Inferior Abdomen Research Articles

Endoscopic removal of an appendiceal foreign body using a disposable pancreaticobiliary imaging catheter.

A 30-year-old man was admitted to our hospital following ingestion of a peg-like foreign body 6 days earlier. The patient reported no significant abnormalities. Physical examination showed a soft abdomen, without tenderness or rebound pain. Plain abdominal radiography revealed a peg-like object with high density in the right inferior abdomen ([Fig. 1]). Computed tomography confirmed that the object was at the appendiceal cavity, with no signs of perforation ([Fig. 2]). Endoscopic removal of the object was performed for this patient.

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

Isolated Endometriosis in the Ischial Spine Region. an Anatomic Laparoscopic Approach

Study Objective This video describes the technique used to treat an isolated endometriotic nodule in the Ischial Spine Region emphasizing the anatomic aspect of this region. Design Isolated endometriotic nodule in the Ischial Spine Region diagnosed preop in one symptomatic patient by MRI. Laparoscopic resection with 6 months follow-up. Setting Through a laparoscopic approach using HD-3D microcamera which was inserted umbilical scar, with 3 auxiliary punctures of 5mm each in the inferior abdomen. Patients or Participants A 39-year-old patient was referred to the Center of Endometriosis. Her symptoms started about six years before the surgery. She reported pelvic pain, proctalgia, sciatica and perineal pain in the right side, paresthesia and burning on the inguinal region and the plantar face of the right foot, and chronic fatigue. Cyclical pain happened during menses, not relieved with non-steroidal anti-inflammatory drugs (NSAIDs). Preop CA-125 marker was 57.0 U/mL. Three years before surgery she reported a spontaneous abortion. Interventions A Laparoscopic resection of the endometriotic nodule in the ischial spine region. Measurements and Main Results The Surgical time: 230min. Removed nodule: 5cm. The patient is totally asymptomatic, without any pain or neurological deficits. After 6 months, she has started reproductive treatment. Conclusion This video demonstrates the infiltration of endometriosis in the complex region of the ischial spine, its excision and various aspects of anatomical dissection in vascular structures, muscles and nerve sparing. This video describes the technique used to treat an isolated endometriotic nodule in the Ischial Spine Region emphasizing the anatomic aspect of this region. Isolated endometriotic nodule in the Ischial Spine Region diagnosed preop in one symptomatic patient by MRI. Laparoscopic resection with 6 months follow-up. Through a laparoscopic approach using HD-3D microcamera which was inserted umbilical scar, with 3 auxiliary punctures of 5mm each in the inferior abdomen. A 39-year-old patient was referred to the Center of Endometriosis. Her symptoms started about six years before the surgery. She reported pelvic pain, proctalgia, sciatica and perineal pain in the right side, paresthesia and burning on the inguinal region and the plantar face of the right foot, and chronic fatigue. Cyclical pain happened during menses, not relieved with non-steroidal anti-inflammatory drugs (NSAIDs). Preop CA-125 marker was 57.0 U/mL. Three years before surgery she reported a spontaneous abortion. A Laparoscopic resection of the endometriotic nodule in the ischial spine region. The Surgical time: 230min. Removed nodule: 5cm. The patient is totally asymptomatic, without any pain or neurological deficits. After 6 months, she has started reproductive treatment. This video demonstrates the infiltration of endometriosis in the complex region of the ischial spine, its excision and various aspects of anatomical dissection in vascular structures, muscles and nerve sparing.

