hold particular significance due to their wireless powering capabilities and in-situ monitoring capabilities of human health. These sensors can operate without the need for external power sources or frequent battery replacements, making them ideal for long-term implantation within the human body. By tapping into the body's own energy sources or ambient environmental factors, self-powered sensors ensure continuous data collection and transmission, enhancing the efficiency and reliability of healthcare monitoring systems. Consequently, this talk aims to demonstrate the feasibility of 3D-printed thermoelectric devices as self-powered sensors, integrated into POP tissue scaffolds. These innovative devices will play a pivotal role in monitoring the tissue scaffold's condition, ensuring its mechanical integrity, and ultimately contributing to improved healthcare outcomes for women affected by POP.

Exosomes from umbilical cord mesenchymal stromal cells promote the collagen production of fibroblasts from pelvic organ prolapse.

Pelvic organ prolapse (POP) involves pelvic organ herniation into the vagina due to pelvic floor tissue laxity, and vaginal structure is an essential factor. In POP, the vaginal walls exhibit abnormal collagen distribution and decreased fibroblast levels and functions. The intricate etiology of POP and the prohibition of transvaginal meshes in pelvic reconstruction surgery present challenges in targeted therapy development. Human umbilical cord mesenchymal stromal cells (hucMSCs) present limitations, but their exosomes (hucMSC-Exo) are promising therapeutic tools for promoting fibroblast proliferation and extracellular matrix remodeling. To investigate the effects of hucMSC-Exo on the functions of primary vaginal fibroblasts and to elucidate the underlying mechanism involved. Human vaginal wall collagen content was assessed by Masson's trichrome and Sirius blue staining. Gene expression differences in fibroblasts from patients with and without POP were assessed via RNA sequencing (RNA-seq). The effects of hucMSC-Exo on fibroblasts were determined via functional experiments in vitro. RNA-seq data from fibroblasts exposed to hucMSC-Exo and microRNA (miRNA) sequencing data from hucMSC-Exo were jointly analyzed to identify effective molecules. In POP, the vaginal wall exhibited abnormal collagen distribution and reduced fibroblast 1 quality and quantity. Treatment with 4 or 6 μg/mL hucMSC-Exo suppressed inflammation in POP group fibroblasts, stimulated primary fibroblast growth, and elevated collagen I (Col1) production in vitro. High-throughput RNA-seq of fibroblasts treated with hucMSC-Exo and miRNA sequencing of hucMSC-Exo revealed that abundant exosomal miRNAs downregulated matrix metalloproteinase 11 (MMP11) expression. HucMSC-Exo normalized the growth and function of primary fibroblasts from patients with POP by promoting cell growth and Col1 expression in vitro. Abundant miRNAs in hucMSC-Exo targeted and downregulated MMP11 expression. HucMSC-Exo-based therapy may be ideal for safely and effectively treating POP.

Exosomes from umbilical cord mesenchymal stromal cells promote the collagen production of fibroblasts from pelvic organ prolapse

BACKGROUND Pelvic organ prolapse (POP) involves pelvic organ herniation into the vagina due to pelvic floor tissue laxity, and vaginal structure is an essential factor. In POP, the vaginal walls exhibit abnormal collagen distribution and decreased fibroblast levels and functions. The intricate etiology of POP and the prohibition of transvaginal meshes in pelvic reconstruction surgery present challenges in targeted therapy development. Human umbilical cord mesenchymal stromal cells (hucMSCs) present limitations, but their exosomes (hucMSC-Exo) are promising therapeutic tools for promoting fibroblast proliferation and extracellular matrix remodeling. AIM To investigate the effects of hucMSC-Exo on the functions of primary vaginal fibroblasts and to elucidate the underlying mechanism involved. METHODS Human vaginal wall collagen content was assessed by Masson’s trichrome and Sirius blue staining. Gene expression differences in fibroblasts from patients with and without POP were assessed via RNA sequencing (RNA-seq). The effects of hucMSC-Exo on fibroblasts were determined via functional experiments in vitro . RNA-seq data from fibroblasts exposed to hucMSC-Exo and microRNA (miRNA) sequencing data from hucMSC-Exo were jointly analyzed to identify effective molecules. RESULTS In POP, the vaginal wall exhibited abnormal collagen distribution and reduced fibroblast 1 quality and quantity. Treatment with 4 or 6 μg/mL hucMSC-Exo suppressed inflammation in POP group fibroblasts, stimulated primary fibroblast growth, and elevated collagen I (Col1) production in vitro . High-throughput RNA-seq of fibroblasts treated with hucMSC-Exo and miRNA sequencing of hucMSC-Exo revealed that abundant exosomal miRNAs downregulated matrix metalloproteinase 11 (MMP11) expression. CONCLUSION HucMSC-Exo normalized the growth and function of primary fibroblasts from patients with POP by promoting cell growth and Col1 expression in vitro . Abundant miRNAs in hucMSC-Exo targeted and downregulated MMP11 expression. HucMSC-Exo-based therapy may be ideal for safely and effectively treating POP.

