Intra-abdominal Volume Research Articles

A huge duplication cyst of the ileum.

SummaryBackground:Massive unilocular intraabdominal cysts in children are rare. Alimentary tract duplications can present diagnostic and therapeutic difficulties. Although they can occur anywhere from the mouth to the anus, they are commonly seen in relation to the ileum. We herein present an unusual case of duplication cyst itself occupying virtually all of the available intraabdominal volume. It appeared to be an enteric duplication cyst of ileal origin.Case Report:A 3-month-old girl was admitted to our hospital for investigation of progressive abdominal distension and biliary vomiting. Plain radiography of the abdomen showed normal air-fluid level in the stomach and paucity of gases in rest of the abdomen. Magnetic resonance imaging showed a huge, homogenous cyst extending from the xiphisternum down to the pelvis. The cyst was excised completely. Macroscopic examination and histologic findings confirmed the diagnosis of a huge enteric duplication cyst arising from the ileum.Conclusions:Enteric duplication cyst should be considered in a patient with an abdominal cystic mass. Radiologist must take into account patient age, clinical parameters, and imaging findings to identify the likely etiology of a cystic mass.

Effect of intra-abdominal volume increment on lungs in hemorrhagic shock

Intra-abdominal hypertension (IAH) causes lung dysfunction in patients after hemorrhagic shock resuscitation. We performed intra-abdominal volume increment (IAVI) to IAH and studied its effect on pulmonary function. Eight minipigs established for IAH model by exsanquination until shock, incomplete blockage of portal vein and overload resuscitation were randomly divided into IAVI group (n=4) and sham-operated control group (n=4). Bladder pressure, arterial blood gas analysis and thoraco-abdominal computed tomography (CT) scans were measured. The minipigs were sacrificed 26 h after surgery, and lung samples were harvested for measuring the wet-to-dry weight ratio and hematoxylin-eosin staining. Compared with sham-operated control group, the respiratory rate and paCO2 remarkably decreased and paO2 notably increased at 8 and 12 h in the IAVI group. The bladder pressure also notably decreased at 8, 12, and 22 h after IAVI treatment. However, a significant improvement in diaphragm height was observed at 22 h after IAVI treatment. The wet-to-dry weight ratio of the lungs in IAVI group was also significantly higher than that that in the sham-operated control group. Our data indicate that IAVI surgery could improve the damaged pulmonary function caused by IAH after hemorrhagic shock resuscitation (Tab. 1, Fig. 7, Ref. 21).

Fistules du dorsum nasal de l’enfant : à propos de six cas

This review will describe the definitions on intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). In order to understand these definitions the reader must be aware of the interactions between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV), explaining why dramatic IAP increases can be observed in some patients related to anthropomorphic measurements, body positioning, use of positive pressure ventilation, or relatively small accumulations of fluid or blood. The adverse effects related to increased IAP have been named IAH for moderate cases and ACS for advanced cases. In order to improve clinical communication as well as evaluation of the scientific literature, the World Society for the Abdominal Compartment Syndrome (WSACS) has published its first guidelines and definitions in 2006. The definitions and guidelines have recently been revised according to evidence based medicine and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This review will be based on the revised guidelines. The standard method to measure IAP is via the bladder and as experience with IAP measurement has evolved considerably, a number of tips and potential pitfalls are listed.

Effect of intra-abdominal volume increment on heart for the treatment of intra-abdominal hypertension after hemorrhagic shock resuscitation in minipigs

Objective To observe the effect of intra-abdominal volume increment (IAVI) on heart functions with intra-abdominal hypertension (IAH).Methods The models of hemorrhagic shock and incomplete blockage of portal vein in 8 healthy adult minipigs were successfully established and randomly divided into two groups:the IAVI treatment group (n =4 ) and the sham-operated group ( n =4). Heart rate,mean aortic pressure (MAP),fractional shortening (FS),ejection fraction (EF) and wet-to-dry ratio of heart were detected and hematoxylin-eosin staining was done. Results As compared with before shock,the heart rate at 2 h after IAH was increased ( 154 beats/min vs 123 beats/min,P ＜0.05 ),and MAP [110.0mm Hg(1 mmHg=0.133kPa) vs.127.5 mm Hg,P＜0.05],FS (29.8％ vs.40.4％,P ＜0.05) and EF (55.5％ vs.72.0％,P ＜0.05) were decreased.At 2 h after IAH,in the IAVI treatment group 8 h and 12 h after surgery,the heart rate (124 beats/min vs.156 beats/min; 120 beats/min vs.156 beats/min) was decreased as compared with sham-operated group.As compared with 2 h after IAH,in the IAVI treatment group 22 h after surgery,EF (66.9％ vs.55.5％,P ＜0.05) was increased.Conclusion Intra-abdominal volume increment can achieve a notable improvement of heart rate and EF in this model. Key words: Hemorrhagic shock; Resuscitation; Intra-abdominal hypertension; Intra-abdominal volume increment; Heart function; Minipig

