Layer Of Peritoneum Research Articles

Clinical analysis of 244 cases with abdominal wall endometriosis

Objective: To investigate the clinical characteristics, diagnosis, treatment, outcomes and prognostic factors of abdominal wall endometriosis (AWE). Methods: A total of 265 AWE patients who underwent surgical treatment in The First Affiliated Hospital of Anhui Medical University from January 2010 to April 2023 were retrospectively selected, and 244 patients had complete follow-up data. According to different depth of lesions, the enrolled patients were divided into three types: type Ⅰ (subcutaneous fat layer, n=30), type Ⅱ (anterior sheath muscle layer, n=174) and type Ⅲ (peritoneum layer, n=40). The general clinical features, perioperative conditions, recurrent outcome and prognostic factors were analyzed in three types. Results: (1) Compared with type Ⅲ patients, the age of onset, parity and incidence of pelvic endometriosis were significantly decreased in type Ⅱ patients [(32.0±4.0) vs (30.0±4.6) years, 1.6±0.6 vs 1.4±0.5, 10.0% (4/40) vs 1.7% (3/174), respectively; all P<0.05], while the proportion of patients with transverse incision was significantly increased [37.5% (15/40) vs 67.3% (115/171); P<0.01]. The first symptoms of type Ⅰ and type Ⅱ were mainly palpable mass in the abdominal wall [73.3% (22/30), 63.2% (110/174), respectively], but the first symptom of type Ⅲ was pain in the abdominal wall [55.0% (22/40); all P<0.05]. (2) No matter the results of preoperative B-ultrasound or intraoperative exploration, the lesion diameters of type Ⅰ, type Ⅱ and type Ⅲ showed significant upward trends (all P<0.05). The proportions of lesion diameter≥3 cm in type Ⅱ and type Ⅲ [67.8% (118/174), 80.0% (32/40)] were significantly higher than that in type Ⅰ (all P<0.05). The median operation time and blood loss of type Ⅰ and Ⅱ were significantly lower than those of type Ⅲ (type Ⅰ vs type Ⅲ: 37.5 vs 50.0 minutes, 10 vs 20 ml, all P<0.05; type Ⅱ vs type Ⅲ: 35.0 vs 50.0 minutes, 10 vs 20 ml, all P<0.05). (3) The median follow-up time was 49 months, the overall symptom remission rate was 98.4% (240/244), and the recurrence rate was 7.0% (17/244). There were no significant differences in recurrence rate and recurrence free time among three types (all P>0.05). Multivariate regression analysis showed that the depth, number, diameter of lesions and postoperative adjuvant medication were not significant factors for postoperative recurrence (all P>0.05). Conclusions: The clinical manifestations of type Ⅲ are the most serious, including obvious abdominal pain symptoms, larger lesion diameter, prolonged operation time, increased intraoperative blood loss and increased incidence of pelvic endometriosis. Complete resection of lesions is an effective treatment for AWE, with high symptom remission rate and low recurrence rate. The depth, number, diameter of lesions and postoperative adjuvant medication are not risk factors for recurrence.

A case of omphalocele associated with teratoma in a new born baby: a very rare case report

An omphalocele is a congenital midline abdominal wall defect at the level of the umbilical cord insertion into the fetal abdomen that results in herniation of intra-abdominal contents into a sac comprising of an outer layer of amnion and an inner layer of peritoneum. The most common eviscerated contents are liver and small intestine though virtually any organ can be seen within the omphalocele sac including colon, pancreas, spleen, omentum, stomach, heart or genitalia. We report an unusual case of omphalocele associated with mature teratoma in Tripura medical college and DR. BRAM teaching hospital. Only five cases of teratoma arising in a case of omphalocele are reported in the literature reviewed.