OCCURRENCE OF PELVIC ORGAN PROLAPSE IN WOMEN: PREVALENCE, CONTRIBUTING FACTORS, AND IMPACT ON QUALITY OF LIFE

Pelvic Organ Prolapse (POP) stands as a prevalent health concern among women worldwide, characterized by the descent or herniation of pelvic organs, including the bladder, uterus, and rectum, into the vaginal canal. Objective: The primary aim of the study is to find the occurrence of pelvic organ prolapse in women and its prevalence, contributing factors, and impact on quality of life. This cross-sectional study was conducted in Catchment areas of Rural Health Centres Kangra and Kot Najibullah, District Haripur, Pakistan, from 1st November 2022 to 31st November 2023. Data was collected from 3284 women to find the pelvic organ prolapse in women and its prevalence, contributing factors, and impact on quality of life. The study comprised females diagnosed with various stages and types of POP, confirmed through clinical examinations, imaging studies, and documented medical history. Data was collected from 3284 female patients. The mean age of the patients was 54.01 ± 7.61 years. 60% of females are in the Pre-menopausal stage and 40% in the Post-menopausal stage. In managing Pelvic Organ Prolapse (POP), treatment modalities varied in utilization and exhibited distinct outcomes. Non-surgical interventions were employed in 30% of cases, resulting in a notable 70% relief in symptoms and a high patient satisfaction rate of 65%. It is concluded that this is a substantial problem for the women affected, yet the majority of affected women did not seek medical care. Pelvic organ prolapse is highly prevalent in rural Pakistan, impacts women’s everyday lives, and remains mainly untreated.

Grade IV Hiatal Hernia Resolved Laparoscopically with Diaphragmatic Hiatal Plasty and Fundoplication

Hiatal hernias are classified according to their anatomy into: Type I hiatal hernia, or sliding hiatal hernia, Type II (paraesophageal) hernia, Type III (mixed) and Type IV hiatal hernia is associated with a large defect in the phrenoesophageal membrane. Type IV hiatal hernia is a rare pathology with a low incidence in medical practice, but with great clinical relevance due to the risk of imminent morbidity; it is commonly repaired once identified due to concerns of acute gastric volvulus and strangulation of the stomach, although herniation and strangulation of some other intra-abdominal organ is not exempt. We present the clinical case of a patient with a grade IV hiatal hernia, incidental finding, relatively asymptomatic prior to clinical evaluation, repaired by laparoscopy; Performing reduction of the herniation of intra-abdominal organs, diaphragmatic plasty and fundoplication successfully, with a post-surgical evolution that was adequate.

To evaluate the predisposing factors of uterovaginal prolapse in women admitted in gynaecology ward