Usefulness of Speckle Tracking Imaging to Assess Myocardial Contractility in Intra-Abdominal Hypertension: Study in a Mini-Pig Model

This study evaluated the usefulness of speckle tracking imaging (STI) in assessment of myocardial contractility in intra-abdominal hypertension experimentally induced in mini-pigs. To this effect, 12 mini-pigs were anesthetized with intravenous injection of 3 % sodium pentobarbital, hemorrhaged to reach the shock status, and resuscitated with excessive volume of lactated Ringer's solution. The animals were either sham-operated (study group 1) or underwent treatment with intra-abdominal volume increment (study group 2). Observations were made prior to induction of shock, 1 h after shock, 2 h after induction of intra-abdominal hypertension, and 8 and 12 h after treatment. The heart rate and mean artery pressure were conventionally measured. STI was used to assess radial and circumferential strains of segmental ventricular wall. The results obtained demonstrated that myocardial contractility, as manifested by radial and circumferential strains of different ventricular wall segments, was decreased after induction of intra-abdominal hypertension. Treatment with intra-abdominal volume increment was able to decrease heart rate and intra-bladder pressure (indicator of effectiveness of treatment) and significantly improved myocardial contractility of involved ventricular wall segments. In conclusion, STI is a useful method to assess myocardial regional functions.

Description of a novel approach for intraperitoneal drug delivery and the related device

Two significant limitations of intraperitoneal drug therapy are limited drug distribution and poor penetration into peritoneal nodules. A possible solution is the application of the so-called "therapeutic pneumoperitoneum," taking advantage of the gaseous nature and the pressure of capnoperitoneum during laparoscopy. Our objective was to develop a device able to apply such therapeutic pneumoperitoneum. The technology presented here is a spraying device and can be introduced through a trocar. It is driven by mechanical pressure and consists of an injector, a line, and a nozzle. An in vivo experimental study was performed in five pigs. A transvaginal cholecystectomy was performed. At the end of the procedure, a standard dose of methylene blue was sprayed/infused into the abdominal cavity for 30 min (4 test animals w/therapeutic pneumoperitoneum (12 mmHg CO(2)) and 1 control animal w/conventional lavage (2 l intra-abdominal volume with extracorporeal circulation)). At the end of the procedure, all animals were autopsied and the peritoneum was analyzed. Outcome criteria were: (1) drug distribution (as assessed by the stained peritoneal surface at autopsy), and (2) diffusion into the peritoneum (presence or not of macroscopic staining of the outer aspect of the peritoneum immediately after surgery). Stained peritoneal surface was larger after aerosol application compared with peritoneal lavage, and staining more intense. Hidden peritoneal surfaces and the anterior abdominal wall were stained only in the aerosol group. In contrast to peritoneal lavage, the outer aspect of peritoneal membrane was immediately stained after pressurized spraying. This device and the related approach significantly improve both distribution and penetration of a test substance into the peritoneal cavity in a large animal model. This might be a significant progress in treating intraperitoneal disease, in particular peritoneal carcinomatosis.