Analysis of ascitic fluid in differentiating transudate versus exudate - in a tertiary care centre

Introduction: Ascites is the accumulation of fluid within the peritoneal cavity. Normally, 5-20ml of peritoneal fluid is found between the layers of peritoneum, acting as a lubricant and reducing the friction of organ movement during digestion and bodily movements. The use of serum ascites albumin gradient has out dated the total protein measurement in differentiating transudate from exudate fluid. Analysis is done in two broad spectrums: (1) Biochemical analysis (2) Clinical pathology and Cytological analysis Aim & Objectives: This study was done with the objective to evaluate the ascitic fluid analysis for differentiating transudate versus exudate and also the characteristics of the peritoneal fluid in various causes of ascites. Materials and Methods: In this study, 100 patients of ascites were evaluated for ascitic fluid total protein (AFTP) and Serum Albumin Ascitic Gradient (SAAG) along with ultrasound and other required investigations. Ascitic fluid was obtained by Paracentesis, an invasive sampling procedure to remove fluid or air from the peritoneal cavity for diagnostic or therapeutic purposes. The fluid obtained is sent for analysis. Ascitic fluid analysis is a group of tests used to diagnose the etiology of fluid accumulation. Result: Study shows that ascites due to various aetiology is common among 31-50 years of age group with a slight male predominance. The present study suggests that transudative ascites are more common than exudative ascites with a percentage of 52%. Conclusion: Serum Albumin Ascitic Gradient (SAAG) is much more superior to ascitic fluid total protein (AFTP) in the differential diagnosis of Ascites. Ascitic fluid analysis helps in diagnosing the aetiology of ascites based on the cytological and biochemical parameters. The common aetiology for ascites reported in India is liver cirrhosis. The development of ascites in cirrhotic patients is associated with a mortality of 15% and 44% at one-year and five-year follow-up periods, respecti

Effects of Acupuncture Stimulation of Different Layers of "Tianshu" (ST 25) Region on Changes of Intra-colonic Pressure in Normal Rats

To observe the effect of manual acupuncture stimulation of different layers (skin, muscle, peritoneum, sub-peritoneum) of "Tianshu" (ST 25) region on proximal colonic pressure in normal rats. Forty-eight male SD rats were divided into 6 groups: all layer-needling, brushing, cutaneous needling, muscular needling, peritoneum-needling and sub-peritoneum-needling groups (n＝8 in each group). Manual needling or brushing was applied to "Tianshu" (ST 25) region. The colonic internal pressure was measured by using an amplifier and a pressure transducer-connected balloon which was implanted into the colonic cavity about 6 cm from the ileocecal valve. For rats of the all-layer needling group, an acupuncture needle was inserted into ST 25 about 1 cm deep and rotated for a while, for rats of the brushing group, a Chinese calligraphy brush pen was used to brush the skin hair for 1 min. For rats of the rest 4 groups, an acupuncture needle was inserted into the skin, muscle layer after cutting open the skin (about 0.1 cm), the peritoneum layer after cutting open the skin and muscle layers, and the sub-peritoneum layer after cutting open the skin, muscle and peritoneum layers, respectively, and rotated using the uniform reinforcing-reducing technique for about 1 min at a frequency of 120 twirlings per minute every time. During manual needling stimulation of the full layers, cutaneous layer, muscle layer, peritoneum layer and the sub-peritoneum layer of bilateral "Tianshu" (ST 25), the internal pressure of proximal colon was significantly decreased relevant to pre-stimulation in each group (P<0.05), and there were no significant differences between bilateral sides needling stimulation in the decreased pressure levels (P>0.05). During hair brushing of ST 25 region, the colonic pressure was observably increased relevant to pre-needling stimulation (P<0.05). One min after the acupuncture stimulation, the decreased pressures maintained in needling the all-layer on the left side, needling the skin on the right side, needling the peritoneum layer on both sides, and needling the sub-peritoneum layer on both sides relevant to the brushing group of the same side (P<0.05). Manual acupuncture stimulation of each layer tissue of ST 25 on both sides may lower internal pressure of proximal colon in normal rats, suggesting their involvement of acupuncture effect in relaxing proximal colonic contraction.

Evidence of disseminated infection by Mycobacterium avium subspecies hominissuis in a pet ferret (Mustela putorius furo)

The infection caused by the zoonotic opportunistic pathogen Mycobacterium avium subsp. hominissuis (Mah) was reported for the first time in a pet ferret. Both owners were HIV-positive. Euthanasia of the pet was recommended due to medical reasons and as a preventive action. Disseminated and open tuberculosis lesions were observed in the gastrointestinal and respiratory systems of the ferret. Ecographic and radiographic surveys showed a severe generalized lymphadenopathy, strong thickening of the gastric wall and peritoneum layer. The histopathological findings revealed a disseminated, granulomatous, chronic inflammation affecting the gastrointestinal tract, lungs, lymphoid tissues (spleen, tonsils and lymph nodes) and liver. Ziehl-Neelsen staining displayed the presence of positive acid-fast bacilli within these granulomas. Bacteriology and sequencing of the isolates yielded Mah sequevar code 3. Ferrets can act as reservoirs of mycobacteria exposing their owners to the infection, which is of major concern in immunodeficient individuals, as those HIV-infected.