: Uterovaginal prolapse is an abnormal protrusion or herniation of pelvic organs from its normal position in the pelvis, due to failure of anatomical support. The prevalence of uterovaginal prolapse is difficult to be determined because many women are asymptomatic and many are hesitant to discuss with family. It can be considered a silent epidemic. The cause of uterovaginal prolapse is multifactorial. The parity, mode of delivery, postmenopausal status, obesity are some of the factors affecting the severity. The condition is preventive and by counseling and care during antenatal and postnatal period, the prevalence of this condition can be curtailed and quality of life can be improved.To evaluate the predisposing factors of uterovaginal prolapse in women admitted to the gynaecology ward.: A retrospective study was done for a period of 2 years from January 2019 to January 2021 at Integral Institute of Medical Sciences and Research, a tertiary care hospital and medical college, Kursi Road, Dasauli, Lucknow. The women admitted in gynaecology ward with symptoms of mass per vagina were included in the study. The data was retrieved from medical records of the department. The case file as per inclusion and exclusion criteria was identified and included in the study. The information of risk factors was collected using patient proforma. The pelvic organ prolapse quantification system (POPQ) approved by international continence society was used for categorizing uterovaginal prolapse. Data was analysed using SPSS version 20. Frequencies, percentage and mean computed to describe the variables of the study. The Chi-square test was used to compare variables. The statistical significance P<0.05 was considered significant.: The period of study was from January 2019 to January 2021. During this period 11256 patients were seen at the gynaecological clinic, out of which 206 patients had uterovaginal prolapse. The prevalence was 1.8%. The multiparity, prolonged and difficult deliveries, delivery by untrained personnel, mismanaged third stage of labour involving injury to sphincters and vaginal tears are determinants of prolapse uterus. Further postmenopausal condition causing hypoestrogenic state causes weaking of ligaments, collagen and aggravates the condition. Hence, preventive measures like institutional delivery, delivery by trained personnel, menopausal clinics may help the target population.

A serious consequence of pelvic organ prolapse: Hydroureteronephrosis.

We aimed to determine the association between pelvic organ prolapse (POP) and hydroureteronephrosis (HUN), risk factors for developing HUN and resolution of HUN after surgery. A retrospective study was conducted on 528 patients diagnosed with uterine prolapse. All patients with or without HUN were compared in terms of risk factors. The 528 patients were divided into five groups according to the POP-Q classification. A significant relationship was found between POP stage and HUN. The other risk factors for developing HUN were age, rural life, parity, vaginal delivery, smoking, body mass index and increased comorbidity. The prevalence of POP was 12.2% and the prevalence of HUN was 65.3%. All patients with HUN underwent surgery. After surgery, HUN resolved in 292 (84.6%) patients. POP is a multifactorial herniation of pelvic organs out of the urogenital hiatus due to pelvic floor dysfunction. The main etiological factors in POP are older age, grand multiparity, vaginal delivery and obesity. The most important problem in patients with severe POP is HUN due to urethral kinking or urethral obstruction, which is a result of the cystocele squeezing the urethra under the pubic bone. In low-income countries, the main aim is to prevent the development of POP, which is the most common cause of HUN. It is important to increase the level of knowledge about contraception methods and to increase screening and training to reduce other risk factors. Women should be made aware of the importance of gynecological examination in the menopausal period.

Occult diaphramatic injury in penetrating trauma: a diagnostic challenge

Abstract Diaphragmatic injuries in penetrating trauma are occult and may be easily missed. Common signs of diaphragmatic injury on computed tomography scan include discontinuous and/or dangling diaphragm sign, thickened diaphragm, organ herniation, collar sign, associated rib fracture, and contiguous injury on either side of the diaphragm. The detection of these signs varies based on the mechanism of injury, that is, penetrating versus blunt injury. Surgical management of an unstable patient with penetrating trauma and diaphragmatic injury is exploratory laparotomy, while laparoscopy is an alternate option in hemodynamically stable patients. A high level of suspicion is required to avoid missing this occult diagnosis and its associated complications.

Is diagnostic laparoscopy necessary in the management of left thoracoabdominal stab wounds?

The diagnosis of a diaphragmatic rupture and the identification of patients for surgical repair is challenging despite current diagnostic algorithms and imaging technologies. Unless treated on time, acute traumatic diaphragmatic injury due to stab wounds has a high mortality and morbidity rate, with an increasing trend in the presence of organ herniation. In this study, we aimed to investigate the efficacy of diagnostic laparoscopy in patients with an anterior thoracoabdominal stab wound and to compare the follow-up outcomes of cases. We retrospectively reviewed our institutional database of patients who were admitted with stab wounds between Oc-tober 2012 and 2022. Patients who underwent diagnostic laparoscopy were divided into two groups depending on the presence of a diaphragmatic injury. We analyzed demographics, the success of computed tomography (CT) imaging in the diagnosis, the presence of hemomediastinum, pneumomediastinum, tube thoracostomy application, associated organ injury, type of surgery, duration of surgery, complications, and the length of stay between the groups. Of the 39 patients with penetrating left thoracoabdominal injury underwent diagnostic laparoscopy, CT had a diagnostic sensitivity of 63.16% (95% Confidence interval [CI] 38.36-83.71%), and a specificity of 100% (95% CI 82.35-100.00%). We could not find a statistically significant difference between the groups in terms of studied variables, while operation time was significantly higher in the diaphragmatic injury group (P<0.01). Fourteen patients had accompanied visceral injuries. Diagnostic laparoscopy is still the gold standard particularly in the ER setting, particularly in the absence of an experienced radiologist for 24 h and when the close monitoring of the patient by the same team cannot be provided.

