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AJR. American Journal of Roentgenology Dec 2017The objective of our study was to retrospectively determine the anatomic distribution of chest wall ectopic gas resembling pneumoperitoneum (i.e.,...
OBJECTIVE
The objective of our study was to retrospectively determine the anatomic distribution of chest wall ectopic gas resembling pneumoperitoneum (i.e., pseudopneumoperitoneum) and its relationship with trauma mechanisms and clinical outcomes using CT.
MATERIALS AND METHODS
Investigators from two separate trauma referral centers screened 492 chest, abdomen, and pelvis CT examinations of patients who had sustained any form of trauma between 2010 and 2015. After excluding 186 patients with recognized causes of ectopic gas, 306 patients (211 men and 95 women; mean age, 44.5 years; range, 6-95 years) remained for analysis by two radiology residents in center 1 and a radiology resident in center 2. Positive cases were reviewed by all investigators, including an experienced fellowship-trained abdominal radiologist. The anatomic location of the pseudopneumoperitoneum, injury severity score, trauma velocity (high speed vs low or unknown speed), trauma mechanism, clinical findings on follow-up, and exploratory laparotomy data were collected for patients with pseudopneumoperitoneum. Two hundred consecutive nontrauma CT examinations from 2015 were selected as control cases by a resident in center 1. The t test and chi-square test were used for determining associations.
RESULTS
Pseudopneumoperitoneum was identified in 5.2% of patients, occurring bilaterally adjacent to the lower six costochondral junctions, and was significantly more common with high-velocity trauma than with low-velocity trauma (p = 0.010). None of the patients with pseudopneumoperitoneum had evidence of perforated hollow viscus at surgery (n = 2) or on clinical follow-up (n = 14). No patients had unnecessary surgery due to pseudopneumoperitoneum.
CONCLUSION
Pseudopneumoperitoneum is a posttraumatic phenomenon centered near the lower six costochondral junctions. Recognizing these findings may help prevent unnecessary laparotomy in the trauma setting.
Topics: Abdominal Injuries; Adolescent; Adult; Aged; Aged, 80 and over; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pneumoperitoneum; Retrospective Studies; Thoracic Wall; Tomography, X-Ray Computed; Trauma Centers; Wounds, Nonpenetrating
PubMed: 29023149
DOI: 10.2214/AJR.17.17851 -
Journal of Medicine and Life Jun 2022Elements that comprise the inferior hypogastric plexus are difficult to expose, intricate, and highly variable and can easily be damaged during local surgical...
Elements that comprise the inferior hypogastric plexus are difficult to expose, intricate, and highly variable and can easily be damaged during local surgical procedures. We aimed to highlight, through dissection, the origin, formation, and distribution of the hypogastric nervous structures and follow them in the female pelvis. We performed detailed dissections on 7 female formalin-fixed cadavers, focusing on structures surrounding the pelvic organs. For each hemipelvis, we removed the peritoneum from the pelvic floor, and after we identified the hypogastric nerves, we continued our dissection towards the inferior hypogastric plexuses, following the branches of the latter. Laterorectally, the hypogastric nerves form the inferior hypogastric plexus, a variable structure - nervous lamina, neuronal network (more frequently), or sometimes a combination of them. We identified three components of the inferior hypogastric plexus. The anterior bundle travels towards the base of the urinary bladder, the middle part innervates the uterus and the vagina, and the posterior segment provides the innervation of the rectum. The plexus can be identified after removing the pelvic peritoneum and the subperitoneal adipose tissue. Intraoperatively, the structures can be preserved by using an immediately-subperitoneal dissection plane. The variable branches are relatively well-organized around the pelvic vessels, supplying the urinary bladder, the genital organs, and the rectum. The ureter is surrounded by some branches, especially in its last segment, and it also receives innervation directly from the hypogastric nerve. Close to the viscera, the nerves enter neurovascular plexuses, making the intraoperative separation of the nerves and the vessels virtually impossible.
Topics: Female; Humans; Hypogastric Plexus; Pelvis; Peritoneum; Uterus; Vagina
PubMed: 35928357
DOI: 10.25122/jml-2022-0145 -
Abdominal Radiology (New York) Jul 2020Chronic pelvic pain is an important but underrecognized cause of morbidity in men. While there is abundant literature discussing female pelvic pain and the diagnostic... (Review)
Review
Chronic pelvic pain is an important but underrecognized cause of morbidity in men. While there is abundant literature discussing female pelvic pain and the diagnostic role of imaging, much less attention has been given to imaging of non-gynecologic causes of chronic pelvic pain. Chronic pelvic pain in men can be a challenge to diagnose as pain may arise from visceral, musculoskeletal, or neurovascular pathology. Imaging of the pelvic viscera has been covered in detail elsewhere in this edition and therefore will not be reviewed here. We will focus upon topics less familiar to the abdominal radiologist, including imaging of pelvic floor, musculoskeletal, and neurovascular pathology.