Panniculitis of the Mesentery

The mesentery is the double layer of peritoneum that suspends the small intestine (jejunum and ileum) from the posterior wall of the abdomen. The superior mesenteric artery and its branches, accompanying veins, lymphatic, lymph nodes, the autonomic nerve plexuses, with a larger amount of connective tissue and varying amounts of fat tissue around the root of the mesentery, are located between two layers of peritoneum. Mesenteric panniculitis is a benign disorder that characterised by fat necrosis, chronic inflammation, and fibrosis. Although the aetiology is not clear, it is associated with many diseases, such as previous abdominal surgery, and malignancies. Mesenteric panniculitis may be asymptomatic or accompanied by symptoms such as abdominal pain, abdominal distention, palpable mass, and fever. Laboratory tests are non-specific in diagnosis. Although diagnosis of the disease is usually with ultrasound and abdominal CT is definitive, diagnosis is made by histopathological examination. Usually, symptomatic treatments are administered in mesenteric panniculitis; however, immunosuppressive agents or steroids have also been reported to be effective. In this study, we report three cases admitted to the emergency room with abdominal pain and diagnosed as mesenteric panniculitis, to draw attention to the cause of this rare abdominal pain.

Hepatobiliary and Pancreatic: Falciform ligament necrosis

The falciform (sickle-shaped) ligament is one of five ligaments that connect the liver to the under-surface of the diaphragm and to the anterior abdominal wall. It passes in an antero-posterior plane and is the embryonic remnant of the ligamentum teres and the para-umbilical veins wrapped within two layers of peritoneum. It may contain a variable amount of extra-peritoneal fat and represents a potential space. In infants, falciform ligament inflammation or necrosis can occur as a complication of omphalitis. In adults, a falciform ligament abscess is a rare complication of instrumentation during laparoscopic surgery. The ligament can also become canalized in patients with portal hypertension creating engorged veins which radiate from the umbilicus (caput medusae). Another rare complication is inflammation of the falciform ligament associated with acute cholecystitis. In the patient illustrated below, abdominal pain appeared to be caused by necrosis of the falciform ligament, perhaps related to mild cholecystitis or ischemia. A male, aged 88, was transferred to our hospital with a 2-week history of increasing pain in the right upper quadrant of his abdomen. On arrival, he was noted to be febrile (37.8°C) and hypotensive and required admission to an Intensive Care Unit. Blood tests revealed an elevated white cell count (24x10/l) and C-reactive protein (179 mg/l) and minor changes in liver function tests. An abdominal computed tomography (CT) scan showed dilated intrahepatic ducts and a thickened gallbladder wall with multiple stones (Figure 1). Endoscopic sphincterotomy was performed at the time of endoscopic retrograde cholangiopancreatography but only two very small stones were removed from the bile duct. Although his blood tests appeared to improve, he continued to have pain in the right upper quadrant with clinical features of localized peritonitis. Magnetic resonance cholangiopancreatography (MRCP) confirmed effective decompression of the biliary system but a fluid tract with subacute hemorrhage was seen extending from the portahepatis to the anterior abdomen (Figure 2). Review of the initial CT scan identified a fluid collection with no interval change in size compared to MRCP (Figure 1, arrow). At laparotomy, the falciform ligament was found to be necrotic with possible involvement of the posterior rectus sheath. The falciform ligament was excised and a cholecystectomy was performed although the gallbladder did not appear to be inflamed. Histology of the falciform ligament showed large areas of hemorrhagic necrosis with no evidence of abscess formation. Unfortunately, he died 7 days after surgery because of pulmonary complications.