Pulmonary Adenosquamous Cell Carcinoma With Systemic Lymphadenopathy due to Immunoglobulin G4-Related Disease: A Case Report

A 75-year-old man with diabetes mellitus showed elevated C-reactive protein (CRP) level at his regular visit. Computed tomography scan showed a lung tumor in his left lower lobe and systemic lymphadenopathy including abdominal lymph nodes. The patient was diagnosed as primary pulmonary squamous cell carcinoma with systemic lymph node metastasis. Thereafter, unexpected steroid pulse therapy for accidental acute exacerbation of interstitial pneumonia rapidly shrank lymphadenopathy. At this time, we also found elevated serum immunoglobulin G4 (IgG4) level (385 mg/dL). Considering these findings, we doubted the lymph nodes metastases at the initial staging, and then corrected cancer-staging (C-staging) from inferior vena cava (IVC) to inferior abdomen (IA). In addition, during the steroid tapering, sudden onset and uncontrollable left pneumothorax required surgical approach. Curative-intent left lower lobectomy with lymphadenectomy was performed for the lung cancer. Pathological findings revealed coexistence of adenosquamous carcinoma and infiltration of IgG4-positive plasma cells in the resected mediastinal lymph node. We detected 384 IgG4-positive cells per high power field. IgG4/IgG-positive cell ratio was 54%. Based on these findings, the diagnosis of IgG4-related disease with primary adenosquamous carcinoma (p-stage IIIA) was confirmed. The patient died 24 days after surgery because of another acute exacerbation of interstitial pneumonia. Our case alerts oncologists to IgG4-related disease as a possible underlying comorbidity which may confuse pretreatment clinical stage. J Med Cases. 2021;12(4):164-171 doi: https://doi.org/10.14740/jmc3649

Total Laparoscopic Rectosigmoidectomy without Bowel Exteriorization: A New Surgical Technique for Endometriosis.

Study Objective The purpose of this video is to demonstrate the technical bases of a new laparoscopic technique for segmental resection of the rectosigmoid without intestinal exteriorization. Design 19 patients with indication for segmental resection of the rectosigmoid, due to infiltrative endometriosis, underwent this less invasive technique compared to classic techniques, which involves the externalization of the bowel through minilaparotomy or vaginally for intestinal resection and anvil placement. Setting The insertion of the endoscopic linear stapler and anvil, as well as the removal of the surgical specimen, were carried out through the vaginal route using intentional colpotomy or opportunely during the hysterectomy or resection of endometriosis infiltrating the posterior vaginal fornix. Patients or Participants Between June 2019 and January 2020, 19 patients underwent total laparoscopic rectosigmoidectomy to treat deep endometriosis. Interventions A 0˚ optic was introduced in a 10mm trocar and 3 auxiliary 5mm punctures were used in the inferior abdomen. Lesions located in the rectosigmoid were identified. The segment was prepared and isolated. A linear endoscopic stapler vaginally inserted was used to section the bowel. The proximal stump had its suture line opened with scissors and a purse-string suture was used to fix the anvil vaginally inserted into the abdominal cavity. A transanal circular stapler was used together with the anvil for anastomosis. Measurements and Main Results There were no intraoperative complications. At postoperative, there was no evidence of leakage, need for transfusion nor readmissions for a period of up to 60 days. Conclusion The total laparoscopic technique prevents traction and externalization of the intestinal loop through minilaparotomy or the vagina. There was a decrease in surgical time, less traction of the mesentery, preserving of vascularization and innervation, thus improving the quality of the anastomosis and protecting the nerves of the intestinal segment.

An atypical case of disseminated cutaneous leishmaniasis due to Leishmania peruviana in the valleys of Ancash-Peru.

We present an atypical case of disseminated cutaneous leishmaniasis in the Sihuas district, located in the Andean valleys of Ancash-Peru. A 62-year-old man with no particular medical history presented multiple lesions located on the inferior abdomen, lumbar region and the right anterior thigh. Histological analysis found leishmanial amastigotes in the lesion sample, the Montenegro reaction was positive for Leishmania spp, and the polymerase chain reaction was positive for Leishmania peruviana. In conclusion, the atypical presentation of this disease may be related to the presence of an uncommon parasite strain or host immune deficiencies. The molecular identification of the etiology for disseminated leishmaniasis, will allow a better understanding of the presentation and proper treatment, as well as associated risk factors.

Modified Lipoabdominoplasty: Updating Concepts.