Volvulus of the stomach and wandering spleen after repair of congenital diaphragmatic hernia: unexpected manifestations in a neonate

BackgroundCongenital diaphragmatic hernia (CDH) is sometimes associated with complications involving herniation of intrathoracic organs, which further increase mortality rate. We encountered a case of postoperative gastric and splenic volvulus shortly after left CDH repair in a female neonate who was treated with gastropexy.Case presentationAt 39 weeks gestation, a female patient with left Bochdalek CDH was delivered (birth weight: 3748 g, Apgar score: 3/4). The patient was provided ventilator support with nitric oxide. After pulmonary hypertension improved, CDH repair was performed via the abdominal approach on day 7. The stomach, small intestine, large intestine, and spleen were herniated through a diaphragmatic defect of 4 × 2 cm. Although the diaphragm was directly closed, it was tight and the reconstructed diaphragm “dome” was shallow, restricting space for the spleen and stomach. Nonetheless, the spleen was positioned in the left upper abdomen and the stomach was positioned medially. The postoperative course was complicated by organo-axial gastric volvulus, and laparotomy was performed on day 14. In addition to the gastric volvulus, we confirmed a wandering splenic volvulus. The spleen was easily detorted and returned to the left upper abdomen. However, the patient experienced relapse of gastric volvulus without splenic volvulus. Gastropexy was performed electively on day 47. Postoperatively, the patient could be fed orally, and the patient’s development was satisfactory 6 years after surgery.ConclusionsThe cause of these rare complications appeared to be tight direct diaphragmatic closure, which reduced space for the spleen and stomach beneath the left diaphragm.

Traumatic Diaphragmatic Injuries at Medicolegal Autopsy: A 1-Year Prospective Study.

Traumatic diaphragmatic injuries (TDIs) are relatively rare. The forensic literature pertaining to TDIs consists mainly of case studies, suggesting little attention to these injuries during autopsies and research. This prospective study was conducted at the Ga-Rankuwa Forensic Pathology Services mortuary over a 1-year period. We included all cases who had a full medicolegal autopsy, as prescribed by the relevant South African legislation (Inquest Act 58 of 1959). All diaphragms were examined by a forensic medical practitioner performing the autopsy. Nine hundred ninety-nine cases were analyzed; of these, 71 cases with TDIs were identified. The incidence of TDI was, therefore, determined to be 7.11%. A total of 60.56% involved the right hemidiaphragm, 19.72% the left hemidiaphragm, and 19.72% were present bilaterally. A total of 85.92% were present in men and 14.08% in women. Blunt force trauma comprised 33.80%, and penetrative trauma 61.97%. Most were associated with severe injuries. A total of 12.68% had organ herniation through the defects present. Our study revealed that TDIs were more common than initially reported. The right side was more often involved in our study than in other studies. Diaphragmatic injuries were observed in 21.46% of all penetrative trauma cases received in a year.

A novel surgical approach to thoracoschisis

Thoracoschisis is a very rare congenital anomaly defined by the herniation of intra-abdominal organs through a defect in the thoracic wall, often associated with defects in the limb-body wall complex. We present a Case of a 33-week gestation female born with thoracoschisis between her left 7th and 8th ribs, with protrusion of her liver, stomach, spleen, small and large intestines. Owing to the amount of herniated organs and loss of abdominal domain, she required a silo placement initially followed by a delayed reduction of her abdominal contents. Due to a lack of abdominal wall musculature at the defect, she required a repair with biologic mesh and negative pressure wound vac therapy. Based on our review, this is the 7th reported Case of isolated thoracoschisis, and the only case with such extensive herniation of abdominal contents. An extensive search revealed only 15 reported cases of thoracoschisis in current literature. Given the rarity of thoracoschisis, we present our case, an approach for repair of a thoracoschisis defect using biologic mesh when primary repair is not feasible, and a review of the current literature.