Significance of using nephridia in the taxonomy of family Enchytraeidae

A survey of the structure and variety of the nephridia in the subclass Oligochaeta is presented. The most diversified forms are discernible in the families of Megadrile earthworms Two main types can be differentiated: holonephridia and meronephridia. Both types can be exonephric when they penetrate the body-wall and open to the exterior. However, in the meronephridia, the ducts can open also into the intestine; in this case, it is called enteronephric. The nephridia in the family of Enchytraeidae are holo-exonephric; namely, they always have a ciliated funnel connected to a coiled duct much folded and embedded in a compact elongated body covered by a layer of peritoneum and through an efferent duct open to the exterior in the next segment. The shape of this organ, the structure and the ratio of pre- and post-septale parts, and the origin of the efferent duct can be generic or specific in character. The number of nephridia in pre-clitellar segments may contribute to identification of the species, but our knowledge on these characteristics is insufficient; therefore, it would be very useful to record these traits in all species descriptions.

301. Safe and Effective Treatment of Ovarian Cancer Models Using Targeted Adenovirus Vector Delivery and Selective Expression of Tumor Necrosis Factor

Ovarian cancer is the fourth most common cancer among women, and despite advances in therapy most patients still die as a consequence of disease that is disseminated within the peritoneal cavity. Delivery of hTNFa gene to tumors using direct intra-tumoral injection of a non-replicating adenovector is a promising strategy for treatment for a variety of diseases. The relative abundance of the coxsackie and adenovirus receptor (CAR) in the mesothelial lining of the peritoneal space and paucity of CAR in tumors may limit on the use of un-targeted adenovectors administered to the peritoneal cavity. To enhance selectivity of TNFa exposure to the tumor we combined two approaches. We modified adneovector capsids to limit transduction of normal cells. We analyzed the ability of Ad5 based vectors in which the fiber and penton base binding interactions were deleted. To allow tumor uptake we incorporated a RGD-4C motif in the fiber knob (Ad|[ast]||[ast]|RGD) to target |[alpha]|v|[beta]|3/5 integrins receptors that are highly expressed in tumor and sparsely expressed in the epithelial layer of peritoneum. Ad|[ast]||[ast]|RGD vector exhibits effective gene transfer in a variety of ovarian cancer cell lines that we examined in vitro and in vivo. Importantly, the Ad|[ast]||[ast]|RGD vector has a capability to target ovarian tumor nodules and avoid infecting the normal mesothelial cells that line the intraperitoneal space of athymic nude mice following intraperitoneal (ip) administration. We have now added an additional level of control by placing the TNFa expression under the control of tumor selective promoters. These promoters were incorporated into the capsid-modified vector to confer the expression of human tumor necrosis factor alpha (hTNFa) therapeutic gene. We compared both constitutive (CMV or RSV) and tumor selective promoters (DF3, E2F or hTERT) for safety and efficacy in human ovarian cancer models. Vector containing capsid targeting combined with the DF3 promoter expression control was shown to reduce tumor burden in the human ovarian cancer models (Caov3 and Igrov1) following ip administration. The DF3 vector was well tolerated with no evidence of body weight changes, and limited exposure to systemic TNFa at the effective dose (1.2e11 pu/20g). Together, our data support a strategy of combining receptor targeting combined with expression control of TNFa as a potential gene delivery mechanism for ovarian cancer treatment.

Untersuchungen zur Mitreaktion der Pleura bei peritonealen Reizungen

Intraperitoneal injection of phytohemagglutinin in rats resulted in ascites and hydrothorax with a high content of hyaluronic acid. Cell proliferation was increased 48–72 h after PHA application in the mesothelial layer of peritoneum and pleura. It is suggested that intraperitoneally injected PHA stimulates mesothelial cell proliferation and is transported via lymphatic vessels to the pleural cavity.

Further experiences with the roentgenology of the paracolonic gutter: differentiation between free fluid and localization within the serosa.

