Lower Abdominal Quadrant Research Articles

Incidence of Intra-abdominal Adhesions Following Intraperitoneal Injection of Hemostatic Products in Rabbits.

Definitive management of non-compressible intra-abdominal hemorrhage (NCIAH) currently requires a surgeon and operating room capable of performing damage control surgery. In a wartime scenario or a geographically remote environment, these may not be readily available. In this study, we sought to test the safety of 2 emerging injectable hemostatic agents (CounterFlow and Fast Onset Abdominal Management, or FOAM, poloxamer component) versus normal saline control over a prolonged monitoring duration following administration by a non-surgical provider. The Institutional Animal Care and Use Committee approved all research conducted in this study. We randomized male New Zealand white rabbits into 2 monitoring cohorts of 24 hours and 2 weeks. Each cohort contained 3 treatment groups (n = 4 rabbits/group): CounterFlow, the testable poloxamer component of FOAM, and normal saline control. We injected each treatment intraperitoneally in the left lower abdominal quadrant. Doses were 15 mL/kg for CounterFlow, 6.3 mL/kg for the poloxamer component of FOAM, and 15 mL/kg for normal saline. We conducted all injections under isoflurane anesthesia monitored by trained veterinary staff. Animals were euthanized at each cohort end point, and a veterinary pathologist blinded to treatment type performed necropsy. The primary outcome was incidence of intra-abdominal adhesions at necropsy. Quantitatively, adhesions when present were graded by the veterinary pathologist on a 1 to 4 scale, where "1" represented adhesions involving from 1 to 25% of the examined abdomen, "2" represented from 26 to 50%, "3" represented from 51 to 75%, and "4" represented from 76 to 100%. Qualitatively, adhesions present were graded by degree ("1" = minimal, "2" = mild, "3" = moderate, and "4" = severe) and chronicity ("1" = acute, "2" = subacute, and "3" = chronic). We also drew d-dimer blood values and measured body weights for each animal. Statistical analysis included either repeated measures 2-way ANOVA or a mixed-effects model (in the case of missing data) with Geisser-Greenhouse correction. We adjusted multiple comparisons using Tukey statistical hypothesis tests. In the 2-week cohort, 3 CounterFlow animals showed adhesions judged to be "1" quantitatively. Qualitatively, 2 of these were assessed as "1" for degree of adhesions and the other demonstrated a "2." On the chronicity of adhesions scale, 1 animal demonstrated a "2" and 2 demonstrated a "3." No animals in other groups (FOAM and control) demonstrated adhesions. CounterFlow-treated animals showed a statistically significant rise in d-dimer values in the 24-hour cohort only. In the 2-week cohort, CounterFlow-treated animals showed a decrease in body weight at 24 hours after injection but returned to their baseline (normal) body weights at 7 days. Findings from this study demonstrate that the tested ingredients of FOAM poloxamer component are safe for intraperitoneal injection and hold potential for further study directed toward prehospital non-compressible intra-abdominal hemorrhage management by non-surgical providers. Although CounterFlow produced abdominal adhesions in 3 of 4 rabbits in the 2-week cohort, these were determined to be "minimal" or "mild" in degree.

Diagnostic criteria and case definitions for abdominal angiostrongyliasis: a systematic review from the Brazilian experience.

Although rare, Angiostrongylus costaricensis infection may be a more prevalent etiology of inflammatory bowel disease than ulcerative colitis and Chron's disease in endemic areas in Central and South America. The present study reviewed the occurrence of A. costaricensis in Brazil, its clinical presentation and pathology; and proposed diagnostic criteria and case definitions for abdominal angiostrongyliasis (AA). Southern and southeastern Brazilian regions are the main endemic areas, and AA affects both genders and all age groups. A review of all 23 published reports of 51 Brazilian patients highlighted the following features that were subsequently classified as minor diagnostic criteria: abdominal pain, palpable mass in the right lower abdominal quadrant, history of exposure, ileocecal tumor, and intestinal perforation with wall thickening. Proposed major criteria include right lower quadrant abdominal pain, blood eosinophilia, positive serology (antibody detection), intense eosinophilic infiltration that involves all strata of the intestinal wall, eosinophilic granulomatous reaction, and eosinophilic vasculitis. In addition to the definitions of suspected and possible cases according to increasing strength of evidence of this infection, demonstration of worms/eggs/larvae in tissues or Angiostrongylus DNA in tissues or serum are required for a confirmed diagnosis. The application of the proposed criteria and definitions may improve patient management, epidemiologic surveillance, and identification of new endemic areas.