Abdominoplasty is a commonly performed aesthetic surgical procedure worldwide, and one of the most frequently performed cosmetic surgical procedures in the United States. Classic abdominoplasty was merged with liposuction in the past decade to create a new technique-lipoabdominoplasty-that was proven to be safe and effective and that improves body contour. The authors have been using lipoabdominoplasty since 2003 with excellent outcomes; however, some details have been added to improve significant shortcomings, including the lack of treatment of the pubic area and flanks, the presence of a high-position scar and, sometimes, a bulging inferior abdomen. The authors retrospectively studied 348 patients who underwent lipoabdominoplasty with these related surgical improvements between January of 2010 and February of 2015. Improvements to the original surgical technique included deep liposuction in the lower abdomen, pubic liposuction, and liposuction of the flanks or dorsum with power-assisted liposuction, Scarpa fascia removal in the inferior abdomen, lipoplasty and mons lipolifting, and pubic fixation. Following these key points, superior flap slides to the pubic region by elongation of the vessels and nerves, preserving those structures, avoiding creation of a dead space, and reducing the number of the most common complications. Scarpa fascia removal in the infraumbilical region avoided bulging without increasing the seroma rate. Pubic lifting and its fixation promote rejuvenation of the entire region and avoid elevation of the remnant scar. These surgical modifications are safe and avoid common complications related to lipoabdominoplasty, with improved outcomes. Therapeutic, IV.

Thoracoabdominal mobility is improved in subjects with tetraplegia after one year of wheelchair rugby training

Summary Objective The purpose of this study was to analyse the effect of one year of wheelchair rugby training on thoracoabdominal mobility and its association with lung volume in adults with tetraplegia. Equipment and methods Participants (10 male adults with chronic spinal cord injury at cervical level) underwent to regular training in wheelchair rugby. At the beginning and after one year of training, lung volume and tridimensional mobility of four-chest wall compartments (superior and inferior thorax, superior and inferior abdomen) were obtained by spirometric testing and kinematic analysis, respectively. Results Seven athletes completed the study. During quiet breathing, significant improvements and linear relationships were observed for the tidal volume (16.9%), superior thorax (61.3%) and inferior thorax mobility (83.7%). During maximal breathing, significant improvements were found for the vital capacity (24.8%) and superior thorax mobility (31.5%). Besides that, there was also a significant linear relationship between the vital capacity volumes and mobility in the superior and inferior thorax and superior abdomen. These findings could support the practice of wheelchair rugby to reduce respiratory dysfunction in tetraplegics.

Dolor pélvico crónico como origen de sintomatología urinaria. Aspectos generales

Chronic pelvic pain presents characteristics that separate it from other pain. It is located at the level of the inferior abdomen or pelvis and persists for at least 6 months. It can be continuous or intermittent, without being associated with the menstrual cycle or sexual relations. The region's complex anatomy of bones, muscles, fasciae, vessels, nerves, and viscera determines the signs and symptoms that, with the passage of time, lose their specific characteristics and make diagnosis difficult.The origin of chronic pain is associated with changes in the neurons of the central nervous system; they result in a central hypersensitivity that explains the perception of chronic pain in the confirmed absence of a peripheral pathology.The patient with chronic pelvic pain syndrome presents with a high percentage of symptomatology involving the lower urinary tract. This can confuse both the general physician and the specialist, and thus a multidisciplinary team of physicians should make the diagnosis so that the most adequate treatment can be established.