In earlier papers (l, 2), we discussed the roentgenologic findings of the lateral paracolonic gutter in the normal state and in those conditions characterized by thickened colonic wall or by free fluid within the peritoneal cavity (Fig. 1). The present paper relates further experiences with these findings. The muscular part of the wall of the colon is often visualized as a fine stripe of water density contrasted by gaseous density within the lumen and by fatty density of the combined mass of serosal and retroperitoneal lipid. Occasionally, especially in the obese subject, the two layers of peritoneum are visualized separating the serosal and retroperitoneal components (2). Thickening of the water-density component of the colonic “wall” usually means either thickened wall (1) or normal wall plus peritoneal fluid (2). The following observations show that roentgenologic thickening of the water density component of the colonic “wall” can indicate still another combination, heretofore unreported: a normal colonic wall plus serosal infiltration from retroperitoneal bleeding. Case Reports Case I. Retroperitoneal hemorrhage; differential from free blood not made roentgenologically: A. L., a 16-year-old white male, was hit by an automobile shortly before admission. He had tenderness and fullness in the right groin. Roentgenologically, the thickening of the soft-tissue band between the descending colon and the retroperitoneal fat suggested free fluid in the left paracolonic gutter (Fig. 2). At surgery, retroperitoneal hemorrhage around the bladder and up lateral gutters into the lateral mesentery of the large bowel was found. The spleen was normal and there was no free blood. Case II. Retroperitoneal hemorrhage; differential from free blood not made roentgenologically: Shortly before admission, L. W., a 13-year-old white male, fell from a tree, striking his abdomen on the rim of a garbage can. The left upper quadrant was tender. The urine contained gross blood, and the clinical impression was that the patient was suffering from severe renal contusion. The roentgenologic impression was that there was free fluid from the ruptured spleen or, less likely, retroperitoneal bleeding dissecting up the serosa of the descending colon (Fig. 3). At surgery, the spleen was normal, and no free peritoneal blood was present. A massive retroperitoneal hematoma arose from a fractured left kidney, which was then removed. Case III. Retroperitoneal hemorrhage differentiated from free blood roentgenologically by a technic using gravity: W. C., a 3-year-old white female, was hit by an automobile shortly before admission. She had extensive bruises on the left side of the back, but no marked abdominal tenderness. During the first twenty-four hours, the hemoglobin dropped from 10.7 to 8.8 g per 100 cc.

Internal hernia of embryological origin.

AbstractAn anatomical specimen is described in which a considerable part of the small bowel had, apparently, in its return to the abdomen during fetal development invaginated the descending mesocolon and that of the left half of the transverse colon, thus producing a large internal hernia. The ascending branch of the left colic artery and the inferior mesenteric vein were in the neck of the sac, anterior to the loops of bowel entering and emerging from the sac. These relationships were obscured by the fact that there was a broad adhesive band extending from the mesentery of the free loops of small intestine to the descending colon, thus bridging over the vessels. The relationships referred to and as shown in the drawings, which include a cross‐sectional view, would indicate that the mechanism of production of the hernia was as suggested and that there were in fact four layers of peritoneum in the anterior wall of the sac.

The Mobility of the Antrum, Pylorus, Duodenum, and Gall Bladder in Health and Disease: the Influence of Mobility in the Functioning of These Organs in the Biliary Tract

IN order to discuss this subject intelligently, it is necessary to give a detailed description of the method of suspension of the organs of the upper right quadrant which permits their mobility, and also, why mobility is necessary for the proper functioning of these organs. The peculiar method of their suspension also explains why these organs can assume such varied locations in the abdomen. It is a matter of everyday observation by roentgenologists and surgeons that the location of the stomach, pylorus, cap, and gall bladder varies with different types of habitus. In the sthenic types, the organs lie high and the gall bladder some distance from the midline; in the asthenic types, the organs lie low and the gall bladder nearer the midline. The gall bladder is attached to the liver and partakes of its mobility. Gray's “Anatomy” states: “The position of the pylorus in the erect living body of the male varies from 14.5 cm. above to 8 cm. below and in the female from 15 cm. above to 2.5 cm. below the interiliac line. The range of position in regard to the sagittal axis of the erect body varies in males from 8.8 cm. to the right to 2 cm. to the left of the axis. In 84 per cent it is to the right of the axis. In females the position ranges from 6 cm. to the right to 2.6 cm. to the left of the sagittal axis. In 89.5 per cent it is to the right. The most common position in both males and females is from 2.5 cm. to 5 cm. to the right.” The first portion of the duodenum or cap is covered by peritoneum and, consequently, is freely movable. It begins at the pylorus and ends at the neck of the gall bladder. Gray's “Anatomy” states: “It is in such close relation to the gall bladder that it is usually found stained by bile after death, especially on its anterior surface.” The stomach is covered with peritoneum anteriorly and posteriorly, thus allowing complete mobility. It is continuous with the esophagus at its upper extremity, and has a fairly rigid attachment at this point. From here, the stomach is suspended to the diaphragm and liver by the lesser omentum. Gray's “Anatomy” describes this attachment as follows: “The lesser omentum (or gastrohepatic omentum) is the duplicature which extends to the liver from the lesser curvature of the stomach and the commencement of the duodenum. It is extremely thin, and is continuous with two layers of peritoneum which cover, respectively, the antero-superior and postero-inferior surfaces of the stomach and first part of the duodenum. When these two layers reach the lesser curvature of the stomach and the upper border of the duodenum, they join together and ascend as a double fold to the porta of the liver; to the left of the porta the fold is attached to the bottom of the fossa for the ductus venosus, along which it is carried to the diaphragm, where the two layers separate to embrace the end of the esophagus.