Validation of inner ear MRI in patients with M\xe9ni\xe8re\u2019s disease by comparing endolymphatic hydrops from histopathologic specimens

Intravenous gadolinium-enhanced inner-ear magnetic resonance imaging (IV-Gd inner-ear MRI) has been used to visualize endolymphatic hydrops (EH) in clinical diagnosis of Ménière’s disease (MD). However, lack of histological validation has led to several concerns regarding how best to interpret the resulting images. Here, we compared hydropic changes in temporal bone specimens with the results of IV-Gd inner-ear MRI in patients with MD. Histopathologic images of temporal bones from 37 patients with MD and 10 healthy controls were collected from the National Temporal Bone Bank of the Massachusetts Eye and Ear Infirmary in the United States. The EH ratios in the vestibule and cochlea were calculated from temporal bones using the methods used for IV-Gd inner-ear MRI, and the degree to which the saccular and utricular hydrops contributed to vestibular hydrops was measured. The presence of hydropic change in each semicircular canal was assessed using temporal bone images and compared with IV-Gd inner-ear MRI scans of 74 patients with MD. Based on human temporal bone imagery, the EH ratios in the cochlea and the vestibule on the affected side were 0.314 and 0.757, respectively. In the healthy control group, the ratio was 0.064 for the cochlea and 0.289 for the vestibule; these values were significantly different from those for the affected side of MD patients. The values for the affected ear were similar to the ratios from the IV-Gd inner-ear MRI scans in MD patients. In the vestibule, saccular hydrops were more common than utricular hydrops. The average EH ratios in the saccule and utricle were 0.513 and 0.242, respectively. No significant hydropic change from each of three semicircular canals was evident in temporal bone histopathology. However, herniation of otolithic organs (saccule or utricle) into the lateral semicircular canal was found in 44.4% of the patients, with saccular herniation (24.8%) more common than utricular herniation (16.7%). Although IV-Gd inner-ear MRI might not reflect fully the results of actual histopathology due to the limited resolution of MRI and image-processing techniques, the measured EH ratios from temporal bone specimens and IV-Gd inner-ear MRI scans were similar. Hydropic change in the three semicircular canals was not significant at either the ampullated or nonampullated end. Canal invasion of vestibular hydrops seen on MRI also appeared in temporal bone histopathology, and saccular invasion was dominant.

Blunt Trauma Leading to Anterior Abdominal Wall Hernia

Traumatic abdominal wall hernia (TAWH) has a reported incidence of around 1%. It is defined as herniation of intra-abdominal organs following trauma without skin penetration. High-energy trauma is often associated with intra-abdominal injury. Treatment options vary from non-operative management to surgical repair either open or laparoscopic. We present a case of a middle-aged male who presented with a history of rickshaw roll over injury. On examination, there was tender abdominal swelling with abrasions. Computerized Tomography (CT) scan confirmed the diagnosis of TAWH and free fluid in abdomen. Emergency exploratory laparotomy was performed. Mesenteric tears were repaired and primary restoration of abdominal wall was done. The patient was discharged on a fourth post-operative day without any complications. Management of TAWH should be tailored according to individual patient presentation. Midline exploratory laparotomy with the primary hernial repair is an operative intervention of choice for those with high-energy injury as there is an increased chance of accompanying visceral trauma. Keywords: Laparotomy; Trauma; Hernia.