Right low abdominal pain (RLAP): a new signal in food allergy

Methods We studied the data of the physical examination of the right low abdomen area of 355 patients with food allergy, retrospective using the medical data from the medical records of the Brazilian Society of Food Allergy (SBAA). Results Our patients were 48% male and 52 % female, and those numbers are not different from those of the pertinent literature. The age was distributed according with the literature, similar to all tree groups: 42.8% were infants, 32.7% were children (3 to 13 years) and 24.5% were adolescents and adults. In anamneses of the GALT system, the abdominal pain was the most frequent complain, present in 15.6% of the patients, followed by diarrhea and vomits in 12.6 and constipation in 11.7%, next to them we had vomiting in 11.7% of patients studied. In the physical examination of the patients selected to the study, pain of the right inferior abdomen was present in 18% of patients followed by abdominal distension in 13.5%. Left abdominal pain was found in 3.3% . Epigastric pain and splenomegaly in 2.6%. Conclusion One explanation for the RLAP in patients with food allergy is related to the ileal nodular lymphoidhyperplasia expressing the immunereaction at the Payers Patches in the terminal ileum. Another splanation to the pain is the degranulation of eosinophils in the mucosal or muscular structure of the bowel wall inducing pain. All physician doing physical examination in patients with the suspicious diagnosis of food allergy, have to do a careful examination of the right low abdomen, considering the presence of pain. The evidence of this signal will be very suggestive for food allergy.

SU-E-T-418: Evaluation of Peripheral Dose for SRS Treatment Radiations with the VIS CyberKnife: A Phantom Study.

Stereotactic radiosurgery (SRS) procedures are known to deliver a very high dose per fraction and thus, the increased risk of secondary types of cancer due to increased peripheral dose could be a limiting factor for the long term survival of the patients. The aim of this study is to evaluate the peripheral dose (PD) received at preselected anatomical sites in an anthropomorphic phantom for treatments of intracranial lesions with the CyberRnife. Eight patients treated using the CyberRnife were selected for this study. Organs at risk and target were delineated on volumetric CT data and treatment planning (Multiplan v.4.5.0) was optimized accordingly, in order to achieve the required prescribed target dose and critical structures sparing for each patient. The final treatment plan was delivered with a CyberRnife VIS (Accuray, Inc., Sunnyvale, CA) operating with a dose rate of 1000 MU/min at a flattening filter free mode and upgraded shielding. We performed our measurements using a male anthropomorphic RANDO phantom (Alderson Research Laboratories, Inc., Stamford, CT). Groups of three TLD 100 were placed anteriorly inside RANDO at a depth of 5 cm at locations corresponding to the thyroid, breast or lung, uterus and inferior abdomen for each treatment plan. The average percentage dose normalized to the prescribed dose for the thyroid gland was 0.92+0.23 % with a max of 1.95%. The maximum reduction of the PD (expressed as percentage of the prescribed dose) was 80% between the thyroid gland and the lower pelvic area. Similarly the PD normalized to the number of MU showed an average of 0.84×10-3 (cGy/MU), with a max of 0.0025 (cGy/MU) for the thyroid gland region. It is evident that the PD is proportional to the number of MU as well as to the prescribed dose. These correlations can be utilized to estimate the PD during intracranial treatments.

Splenic autotransplantation in a patient with human immunodeficiency virus infection: a case report

IntroductionSplenectomy is performed mostly because of traumatic events that cause rupture of the spleen. Postsplenectomy, a patient has a higher risk of developing sepsis. Autotransplantation of splenic tissue decreases the risk of opportunistic infection and sepsis, but its role in patients with human immunodeficiency virus is debated because the spleen is a replication site, especially during the asymptomatic phase of this infection. We present a case of a patient with human immunodeficiency virus infection who was admitted to our hospital for a traumatic rupture of the spleen and underwent spleen autotransplantation.Case presentationA 36-year-old Caucasian man was admitted to the shock trauma center of our hospital after a car accident. Anamnesis showed that the patient had been human immunodeficiency virus-positive for 13 years. A computed tomography scan showed abundant fluid collection in his superior and inferior abdomen caused by splenic rupture, with no other associated intra-abdominal lesions. During surgery, the spleen appeared severely damaged. A splenectomy was performed, and 35 g of splenic tissue was autotransplanted in a pouch created in the omentum. No complications occurred after surgery, and our patient was discharged from our hospital nine days after the operation. One year later, computed tomography and scintigraphy showed that the transplanted tissue was functioning well.ConclusionsAutotransplantation of splenic tissue decreases the risk of opportunistic infection and sepsis, and it might also be useful in patients with human immunodeficiency virus. Other studies need to be done to validate this hypothesis.