Topics: Abdomen; Diagnostic Imaging; Female; Humans; Male; Pelvic Floor; Pelvic Pain
PubMed: 31834458
DOI: 10.1007/s00261-019-02353-0 -
Radiographics : a Review Publication of... 2017Abdominal and pelvic hernias may be indolent and detected incidentally, manifest acutely with pain and distress, or cause chronic discomfort. Physical examination... (Review)
Review
Abdominal and pelvic hernias may be indolent and detected incidentally, manifest acutely with pain and distress, or cause chronic discomfort. Physical examination findings are often ambiguous and insufficient for optimal triage. Therefore, accurate anatomic delineation and identification of complications are critical for effective treatment planning. Imaging, particularly computed tomography, provides a vital understanding of the hernia's location and size, involved viscera, and severity of associated complications. Reader familiarity with the imaging appearances and anatomic landmarks of hernias is important for correct diagnosis, which may impact preoperative planning and reduce morbidity. This article reviews the appearance of anatomic structures in the abdominal wall and pelvis that are important for diagnosing common and uncommon abdominal and pelvic hernias, and it highlights key imaging features that are helpful for differentiating hernias, mimics, and their complications. Online DICOM image stacks are available for this article . RSNA, 2017.
Topics: Anatomic Landmarks; Diagnosis, Differential; Hernia; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Ultrasonography
PubMed: 29131768
DOI: 10.1148/rg.2017170070 -
Zhonghua Wai Ke Za Zhi [Chinese Journal... Jul 2020Pelvic fascia is considered to be one controversial human anatomic structure. According to the characteristics of specialized surgery, colorectal surgeons, gynecologic... (Review)
Review
Pelvic fascia is considered to be one controversial human anatomic structure. According to the characteristics of specialized surgery, colorectal surgeons, gynecologic surgeons and urologic surgeons respectively marked the pelvic fascia, but the naming is not unified. For some specific anatomic structures (such as pelvic plexus), different scholars have different descriptions of their positions. The lack of standard anatomic terms makes it difficult to understand the corresponding anatomic structures, and also hinders the communication between disciplines. Combined with autopsy research, surgical observation and literature review, we discussed the common puzzles of pelvic clinical anatomy. The main points of this article are as follows. (1) Urogenital fascia and vesicohypogastric fascia are the components of visceral fascia. (2) The visceral fascia and fascia propria of rectum are two separate layers. (3) The pelvic plexus is located on the outside of the confluence of visceral fascia and Denonvilliers' fascia. (4) To understand the pelvic lateral ligament from the perspective of layers. (5) To understand pelvic fascia from a holistic perspective.
Topics: Autopsy; Fascia; Female; Humans; Hypogastric Plexus; Pelvis; Peritoneum; Rectum; Urinary Bladder; Urogenital System; Viscera
PubMed: 32610425
DOI: 10.3760/cma.j.cn112139-20191224-00636 -
Radiographics : a Review Publication of... 2020Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate. The diagnosis of AMI is challenging because patient symptoms and laboratory... (Review)
Review
Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate. The diagnosis of AMI is challenging because patient symptoms and laboratory test results are often nonspecific. A high degree of clinical and radiologic suspicion is required for accurate and timely diagnosis. CT angiography of the abdomen and pelvis is the first-line imaging test for suspected AMI and should be expedited. A systematic "inside-out" approach to interpreting CT angiographic images, beginning with the bowel lumen and proceeding outward to the bowel wall, mesentery, vasculature, and extraintestinal viscera, provides radiologists with a practical framework to improve detection and synthesis of imaging findings. The subtypes of AMI are arterial and venoocclusive disease, nonocclusive ischemia, and strangulating bowel obstruction; each may demonstrate specific imaging findings. Chronic mesenteric ischemia is more insidious at onset and almost always secondary to atherosclerosis. Potential pitfalls in the diagnosis of AMI include mistaking pneumatosis as a sign that is specific for AMI and not an imaging finding, misinterpretation of adynamic ileus as a benign finding, and pseudopneumatosis. Several enterocolitides can mimic AMI at CT angiography, such as inflammatory bowel disease, infections, angioedema, and radiation-induced enterocolitis. Awareness of pitfalls, conditions that mimic AMI, and potential distinguishing clinical and imaging features can assist radiologists in making an early and accurate diagnosis of AMI. RSNA, 2020.
Topics: Computed Tomography Angiography; Diagnosis, Differential; Humans; Mesenteric Ischemia
PubMed: 32125953
DOI: 10.1148/rg.2020190122 -
Clinics and Practice Dec 2023The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe... (Review)
Review
The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.
PubMed: 38248429
DOI: 10.3390/clinpract14010005