Observations on the Study of Second Gas Effects

Observations on the Study of Second Gas Effects

Relation between trunk fat volume and reduction of total lung capacity in obese men

Reduction in total lung capacity (TLC) in obese men is associated with restricted expansion of the thoracic cavity at full inflation. We hypothesized that thoracic expansion was reduced by the load imposed by increased total trunk fat volume or its distribution. Using MRI, we measured internal and subcutaneous trunk fat and total abdominal and thoracic volumes at full inflation in 14 obese men [mean age: 52.4 yr, body mass index (BMI): 38.8 (range: 36-44) kg/m(2)] and 7 control men [mean age: 50.1 yr, BMI: 25.0 (range: 22-27.5) kg/m(2)]. TLC was measured by multibreath helium dilution and was restricted (<80% of the predicted value) in six obese men (the OR subgroup). All measurements were made with subjects in the supine position. Mean total trunk fat volume was 16.65 (range: 12.6-21.8) liters in obese men and 6.98 (range: 3.0-10.8) liters in control men. Anthropometry and mean total trunk fat volumes were similar in OR men and obese men without restriction (the ON subgroup). Mean total intraabdominal volume was 9.41 liters in OR men and 11.15 liters in ON men. In obese men, reduced thoracic expansion at full inflation and restriction of TLC were not inversely related to a large volume of 1) intra-abdominal or total abdominal fat, 2) subcutaneous fat volume around the thorax, or 3) total trunk fat volume. In addition, trunk fat volumes in obese men were not inversely related to gas volume or estimated intrathoracic volume at supine functional residual capacity. In conclusion, this study failed to support the hypotheses that restriction of TLC or impaired expansion of the thorax at full inflation in middle-aged obese men was simply a consequence of a large abdominal volume or total trunk fat volume or its distribution.

Abdomino-Phrenic Dyssynergia in Patients With Abdominal Bloating and Distension

The abdomen normally accommodates intra-abdominal volume increments. Patients complaining of abdominal distension exhibit abnormal accommodation of colonic gas loads (defective contraction and excessive protrusion of the anterior wall). However, abdominal imaging demonstrated diaphragmatic descent during spontaneous episodes of bloating in patients with functional gut disorders. We aimed to establish the role of the diaphragm in abdominal distension. In 20 patients complaining of abdominal bloating and 15 healthy subjects, we increased the volume of the abdominal cavity with a colonic gas load, while measuring abdominal girth and electromyographic activity of the anterior abdominal muscles and of the diaphragm. In healthy subjects, the colonic gas load increased girth, relaxed the diaphragm, and increased anterior wall tone. With the same gas load, patients developed significantly more abdominal distension; this was associated with paradoxical contraction of the diaphragm and relaxation of the internal oblique muscle. In this experimental provocation model, abnormal accommodation of the diaphragm is involved in abdominal distension.

Application of intra-abdominal volume increment in abdominal surgery

Intra-abdominal volume increment is a new abdominal surgery, which is used to prevent the abdominal compartment syndrome caused by intra-abdominal hypertension.In this article, the author emphasizes the concept, indications,operative principles of intra-abdominal volume increment. Firstly,laparotomy was performed, active bleeding and source of infection were controlled. Then greater omentum was put under the incision, vacuseal dressings were apphed on the greater omentum,and the abdominal incision was sutured. If the intra-abdominal pressure was less than 12 mm Hg (1 mm Hg=0. 133 kPa) for 48 hours during 7-14 days after operation, abdominal incision could be closed, while if the intra-abdominal pressure was more than 12 mm Hg, dermatoplasty was used to close abdominal incision to form a ventral hernia, then definitive abdominal wall reconstruction was performed 6 months after operation. Key words: Abdominal compartment syndrome; Intra-abdominal hypertension; Intra-abdominal volume increment

The Impact of Scoliosis Among Patients with Giant Paraesophageal Hernia

BackgroundKyphoscoliosis is seen in approximately 1.4–15% of the octogenarian population of the US. We hypothesized that patients with kyphoscoliosis are affected with a reduced intra-abdominal volume and progressive laxity of the diaphragmatic hiatal sling musculature leading to an increased risk of hiatal hernia formation and progression over time. MethodsWe retrospectively reviewed the clinical history and roentgenographic data of 320 paraesophageal hernia patients from 2003 to 2007. The prevalence of kyphoscoliosis among this patient cohort and the outcomes of surgical management were compared to paraesophageal hernia patients without kyphoscoliosis. ResultsNinety-three of the 320 patients (29.1%) were found to have significant K/S (mean age 74; 83% female). Laparoscopic repair of paraesophageal hernia with fundoplication was performed in 91% of these patients. There was one death (1.1%; aspiration pneumonia) and 17.2% major postoperative morbidity. Mean length of hospital stay was 8 days (median = 4; range 2–71). Prolonged stays were related mainly to marginal pulmonary status. Kyphoscoliosis was associated with increased peri-operative pulmonary morbidity (16.1%) compared to patients without kyphoscoliosis (7.0%, p = 0.02). ConclusionKyphoscoliosis may contribute to the development and progression of paraesophageal hernias. Surgeons approaching paraesophageal hernia repair should be aware of the increased pulmonary morbidity and the postoperative care required in managing these patients.

Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation?

Prone ventilation (PV) is a ventilatory strategy that frequently improves oxygenation and lung mechanics in critical illness, yet does not consistently improve survival. While the exact physiologic mechanisms related to these benefits remain unproven, one major theoretical mechanism relates to reducing the abdominal encroachment upon the lungs. Concurrent to this experience is increasing recognition of the ubiquitous role of intra-abdominal hypertension (IAH) in critical illness, of the relationship between IAH and intra-abdominal volume or thus the compliance of the abdominal wall, and of the potential difference in the abdominal influences between the extrapulmonary and pulmonary forms of acute respiratory distress syndrome. The present paper reviews reported data concerning intra-abdominal pressure (IAP) in association with the use of PV to explore the potential influence of IAH. While early authors stressed the importance of gravitationally unloading the abdominal cavity to unencumber the lung bases, this admonition has not been consistently acknowledged when PV has been utilized. Basic data required to understand the role of IAP/IAH in the physiology of PV have generally not been collected and/or reported. No randomized controlled trials or meta-analyses considered IAH in design or outcome. While the act of proning itself has a variable reported effect on IAP, abundant clinical and laboratory data confirm that the thoracoabdominal cavities are intimately linked and that IAH is consistently transmitted across the diaphragm - although the transmission ratio is variable and is possibly related to the compliance of the abdominal wall. Any proning-related intervention that secondarily influences IAP/IAH is likely to greatly influence respiratory mechanics and outcomes. Further study of the role of IAP/IAH in the physiology and outcomes of PV in hypoxemic respiratory failure is thus required. Theories relating inter-relations between prone positioning and the abdominal condition are presented to aid in designing these studies.

Prospective Measurements of Intra-Abdominal Volume and Pulmonary Function After Repair of Massive Ventral Hernias With the Components Separation Technique

To assess the effect of components separation on abdominal volume and pulmonary function after repair of hernias with loss of domain. Immediate postoperative abdominal compartment syndrome is a feared complication after hernia repair in patients with a "loss of abdominal domain." Replacement of the viscera within an unyielding stiff abdominal wall may compromise the perfusion of the intestines, elevate the diaphragm, and interfere with ventilation. The components separation technique, used to repair these massive hernias, employs bilateral relaxing incisions in the external oblique muscle and fascia to approximate the rectus abdominis muscles in the midline. Nineteen consecutive patients with large ventral hernias were enrolled. Intra-abdominal volumes were prospectively measured before and after hernia repair, using computer analysis of abdominal CT scans. Pulmonary function tests were similarly obtained before and after surgery. Statistical analysis was performed using paired student's t test. This study was registered at clinicaltrials.gov (ID# NCT00894582). Nine women and 10 men ages 24 to 76 with an average BMI of 30 kg/m had an average hernia size of 915 mL. Intra-abdominal volume increased significantly after separation of parts hernia repair from an average of 7640 to 8166 mL (P=0.01). Diaphragm height did not change significantly (37.1 cm to 37.5 cm, P=0.42). Intraoperative peak airway pressures remained within normal limits for all patients. Pulmonary function testing revealed no significant differences before and after surgery. The components separation repair technique acts to restore lost abdominal domain by increasing its volume, and can be performed on patients with large ventral hernias with acceptable outcomes and without measurable changes in pulmonary function.

Preliminary results on the validation of a novel method for measuring intra-abdominal pressure and gastric residual volume

This study will look at the validation of a novel method combining measurement of gastric residual volume (GRV) and estimation of intra-abdominal pressure (IAP) via intragastric pressure (IGP).