Rectus Diastasis Corrected with Absorbable Suture: A Long-Term Evaluation

Correction of rectus diastasis (RD) is performed during most abdominoplasties. This study aimed to evaluate the long-term result of RD correction when the plication of the anterior rectus sheath is performed with an absorbable suture. Abdominoplasty was performed for 12 women who presented with Nahas' type A musculoaponeurotic deformity. The RD was measured preoperatively with two computed tomography (CT) scan slices at two levels: 3 cm above and 2 cm below the umbilicus. The bony levels at which the slices were taken served as a reference for the postoperative CT scans. During the operation, the RD was measured with a ruler at the same levels as the preoperative CT scan slices. The force necessary to bring the medial edge of the rectus muscle to the midline was measured on both levels with a dynamometer. Plication of the anterior rectus sheath was performed using a double-layer 0-PDS (polydioxanone) suture. Postoperative CT scans were performed 3weeks after the operation. A long-term follow-up CT scan was performed 32-48months postoperatively for every patient. The 3-week postoperative CT scan proved that the correction of RD was achieved by the procedure. Despite the fact that there were different abdominal wall resistances and that the average weight gain during this period was 4.5kg, the long-term CT-scans showed no recurrence of RD for any patient of this series in either the superior or inferior abdomen. Plication of the anterior rectus sheath with PDS suture to correct RD seems to be a long-lasting procedure.

A New Extra-Abdominal Channel Alternative to the Mitrofanoff Principle Based on two Lower Abdominal Cutaneous Flaps: Preliminary Clinical Experience

Purpose The appendix is the gold-standard channel for the Mitrofanoff principle in pediatric urology, but the search for alternatives is justified. The aim of this study is to report on technical feasibility and present our preliminary clinical experience with an alternative conduit based on two lower abdominal skin flaps. Material and Methods We configured a tube from two rectangular skin flaps 1x4 cm opposite each other in the middle line of the lower inferior abdomen. The vascular support of the flaps is based on inferior epigastric and circumflex branches in the subcutaneous tissue. The channel was anastomosed to the bladder dome with embedding 3.0 prolene sutures to create a valvular mechanism. None patients required bladder augmentation and surgery was performed entirely extraperitoneally. We used this method sofar in 4 patients with congenital non-neurogenic bladder diseases presenting with residual volumes without compliance deficits. The last patient was a 16 year old boy and he underwent a laser skin follicules ablation regimen before surgery. Results Mean follow-up of the clinical series is 10.4 months. Three patients remained continent up to 4 hours, whereas 1 patient had urinary leakage through the stoma and underwent open revision of the valve mechanism by crossing the rectus abdominal muscle in the midline to create a neosphincter-shape. Conclusions We were able to confirm feasibility of a new extra-abdominal channel based on the Mitrofanoff. Follow-up is still short but initial experience of a totally extraperitonel method is very appealing sofar.

A new extra-abdominal channel alternative to the mitrofanoff principle: experimental and preliminary clinical experience

The appendix is the gold-standard channel for the Mitrofanoff principle in pediatric urology, but the search for alternatives is justified considering it may not be available or preferably used for colonic stomas (Malone antegrade continence enema). The aim of this study is to report on technical feasibility of a new approach for creating catheterizable channels in a rabbit model and to present our preliminary clinical experience. We configured a tube from two rectangular skin flaps 1x4 cm opposite each other in the middle line of the lower inferior abdomen. The channel was anastomosed to the bladder dome with embedding sutures to create a valvular mechanism. The experimental study consisted of 12 rabbits, divided in 4 groups according to the sacrifice schedule at 2, 4, 8 and 12 weeks. At 30th postoperative day, an urodynamic evaluation was performed to record continence of the stoma. A histological analysis of the specimens stained with hematoxylin-eosin, Masson trichrome and Picrosirius red was also done in group 2 (sacrifice at 4 weeks postoperatively). We used this method in 3 patients with congenital non-neurogenic bladder disease presenting with massive residual volumes without compliance deficits. The technique proved feasible in all animals, 9 of 12 could be easily catheterized and underwent urodynamic study. No stoma leakage was observed in 7 animals at high bladder pressures (> 50 cm H20) and only 2 animals had some leakage at 40 cm H20. Urodynamics performed through the stoma showed urethral leakage at 20 cm H20, therefore demonstrating the efficacy of the valvular mechanism. Histological analysis confirmed good integration between the tube and the bladder. Mean follow-up of the clinical series (3 patients) was 7.2 months. Two patients remained continent up to 4 hours, whereas 1 patient had some leakage after 2 hours. We were able to confirm feasibility of a new extra-abdominal channel based on the Mitrofanoff principle and successfully reproduced the method in a clinical setting. Follow-up was short and long term results are required before any conclusive judgment can be made.