Diaphragmatic Hernia, Non-Traumatic

THE definition of diaphragmatic hernia requires the protrusion of abdominal viscera through a congenital or acquired opening in the diaphragm into the thorax. A true hernia requires the presence of a sac composed of a layer of peritoneum within and a layer of pleura without. A false hernia has no hernial sac, the abdominal viscera lying free within the thoracic cavity. These visceral protrusions occur either when there is deficient development with congenital weakness of the muscular layer of the diaphragm, and a weak spot exists through which the abdominal contents can force themselves, or when any one of the existing foramina is congenitally wide or at some time later in life becomes so. Diaphragmatic hernia has been recognized for many years. Stehelinus, in 1724, reported a case in which postmortem examination showed that the stomach had passed through the diaphragm into the thorax. However, a cross-reference to the writings of Clauder, in 1661, seemed to indicate that he had preceded Stehelinus in the...

The relation between chronic irritation of peritoneal mesothelium and the formation of adhesions

During a systematic investigation of the normal and pathological reactions of the peritoneal mesothelium, certain rather surprising facts have been revealed which are interesting because of their bearing on the question of adhesions. Elsewhere experiments have been reported in which rats received repeated injections of solutions of glucose, the mesothelium undergoing certain changes of a morphological character which were not followed by adhesions. It seemed important to determine to what extent such changes could be produced without sufficient injury occuring to cause the development of adhesions. Such experiments have been carried out by the repeated introduction into the peritoneal cavity of various types of mild irritants, the best results having been obtained with laked heterogenous blood. Cats were given injections of 10 to 20 c.c. of laked rabbit's blood made isotonic with NaC1, the dose being repeated twice weekly over a period of 3 to 6 months. In such animals when the procedures were carefully guarded to prevent undue injury on puncture of the abdominal wall, and precautions taken to avoid any septic involvement, there resulted very remarkable changes in the entire mesothelial membrane without the formation of a single adhesion. The peritoneum on section was often made up of two or three layers of cuboidal or columnar cells, attaining at times a thickness of 20 micra, and yet such a peritoneal lining seemed entirely adequate to prevent the formation of adhesions. From such observations the conclusion seems wholly justified that the presence of a complete layer of peritoneal lining cells, no matter how much their morphological appearance may be altered by such irritations as those used, is entirely sufficient to prevent the adherance of the two layers of peritoneum and thus prevent adhesions.

OPERATION FOR THE SHORTENING OF THE BROAD LIGAMENTS.

The material underlying this study was as follows: Forty adults and a larger number of pelves of newborn infants were dissected. Microscopic sections were made in various planes of the broad ligaments. Serial sections were made of these structures in fetuses of from three to six months, and also of pelvis of younger embryos. The whole clinical study is based on 46 cases operated on in the past four years. Works on anatomy are in accord in describing the broad ligament as formed of two layers of peritoneum. It is described in a recent work by my distinguished teacher, Waldeyer, 1 in a general way as composed of two serous layers, between which are vessels and nerves, many smooth muscle fibers and more or less connective tissue. This generally accepted opinion becomes questionable when it is considered that the peritoneum, strictly speaking, can be dissected from the pelvis complete, except