120 Hadlock growth curves over-diagnose fetal growth restriction among fetuses with gastroschisis

Fetal growth restriction (FGR) occurs in a significant proportion of pregnancies complicated by gastroschisis, however is diagnosed based on growth percentiles for non-anomalous fetuses. Due to abdominal organ herniation, fetal abdominal circumference (AC) often measures less than expected when using Hadlock biometric measurements. This may over-diagnose FGR in these fetuses. Our objective was to evaluate 2nd and 3rd trimester biometric measurements of fetuses with gastroschisis to create growth curves specific to this anomaly. This single-center retrospective cohort study included biometric data from 413 ultrasounds of 116 fetuses with isolated gastroschisis between January 2011 and July 2020. Estimated fetal weight (EFW) was calculated by Hadlock 1984. Revised growth curves were generated using gastroschisis biometric measurements, with the 10th, 50th and 90th centiles calculated. A non-parametric model and ANOVA chi-square test were used to compare gastroschisis-specific curves to Hadlock growth curves. Five growth curves were generated for gastroschisis fetuses including EFW, biparietal diameter, head circumference, AC, and femur length (FL). EFW curves for gastroschisis fetuses were significantly different than 1984 Hadlock growth curves (p<0.001). The gastroschisis 50th percentile curve virtually overlays the Hadlock 10th percentile curve. 60% of fetuses diagnosed with FGR by Hadlock were misdiagnosed based on the gastroschisis-specific growth curve. Curves for AC and FL revealed a similar pattern, with the Hadlock 50th percentile curve just below the gastroschisis 90th percentile curve. Fetuses with gastroschisis have a growth curve that is distinctly different from that defined by Hadlock. Gastroschisis fetuses are over-diagnosed with FGR when compared to non-anomalous fetuses. Given the known risks of preterm delivery, using a gastroschisis-specific growth curve may assist in risk-stratification and potentially adjust the gestational age goal to achieve among otherwise reassuring cases of gastroschisis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

260 Antepartum and delivery outcomes for growth-restricted fetuses based on gastroschisis-specific fetal growth curves

To determine the utility of gastroschisis-specific fetal growth curves by evaluating antepartum and delivery outcomes for fetuses with fetal growth restriction (FGR) based on Hadlock growth curves compared to gastroschisis-specific growth curves. This was a single-institution, retrospective cohort study of pregnancies complicated by isolated gastroschisis delivered between 2011 and 2020. Using ultrasound biometric data, we generated estimated fetal weight growth curves specific to fetuses with gastroschisis, including the 10th, 50th, and 90th percentiles between 15 and 37 weeks. We compared antepartum and delivery outcomes for fetuses diagnosed with FGR by Hadlock growth curves to fetuses diagnosed with FGR by gastroschisis growth curves. 413 ultrasounds from 116 fetuses were included. 67 (58%) of the fetuses met criteria for FGR based on Hadlock growth curves, and 28 (24%) met criteria based on the gastroschisis growth curves. 60% of fetuses diagnosed with FGR by Hadlock were misdiagnosed based on the new growth curves. When comparing fetuses with FGR by Hadlock to those with FGR by the gastroschisis curves, the new curves better predicted 5 out of 16 observed outcomes, including: increased betamethasone administration (52% vs 45%, p=0.001), decreased spontaneous vaginal delivery (43% vs 51%, p<0.001), increased cesarean delivery (54% vs 49%, p=0.001), increased unplanned hospital admission (96% vs 82%, p<0.001), and worsening bowel findings leading to delivery (39% vs 28%, p=0.033). Hadlock growth curves derived from non-anomalous fetuses over-diagnose FGR in fetuses with gastroschisis due to small abdominal circumference measurements caused by abdominal organ herniation. FGR defined by gastroschisis-specific growth curves better predicts many of the common perinatal outcomes seen in pregnancies complicated by this anomaly. Given the known risks of prematurity, using gastroschisis-specific growth curves may assist in improved risk stratification and delivery planning among cases of gastroschisis.

Abandoning the blind legacy passed on horde of routine intra-abdominal drain insertion in cesarean section.

IntroductionCesarean section (CS) delivery is the most common major obstetrical surgical operation carried out in and is increasing in incidence throughout the world. The major involves some risks that might include: infection, coagulation problem, loss of blood, bowel or bladder injury, abnormalities of the placenta in subsequent pregnancies.Aim of the studyTo evaluate the clinical effectiveness of postoperative CS intra-abdominal drain insertion.Material and methodsA prospective study was conducted on 245 patients in labor, at the Department of Obstetrics and Gynecology, Jordan University Hospital, between January 2017 and January 2018. Participants were divided into two groups: group I including those who had abdominal drains insertion during surgery and group II including women who had no abdominal drain inserted before closure. All patients on both groups were term pregnancies, underwent elective vs. emergency CS, and had no subcutaneous drains inserted.ResultsClinical and surgical parameters were comparable in both groups. Postoperative hospital stay was significantly shorter in group II, whereas specific postoperative complication rate was significantly higher in group I. Drain site infection was noted in 2 (1.6%), organ herniation in 2 (1.6%), drain avulsion in 2 (1.6%), severe pain at the site of insertion in 2 (1.6%) patients.ConclusionsRoutine prophylactic intra-abdominal drain insertion post CS has no benefits and therefore should be stopped.