Espondilodiscite causada por Candida parapsilosis: relato de caso e revisão da literatura

INTRODUÇÃO: São raras as espondilodiscites fúngicas decorrentes de espécies do gênero Candida, sendo que até 2004 foram descritos menos de 75 casos. RELATO DECASO: Homem, 42 anos, com história de etilismo por 35 anos, foi admitido com quadro de dor em abdome inferior com irradiação para membros inferiores e fraqueza dos mesmos nos últimos 3 meses. Os achados do exame físico foram: atrofia muscular em região glútea, dor à mobilização da articulação coxo-femoral, lombalgia em níveis L4 e L5 e força muscular grau II de parte distal de membros inferiores. O paciente foi internado e introduziu-se empiracamente clindamicina e ciprofloxacina por suspeita de espondilodiscite, confirmada por meio do exame de Ressonância Magnética (RM). Após duas semanas o paciente começou a apresentar quadro de dor à inspiração. A radiografia e a tomografia de tórax mostraram quadro difuso multinodular em pulmão sugestivo de infecção fúngica ou tuberculose de apresentação atípica. A biópsia demonstrou granuloma com necrose central e a cultura Candida albicans. Após 1 mês deantibioticoterapia houve melhora da dor em abdome inferior e membros inferiores porém sem melhora radiológica. Foi então realizada punção aspirativa da massa lombar com cultura positiva para Candida parapsilosis, introduzindo-se Anfoterecina B. Cinco meses após uso contínuo desta droga houve melhora radiológica pulmonar e da coluna lombar, com remissão dos sintomas. DISCUSSÃO: O uso abusivo de álcool constitui um fator de risco para o desenvolvimento de espondilodiscite por espécies do gênero Candida, visto que teoricamente predispõe a ocorrência de infecções sistêmicas por organismos normalmente de baixa virulência. CONCLUSÃO: A espondilodiscite causada por Candida é um evento raro, mas deve ser suspeitada em pacientes com algum tipo de imunosupressão, como o etilismo grave.

Laparoscopic Pyelolithotomy for Calculus Removal in a Pelvic Kidney

When stones develop in pelvic or ectopic kidneys, treatment may be challenging. We report on a patient with a symptomatic stone in a pelvic kidney managed by laparoscopic pyelolithotomy. CASE REPORT A 31-year-old man with a 2.5 cm. symptomatic renal pelvic stone in the right pelvic kidney was referred after 2 UIISUCcessful attempts at extracorporeal shock wave lithotripsy (ESWL*) (fig. 1). Ureteroscopic access to the stone was attempted but proved to be impossible secondary to a narrow and tortuous ureter. Therefore, we decided to attempt stone removal laparoscopically. The patient was placed in the Trendelenburg position and pneumoperitoneum was established in standard fashion via an infraumbilical port. Through separate stab wounds under direct vision 4 trocars were placed over the inferior abdomen. The bowel was first moved superiorly. A considerable amount of peripelvic inflammation as well as a number of aberrant vessels made renal pelvic exposure difficult. After the pelvis was adequately dissected free a 2 cm. pyelotomy was made.