Einfluss einer Volumenzunahme auf den intraabdominellen Druck

The aim of this review is to summarize the physiological and pathological aspects of the relationship between volume and intra-abdominal pressure (IAP). A capillary leak following trauma or inflammation can induce a volume shift into the abdomen. An increase of the IAP depends on the abdominal compliance, which is reduced by increases in intra-abdominal volume and pressure as well as by an upright body position and obesity. A pathological increase of IAP (>12 mmHg) depends on the amount and type of resuscitation volume and is known to cause increased morbidity und mortality. Colloids or hypertensive solutions can reduce IAP however, current data are still insufficient. Therapeutic options are IAP monitoring and decompression.

Repair of Massive Ventral Hernias with the Separation of Parts Technique: Reversal of the ‘Lost Domain’

Massive ventral hernia repairs are sometimes complicated by the "loss of domain". The separation of parts hernia repair reverses the loss of domain by increasing intra-abdominal volume, but not by elevating the hemidiaphragms into the thoracic cavity. Hernia repair in patients with a "loss of abdominal domain" is thought to be associated with postoperative pulmonary difficulties. A retrospective chart review was performed on 102 patients treated by a single surgeon. The 10 patients with matching preoperative and postoperative abdominal CT scans were computer-analyzed for intra-abdominal volume changes and diaphragm height measurements. Postoperative pulmonary complications in these 102 patients were recorded. Intra-abdominal volume increased after separation of parts hernia repair from 8600 +/- 2800 mL to 9700 +/- 2700 mL (P = 0.01). Diaphragm height did not statistically change. Two of the 102 patients had prolonged intubations, and seven other patients were ventilated briefly. The separation of parts technique is able to close large ventral hernias without a high incidence of pulmonary complications as a result of its ability to expand the abdominal domain without a change in diaphragmatic height.

Intra-Abdominal Pressure Development After Different Temporary Abdominal Closure Techniques in a Porcine Model

Decompressive laparotomy followed by temporary abdominal closure (TAC) is an established prophylaxis and treatment for abdominal compartment syndrome. The herein presented study aimed at the comparison of volume reserve capacity and development of intra-abdominal hypertension after forced primary abdominal closure and different TAC techniques in a porcine model. Eight anesthesized and mechanically ventilated domestic pigs underwent a standardized midline laparotomy. A bag was placed into the abdominal cavity. Before abdominal closure, the bag was prefilled with 3,000 mL water to simulate increased intra-abdominal volume. The intra-abdominal pressure (IAP) was then increased in 2 mm Hg steps up to 30 mm Hg by adding volume (volume reserve capacity) to the intra-abdominal bag. Volume reserve capacity with the corresponding IAP were analyzed and compared for primary abdominal closure, bag silo closure, a zipper system, and vacuum-assisted closure (VAC) with different negative pressures (-50, -100, and -150 mm Hg). Hemodynamic and pulmonary parameters were monitored throughout the experiment. Volume reserve capacity was the highest for bag silo closure followed by the zipper system and VAC with primary abdominal closure providing the least volume reserve capacity in the whole IAP range. Of interest, VAC -50 mm Hg resulted in a lower volume reserve capacity when compared with VAC -100 and -150 mm Hg. Pulmonary and hemodynamic parameters demonstrated no significant differences between primary abdominal closure and the evaluated TAC techniques at all IAP levels. The present experimental in vivo study indicates that bag silo closure and zipper systems may be favorable TAC techniques after decompressive laparotomy. In contrast, the VAC techniques resulted in lower volume reserve capacity and therefore may bear an increased risk for recurrent intra-abdominal hypertension in the initial phase after decompressive laparotomy.