Contribution of Hypersensitivity to Postureteroscopy Ureteral Stent Pain: Findings From Study to Enhance Understanding of Stent-associated Symptoms

To examine the relationships between preoperative hypersensitivity to pain and central sensitization, and postoperative ureteral stent pain after ureteroscopy (URS) for urinary stones. Adults enrolled in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) underwent quantitative sensory testing (QST) prior to URS and stent placement. Hypersensitivity to mechanical pain was assessed using a pressure algometer. Participants rated their pain intensity to pressure applied to the ipsilateral flank area and lower abdominal quadrant on the side of planned stent placement, and the contralateral forearm (control). Pressure pain thresholds were also assessed. Central sensitization was assessed by applying a pointed stimulator (pinprick) and calculating the temporal summation. Postoperative stent pain intensity and interference were assessed using PROMIS questionnaires. Data were analyzed using repeated-measures mixed-effects linear models. Among the 412 participants, the median age was 54.0years, and 46% were female. Higher preoperative pain ratings to 2 kg and 4 kg mechanical pressure to the ipsilateral flank and abdominal areas were associated with higher postoperative stent pain intensity with the stent in situ. Greater degree of central sensitization preoperatively, manifesting as higher temporal summation, was associated with higher postoperative pain intensity. Factors associated with preoperative hypersensitivity on QST included female sex, presence of chronic pain conditions, widespread pain, and depression. Hypersensitivity to pain and central sensitization preoperatively was associated with postoperative ureteral stent pain, suggesting a physiologic basis for stent symptom variation. QST may identify patients more likely to develop stent pain after URS and could inform selection for preventive and interventional strategies.

Parsimonious clinical prediction model for the diagnosis of complicated appendicitis

ObjectiveTo develop a logistic regression model that combines clinical and radiological parameters for prediction of complicated appendicitis. Methods248 patients with histologically proven uncomplicated (n = 214) and complicated (n = 34) acute appendicitis were analyzed retrospectively. All patients had undergone a presurgical abdominal and/or pelvic computed tomography (CT) scan, assessed by two radiologists. A model using univariate and multivariate logistic regression analyses was developed, and the strength of association between independent predictors and complicated acute appendicitis was evaluated by adjusted odds radio. Clinical parameters were gender, age, anorexia, vomiting, duration of symptoms, right lower abdominal quadrant (RLQ) tenderness, rebound tenderness, body temperature, white blood cell (WBC) count, and neutrophil ratio. Radiological parameters were appendix diameter, appendicolith, caecal wall thickening, mesenteric lymphadenopathy, extraluminal air, abscess, fat stranding, and periappendicular fluid. ResultsFour features (body temperature＞37.2 °C, vomiting, appendicolith, and periappendiceal fluid) were included in the logistic regression model, and yielded an area under the curve (AUC) of 0.87 (95% confidence interval (CI), 0.80–0.93), sensitive of 88%, and specificity of 74%. ConclusionThe logistic regression model makes an accurate and simple prediction of complicated appendicitis possible.

Treatment outcome of appendicitis in Azare

Objectives: Appendicitis is and has remained one of the most common abdominal surgical emergencies the world over. Its procedure and appendectomy is also a very common and regularly done surgical procedure and, thus, a very important disease to describe in totality. Hence, we set out to describe the pattern of presentation and management outcome of this condition in our environment. Materials and Methods: Data were collected retrospectively of all patients with the clinical diagnosis of appendicitis during the study period and analyzed. Results: A total of 62 patients had a clinical diagnosis of appendicitis over the period under review. M: F was 1:1.1. Age ranged from 3 years to 47 years with a mean of 21.50 ± 10.07. All (100%) patients presented with right iliac fossa pain. Other symptoms were anorexia (45.2%), nausea (61.3%), and vomiting (40.3%). All (100%) of patients went on to have an appendectomy. Twelve (19.40%) patients had surgical site infection and 2 (3.20%) developed enterocutaneous fistula. Duration of hospital stay ranged from 1 to 30 days. One patient who had uncontrolled diabetes mellitus died giving a mortality rate of 1.6. Conclusion: Typical clinical features of acute appendicitis were lower abdominal quadrant pain associated with nausea, anorexia, and vomiting. It goes without saying that diagnosis can still be made comfortably on clinical grounds and treatment outcome is generally good.

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Management of Abdominal Gunshot Wounds in Children - Case Report

ABSTRACT Introduction One of the causes of mortality in pediatric population is penetrating abdominal injuries, which can affect several organs. Among all types of abdominal trauma, in gunshot wounds a good prognostic requires prompt diagnosis and treatment. In Romania, there is no specific database on gunshot injuries in the pediatric population, but from various sources, it was found that there are 3 cases (1 case of abdominal injury caused by gunshot in rural area and 2 cases of head and cervical spine injury due to gunshot that took place in urban area). Case presentation A 13-year-old boy is brought to the emergency care unit with a penetrating gunshot wound by ricochet in the left lower abdominal quadrant. Abdominal computed tomography revealed abdominal wall discontinuity in the left iliac fossa with oblique and posterior trajectory and a foreign body in the peritoneal cavity measuring 19/7 mm. Intraoperatory, the projectile was found in the sigmoid colon. Conclusion Penetrating gunshot wounds in pediatric population need adequate investigation and prompt diagnosis despite hemodynamic stability at presentation. Successful management of such a patient depends on the accuracy of the surgical intervention as well as the existence of a multidisciplinary medical team, which helps to prevent significant complications, including death.

Transperitoneal Laparoscopic and Robotic Partial Nephrectomy for Renal Cancer in Patients with Previous Abdominal Surgery: a Single Centre Experience

Patients with previous abdominal surgery are at an increased risk of peritoneal adhesions, which may complicate transperitoneal surgery. The objective of this article is to report single centre experience with transperitoneal laparoscopic and robotic partial nephrectomy for renal cancer in patients with previous abdominal surgery. We evaluated data from 128 patients who underwent laparoscopic or robotic partial nephrectomy from January 2010 to May 2020. Patients were divided into three groups according to the localization of main previous surgery: in the upper contralateral abdominal quadrant, in the upper ipsilateral abdominal quadrant or in the middle line, in lower abdominal quadrants. Each group was divided into two subgroups (laparoscopic/robotic partial nephrectomy). We separately analysed data of indocyanine green-enhanced robotic partial nephrectomy. Our study did not find significant difference in the rate of intraoperative or postoperative complications between any of the groups. The type of partial nephrectomy (robotic or laparoscopic) affected the surgery time, blood loss, and length of stay in hospital, but did not significantly influence the frequency of complications. Partial nephrectomy in group of patients with prior renal surgery led to a higher rate of intraoperative low-grade complications. We did not observe more favourable results for indocyanine green-enhanced robotic partial nephrectomy. The location of previous abdominal surgery does not influence the rate of intraoperative or postoperative complications. The type of partial nephrectomy (robotic or laparoscopic) does not affect the frequency of complications.