Abdominal Distention Results From Caudo-ventral Redistribution of Contents

Abdominal bloating is a frequent symptom in various categories of patients; however, its origin is unclear. Our aim was to establish the mechanisms of abdominal bloating. The study evaluated 56 patients whose predominant symptom was abdominal bloating. Of these, 47 (44 female and 3 male; aged 19-74 years) were diagnosed with functional intestinal disorder by Rome II criteria and 9 (7 female and 2 male; aged 18-64 years) were diagnosed with intestinal dysmotility by gastrointestinal manometry. Computed tomographic scans were obtained before (basal level) and during a severe bloating episode. Control scans were also obtained from 12 healthy subjects (11 female and 1 male; aged 19-62 years). Morpho-volumetric differences between basal and severe bloating scans were measured using an original computer analysis program. During severe bloating, patients with dysmotility exhibited anterior wall protrusion (23 +/- 4 mm; P < .001 vs basal) associated with a marked increase in total abdominal volume (1.4 +/- 0.3 L; P = .002 vs basal) and with cephalic displacement of the diaphragm. By contrast, in patients with functional intestinal disorder, total abdominal volume barely increased (0.3 +/- 0.1 L; P < .001 vs dysmotility); in these patients, abdominal distention (14 +/- 2 mm anterior wall protrusion; P < .001 vs basal) was related to diaphragmatic descent (-12 +/- 3 mm; R = -0.62; P < .001). Abdominal distention might be caused by an increase in intra-abdominal volume or abdomino-phrenic displacement and ventro-caudal redistribution of contents.

Challenges of giant ventral hernia repair in children in an African tertiary care center with limited resources

The objective of this study is to report the challenges and outcome of giant ventral abdominal hernia repair in infants/children in a tertiary care center in Africa. A retrospective analysis of infants/children who had a repair of giant ventral abdominal hernia between January 1998 and December 2007 at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was carried out. A total of 41 children aged between 9 months and 12 years (mean 2.6 +/- 1.8 years) comprising 25 males and 16 females with a male:female ratio of 1.6:1 had a repair of giant ventral abdominal hernias which were due to healed omphalocele in 37 (90.3%), incisional hernia in three (7.3%), and following initial skin closure of gastroschisis in one (2.4%). They had an average hernia defect of size 7.1 x 8.3 cm, which contained both solid and hollow viscera in all of the patients, along with 11 (29.7%) syndromic omphalocele. The major challenge was inadequate intraabdominal volume needed to accommodate the herniated viscera in nine children, which was compounded by the nonavailability of silastic materials, a pediatric ventilator, facilities required for intraabdominal pressure monitoring during closure, as well as undiagnosed associated cardiac anomaly. Overall, 39 (95.1%) children survived, while two (4.9%) mortalities were recorded due to postoperative aspiration in one child and cardiopulmonary failure in the other. Of those who survived, 29 (74.4%) had a smooth postoperative course, while ten (25.6%) had morbidity, with a mean hospitalization duration of 10 +/- 2.5 days. There was no recurrence recorded on follow-up for 5 years at the surgical outpatient clinic. Despite the challenges, better results were achieved with repairs in infants/children compared to repairs performed in neonates.

Abdominal Accommodation: A Coordinated Adaptation of the Abdominal Wall to Its Content

We previously showed that colonic gas infusion increases the girth and modifies the muscular activity of the anterior abdominal wall. We hypothesized that abdominal accommodation to volume loads is an active process instrumented by the coordinated activity of the anterior wall and the diaphragm. To increase intraabdominal volume in healthy subjects, a gas was infused into the colon (1.44 L in 1 h) while measuring girth (by tape measure) and electromyography (EMG) activity of the anterior wall (via four pairs of surface electrodes) and the diaphragm (via six ring electrodes over an esophageal tube in the hiatus). After preliminary feasibility studies (N = 12), postural activity (N = 6) and responses to colonic gas loads, both with the trunk erect (N = 8) and in supine position (N = 8), were studied. A morphometric analysis was performed by computed tomography, image analysis (N = 8). In the erect position, anterior wall tone was higher and diaphragmatic tone was lower than in the supine position. With the trunk erect, gas infusion induced diaphragmatic relaxation (by 21 +/- 3%; P < 0.05) and anterior wall contraction (16 +/- 4% EMG increment; P < 0.05). By contrast, in the supine position, it induced diaphragmatic contraction (15 +/- 6%, P < 0.05), while the anterior wall, in the absence of postural tone, showed no change (3 +/- 2%, NS). Gas infusion was associated with girth increase (7.3 +/- 1.0 mm with the trunk erect and 8.6 +/- 1.4 mm in the supine position) and diaphragmatic ascent (17.6 +/- 5.2 mm; P < 0.05). The degree of abdominal distension produced by intraabdominal volume increments results from posture-related abdomino-phrenic muscular responses.