PD34-03 PRE-OPERATIVE CENTRAL SENSITIZATION AND HYPERSENSITIVITY TO PAIN IS ASSOCIATED WITH URETERAL STENT PAIN: FINDINGS FROM THE URINARY STONE DISEASE RESEARCH NETWORK (USDRN)

You have accessJournal of UrologyCME1 Apr 2023PD34-03 PRE-OPERATIVE CENTRAL SENSITIZATION AND HYPERSENSITIVITY TO PAIN IS ASSOCIATED WITH URETERAL STENT PAIN: FINDINGS FROM THE URINARY STONE DISEASE RESEARCH NETWORK (USDRN) Henry Lai, Hongqiu Yang, Jonathan Harper, Alana Desai, Gregory Tasian, Rebecca McCune, Ziya Kirkali, Hussein Al-Khalidi, Charles Scales, and Michele Curatolo Henry LaiHenry Lai More articles by this author , Hongqiu YangHongqiu Yang More articles by this author , Jonathan HarperJonathan Harper More articles by this author , Alana DesaiAlana Desai More articles by this author , Gregory TasianGregory Tasian More articles by this author , Rebecca McCuneRebecca McCune More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Hussein Al-KhalidiHussein Al-Khalidi More articles by this author , Charles ScalesCharles Scales More articles by this author , and Michele CuratoloMichele Curatolo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To examine the relationship between pre-operative central sensitization and hypersensitivity to pain, and post-operative stent pain after ureteroscopy (URS) for stones. METHODS: Adult participants enrolled in the USDRN STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) underwent quantitative sensory testing (QST) prior to URS and stent placement. Hypersensitivity to mechanical pain was assessed with pressure algometer. Participants rated their pain intensity (0-100) to 2 kg and 4 kg pressure applied to the flank and lower abdominal quadrant on the side of planned stent, and the contralateral forearm (control). Pressure pain thresholds (PPT) were also assessed. Central sensitization was assessed by applying a pinprick stimulator and calculating temporal summation (TS). Post-operative stent pain was assessed using PROMIS questionnaires for pain intensity and pain interference. Data were analyzed using repeated-measures mixed-effects models. RESULTS: Among the 412 participants with QST data, median age was 54 years, 46% were female. Higher pre-operative pain ratings to mechanical pressure to the ipsilateral flank and abdominal areas were associated with higher stent pain intensity on post-operative days 1, 3, 5, 7-9, and 30 days post-stent removal (p<0.05). Lower pre-operative PPT (i.e. higher mechanical hypersensitivity) was associated with higher post-operative pain intensity (p<0.05). Greater degree of central sensitization pre-operatively (higher TS) was associated with higher post-operative pain intensity (p<0.05). Significant correlations existed between pre-operative QST measures at the ipsilateral flank area and post-operative stent pain intensity (Table). Similar correlations were observed for ipsilateral abdominal area but not consistently for the forearm control site (data not shown). CONCLUSIONS: We have identified a physiological risk factor associated with stent pain. Preoperative central sensitization and hypersensitivity to pain were associated with post-operative stent pain. QST is a potential tool to identify patients likely to experience post-URS stent pain, which may facilitate early identification for mitigation, counseling, and management options. Source of Funding: NIH/NIDDK © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e920 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Lai More articles by this author Hongqiu Yang More articles by this author Jonathan Harper More articles by this author Alana Desai More articles by this author Gregory Tasian More articles by this author Rebecca McCune More articles by this author Ziya Kirkali More articles by this author Hussein Al-Khalidi More articles by this author Charles Scales More articles by this author Michele Curatolo More articles by this author Expand All Advertisement PDF downloadLoading ...

Double Adnexal Twist

PE with pain on the left lower abdominal quadrant, vaginal bimanual examination with Chandelier's sign positive. Blood work with Lymphocytosis of > 14,000 cells/microL, D-dimer by ELISA testing was 1,500 ng/mL. Laparoscopic surgery was performed (Figure 1), showing double left adnexal torsion (Figure 2). The evidence of necrotic tissue was visualized (Figure 3), and a left salpingo-oophorectomy was performed. The patient's recovery was unremarkable, without any complicated issues.

Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition.

Retroperitoneal sarcomas (RPSs) located in the lower abdominal quadrants involving iliac vessels are difficult to manage. This study introduced a 5-step method for en bloc resection with graft interposition using the abdominoinguinal approach and evaluated its efficacy and safety. Data of 24 consecutive patients who met the inclusion criteria from 272 patients with RPS who underwent surgical treatment between April 2015 and April 2022 were retrospectively collected and analyzed. The patients underwent left- or right-sided abdominoinguinal incision. In all patients, the abdominoinguinal approach provided good exposure, and complete resection was achieved. Iliac artery+vein, vein, and artery resection and replacement by graft were performed in 70.8%, 25.0%, and 4.2% of patients, respectively. Additional resected organs mainly included the colon, ureter, bladder, kidney, and abdominal wall. The median number of organs resected was 5. In 37.5% of patients, reconstruction of the lower abdominal wall and inguinal ligament was performed using a mesh. Venous graft thrombosis occurred in 21.7% of patients, while no patient had pulmonary embolism or arterial occlusion. Major complications occurred in 20.8% of patients, and no 30-day mortality was observed. The estimated 5-year local recurrence and distant metastasis rates were 54.4% and 22.1%, respectively, with a median recurrence-free survival of 27 months. En bloc resection of RPS involving iliac vessels with graft interposition using the abdominoinguinal approach is feasible and advantageous. Good complete resection rate and safety can be achieved. The long-term survival benefit of this surgical approach should be verified by further large-scale prospective controlled studies.

Epiploic appendagitis

Paediatric abdominal pain continues to pose a diagnostic challenge in the acute hospital care setting. We describe an eleven-year-old boy who presented to the emergency department with acute-onset, sharp abdominal pain localised to right lower quadrant. Abdominal imaging was diagnostic for epiploic appendagitis (EA), with pathognomonic 'ring sign' and 'central dot' visualised on the axial computed tomography images. He responded well to conservative treatment, including a short course of non-steroidal anti-inflammatory drugs. EA is a lesser-known paediatric entity mimicking surgical conditions. However, steady but sharp and non-migratory characteristic of the pain in either of the lower abdominal quadrants should raise suspicion for EA. Early accurate diagnosis can prevent unnecessary surgical exploration in these patients.

An Underrated Diagnosis of Superior Mesenteric Artery Syndrome: A Case Report.

Superior mesenteric artery syndrome (Wilkie’s syndrome) is a rare cause of intestinal obstruction caused by a congenital or acquired reduction of the aorto-mesenteric angle leading to duodenal compression. We present the case of a 51-year-old female patient with a previous history of breast cancer. She was admitted to the Emergency Department with acute onset of recurrent vomiting, intense abdominal pain especially in the epigastric region, and abdominal distension. The ultrasound showed an absence of lower abdominal quadrants with an enlarged and distended stomach reaching the pelvis. The computer tomography scans confirmed the diagnosis of superior mesenteric artery syndrome. Conservative management was implemented, and using a nasogastric tube, and upped endoscopy approximately 4000 mL of fluid were aspirated with clinical improvement shortly after. The patient resumed a high-calorie diet and five months later, the patient was completely asymptomatic.

CLINICAL AND ETIOLOGICAL PROFILE OF MALIGNANT ASCITES WITH SPECIAL REFERENCE TO SAAG CRITERIA AND BIOLOGICAL MARKERS

Objective: The aim and objective of the study are to the analysis of the various patterns of malignant ascites (MA) in our setup. Methods: This prospective observational study was conducted from November 2008 to August 2010 in the Postgraduate Department of General Medicine, S.C.B. Medical College, Cuttack. Diagnosed patients with ascites due to malignancy (intra-abdominal or extra-abdominal) were enrolled into the study. A thorough history and clinical examination were recorded. Patients underwent abdominal paracentesis in the first 24 h after the admission. Ascitic fluid was obtained from the left lower abdominal quadrant and samples were sent for biochemical, cytological, and microbiological analysis. Results: Among 62 patients, male predominance was 71% and mean age of presentation was 55±20.5 years. Histopathological study revealed malignant cells in 32 cases in their ascitic fluid and was classified as MA or peritoneal carcinomatosis. In 30 patients, the ascitic fluid was negative for malignant cells and was classified as malignant-related ascites (MRA). The most common cancers causing MA were gastric (62.5%) followed by ovarian (25%). The most frequently associated cancers in MRA were hepatobiliary (53.3%) and ovarian (13.3%) cancers. Biomarkers were positive in total 32 cases. All 32 patients with carcinomatous peritonitis demonstrated a low (&lt;1.1 mg/dL) serum ascites-albumin gradient (SAAG) and all 30 patients with MRA had high SAAG (&gt;1.1 mg/dL). Conclusion: The incidence of MA was 51.61% and MRA was 48.39%, and highest incidence was seen in the elderly males. SAAG was diagnostic in differentiating MA from MRA with an accuracy of 100%.

Mucocele of the appendix: what to expect.

Mucoceles of the appendix are rare and can have quite variable imaging and clinical presentations, sometimes mimicking an adnexal mass. The underlying cause can be neoplastic or non-neoplastic. The typical imaging appearance of a mucocele of the appendix is that of a cystic structure with a tubular morphology. This structure is defined by having a blind-ending and being contiguous with the cecum. Radiologists should be familiar with key anatomical landmarks and with the various imaging features of mucoceles of the appendix, in order to provide a meaningful differential diagnosis of a lesion in the right lower abdominal quadrant. In addition, a neoplastic mucocele can rupture, resulting in pseudomyxoma peritonei, which will change the prognosis dramatically. Therefore, prompt diagnostic imaging is crucial.

Ascending Aortoiliac Bypass for One-Stage Repair of Adult Aortic Coarctation With Concomitant Cardiac Lesions.

To evaluate the efficacy and safety of ascending aortoiliac bypass surgery for one-stage repair of adult coarctation of the aorta (CoA) and concomitant cardiac disease. From March 2012 to October 2018, 51 consecutive CoA patients were treated with ascending aorta to bilateral iliac artery bypass concomitant with and cardiac surgerical procedures performed for a variety of reasons. A Y-shaped graft was used for the bypass procedure. We evaluated early outcomes, including postoperative death, systolic blood pressure and differences between upper and lower limb blood pressure. The average age was 41years and 64.7% of patients were men. Simultaneous cardiac procedures included aortic valve replacement, ventricular septal defect repair, Bentall procedures and Wheat procedures. No deaths occurred in the early postoperative period. Three patients had delayed healing at the site of the abdominal lower quadrant incisions. The average systolic pressure in the upper limb and the average difference between the upper- and lower-limb blood pressure decreased significantly after surgery (162.7 ± 13.4mmHg vs 128.4 ± 6.7mmHg, P = .000; 69.6 ± 15.6mmHg vs 8.7 ± 7.6mmHg, P = .000, respectively); The systolic blood pressure in the lower limb increased after bypass surgery (93.1 ± 6.2mmHg vs 119.6 ± 7.7mmHg, P = .000). The follow-up rate was 100%, with an average follow-up time of 61months. Six patients (11.8%) had graft stenosis or occlusion. Three patients (5.9%) underwent endovascular embolectomy. In our small series, ascending aortoiliac bypass for one-stage repair of CoA with concomitant cardiac lesions appears safe and efficacious in effectively reduceing differences between upper and lower limb systolic blood pressure. Further study with larger sample size and longer follow-up is needed.

Single-incision laparoscopic repair for an arcuate line hernia: a case report

BackgroundThe arcuate line is the inferior margin of the posterior layer of rectus abdominis sheath. An arcuate line hernia is a parietal interstitial hernia consisting of ascending protrusion of intraperitoneal contents above the arcuate line. Arcuate line hernias are rare, and fewer than 20 cases undergoing surgical repair have been reported. Various surgical approaches were used in previous cases, and there is no consensus regarding the ideal repair method. We report the first case of an arcuate line hernia repaired using single-incision laparoscopic surgery.Case presentationThe patient was a 78-year-old man who presented with a history of intermittent lower abdominal quadrant pain of more than 2 month’s duration. He had not previously undergone abdominal surgery, but had a history of mycobacterial lung disease and asthma. His vital signs were normal on presentation, and he experienced no vomiting or nausea. On palpation, his abdomen was flat and soft, and no mass was palpable. However, there was slight tenderness in the right lower quadrant. Blood laboratory test results were within normal ranges. Computed tomography revealed small bowel protrusion between the rectus abdominis and the posterior rectus sheath, and an arcuate line hernia was suspected and subsequently confirmed intraoperatively. The patient underwent single-incision laparoscopic repair with the intraperitoneal onlay mesh technique with tacks and with care to avoid the inferior epigastric vessels. The operation time was 30 min, and no intra- or post-operative complications occurred. Surgery relieved his symptoms, with no recurrence within 1 year postoperatively.ConclusionsSingle-incision laparoscopic surgery was performed easily and successfully in this rare patient with arcuate line hernia. Arcuate line hernia should be considered in patients presenting with abdominal symptoms, and single-incision laparoscopic repair should be considered for repair.

Congenital Spigelian hernia in a neonate associated with several anomalies: A case report

Background: Spigelian hernia (SH) is a rare entity characterized by a defect of the anterior abdominal wall located along the Spigelian line, it may be congenital or acquired.Association with other anomalies is worth reporting. Case Presentation: A 22-day-old male newborn was admitted with strangulated right inguinal hernia and operated on emergently. Clinical examination also revealed a Spigelian hernia in the left lower abdominal quadrant with bilateral cryptorchidism, associated with polydactyly of the small right finger and anal stenosis. At surgery, the SH contained a part of the small intestine and the ipsilateral undescended testis. Conclusion: Pediatric SH is rare, but its association with undescended ipsilateral testis is frequent. Other abnormalities can be concomitant to this association.

Enteroclysis in gastrointestinal tuberculosis: an overview.

42-year-old female, working on a cow farm, without known comorbidities, complained of intermittent bowel movements (2 stools/day) lasting over 8 weeks, weight loss (6 kg), enduring low-grade fever, recurrent dry cough, asthenia and occasionally pain in the right lower abdominal quadrant [...]

Short-term clinical and oncological outcomes after single-incision plus one-port laparoscopic surgery for rectosigmoid cancer: a retrospective clinical analysis of 30 cases.

ObjectiveTo evaluate the safety and feasibility of single-incision laparoscopic surgery+1 (SILS+1) radical resection of sigmoid and upper rectal cancer.MethodsThe clinical data of 30 consecutive patients with sigmoid and upper rectal cancer who underwent SILS+1 radical resection between October 2018 and January 2020 in our hospital were retrospectively analyzed. An initial 5-cm periumbilical transverse incision was made. Then, a multiport device was placed in the umbilical incision. Two 10-mm ports were used for laparoscope insertion, and the other two ports were used for laparoscope device insertion. A 12-mm trocar was placed in the right lower abdominal quadrant under laparoscopic view and served as the surgeon’s dominant operating channel.ResultsAll operations were performed successfully without conversion to conventional laparoscopic surgery or open operation. Three patients developed postoperative complications: one patient developed ileus, one developed postoperative bleeding, and one developed wound infection. There were no perioperative deaths.ConclusionsThe safety and feasibility of SILS+1 radical resection of sigmoid and upper rectal cancer was established by experienced surgeons in our study. However, further studies are needed to demonstrate the advantages of this procedure compared with the benefits of conventional laparoscopic surgery.