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Journal of Medical Case Reports May 2024Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic... (Review)
Review
BACKGROUND
Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not.
CASE PRESENTATION
We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful.
CONCLUSION
Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.
Topics: Adult; Female; Humans; Abdominal Pain; Pelvic Pain; Spleen; Splenectomy; Tomography, X-Ray Computed; Wandering Spleen
PubMed: 38790071
DOI: 10.1186/s13256-024-04580-6 -
Seminars in Ultrasound, CT, and MR Dec 2015Ventral body wall defects (VBWDs) are one of the main categories of human congenital malformations, representing a wide and heterogeneous group of defects sharing a... (Review)
Review
Ventral body wall defects (VBWDs) are one of the main categories of human congenital malformations, representing a wide and heterogeneous group of defects sharing a common feature, that is, herniation of one or more viscera through a defect in the anterior body wall. Gastroschisis and omphalocele are the 2 most common congenital VBWDs. Other uncommon anomalies include ectopia cordis and pentalogy of Cantrell, limb-body wall complex, and bladder and cloacal exstrophy. Although VBWDs are associated with multiple abnormalities with distinct embryological origins and that may affect virtually any system organs, at least in relation to anterior body wall defects, they are thought (except for omphalocele) to share a common embryologic mechanism, that is, a failure involving the lateral body wall folds responsible for closing the thoracic, abdominal, and pelvic portions of the ventral body wall during the fourth week of development. Additionally, many of the principles of diagnosis and management are similar for these conditions. Fetal ultrasound (US) in prenatal care allows the diagnosis of most of such defects with subsequent opportunities for parental counseling and optimal perinatal management. Fetal magnetic resonance imaging may be an adjunct to US, providing global and detailed anatomical information, assessing the extent of defects, and also helping to confirm the diagnosis in equivocal cases. Prenatal imaging features of VBWDs may be complex and challenging, often requiring from the radiologist a high level of suspicion and familiarity with the imaging patterns. Because an appropriate management is dependent on an accurate diagnosis and assessment of defects, radiologists should be able to recognize and distinguish between the different VBWDs and their associated anomalies. In this article, we review the relevant embryology of VBWDs to facilitate understanding of the pathologic anatomy and diagnostic imaging approach. Features will be illustrated with prenatal US and magnetic resonance imaging and correlated with postnatal and clinical imaging.
Topics: Abdominal Wall; Bladder Exstrophy; Diagnosis, Differential; Ectopia Cordis; Female; Gastroschisis; Hernia, Umbilical; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Ultrasonography, Prenatal
PubMed: 26614134
DOI: 10.1053/j.sult.2015.01.001 -
Female Pelvic Medicine & Reconstructive... 2019The internal pelvic floor muscles that support the pelvic viscera lie within the external pelvic structures, which support posture and locomotion. The presence of pain...
OBJECTIVE
The internal pelvic floor muscles that support the pelvic viscera lie within the external pelvic structures, which support posture and locomotion. The presence of pain in the hip, groin, leg, abdomen, and/or back in patients with pelvic pain suggests that external pelvic sites may act as pain generators that contribute to chronic pelvic pain (CPP). The aim of this study was to report musculoskeletal diagnoses resulting from including a physiatry evaluation as part of a Multidisciplinary Pelvic Pain Clinic for women with complex chronic pain.
METHODS
This retrospective case series was conducted by chart review of all women attending the clinic from February 2016 through March 2018. Variable definitions were created for each demographic and clinical characteristic and used to guide a structured review of the chart. Descriptive statistical analysis was performed.
RESULTS
Ninety-six percent of the 68 women (mean age, 51 years) had CPP of 6 months' duration or longer. Levator ani tenderness was present in 81% and obturator internus tenderness in 81%. Seventy-one percent of women had failed pelvic physical therapy. Musculoskeletal diagnoses included osteoarthritis, tendinopathies, enthesopathies, osteitis pubis, ischiofemoral impingement, Paget disease, and other systemic conditions.
CONCLUSIONS
Musculoskeletal abnormalities were common in this highly selected cohort of complex CPP cases with external pelvic symptoms. The imaging findings and specific diagnoses allowed targeted therapy beyond generalized physical therapy for CPP. The expertise of urogynecologists and physical therapists who evaluate the internal pelvic muscles and viscera combined with the physiatrist's expertise in musculoskeletal assessment and imaging provides an expanded, collaborative approach for managing these patients.
Topics: Adult; Aged; Chronic Pain; Female; Gynecology; Humans; Interdisciplinary Communication; Middle Aged; Muscle, Skeletal; Musculoskeletal Diseases; Myalgia; Pain Clinics; Pelvic Pain; Physical and Rehabilitation Medicine; Retrospective Studies; Urology; Young Adult
PubMed: 30807433
DOI: 10.1097/SPV.0000000000000662 -
Annals of the Royal College of Surgeons... May 2023Diaphragmatic hernias can be congenital or acquired and are a protrusion of intra-abdominal contents through an abnormal opening in the diaphragm. Acquired defects are...
Diaphragmatic hernias can be congenital or acquired and are a protrusion of intra-abdominal contents through an abnormal opening in the diaphragm. Acquired defects are rare and occur secondary to direct penetrating injury or blunt abdominal trauma. This case review demonstrates two unconventional cases of large diaphragmatic hernias with viscero-abdominal disproportion in adults. Case 1 is a 27-year-old man with no prior medical or surgical history. He presented following a 24-h history of increasing shortness of breath and left-sided pleuritic chest pain, and no history of trauma. Chest X-ray demonstrated loops of bowel within the left hemithorax with displacement of the mediastinum to the right. Computed tomography (CT) scan confirmed a large diaphragmatic defect causing herniation of most of his abdominal contents into the left hemithorax. He underwent emergency surgery, which confirmed the viscero-abdominal disproportion. He required an extended right hemicolectomy to reduce the volume of the abdominal comtents and laparostomy to reduce the risk of abdominal compartment syndrome and recurrence of the hernia. Case 2 is a 76-year-old man with significant medical comorbidities who presented with acute onset of abdominal pain. He had a history of traumatic right-sided chest injury as a child resulting in right-sided diaphragmatic paralysis. Chest X-ray demonstrated a large right-sided diaphragmatic hernia with abdominal viscera in the right thoracic cavity. CT scan of the chest, abdomen and pelvis demonstrated both small and large bowel loops within the right hemithorax, compression of the right lung and displacement of the mediastinum to the left. The CT scan also demonstarted viscero-abdominal disproportion. Operative management was considered initially but following improvement with basic medical management and no further deterioration, a non-operative approach was adopted. Both cases illustrate atypical presentations of adults with diaphragmatic hernias. In an ideal scenario, these are repaired surgically. When the presumed diagnosis shows characteristics of a viscero-abdominal disproportion and surgery is pursued, the surgeon must consider that primary abdominal closure may not be possible and multiple operations may be necessary to correct the defect and achieve closure. Sacrifice of abdominal viscera may also be necessary to reduce the volume of abdominal contents.
Topics: Male; Child; Humans; Adult; Aged; Hernias, Diaphragmatic, Congenital; Diaphragm; Abdomen; Thorax; Lung
PubMed: 36239968
DOI: 10.1308/rcsann.2022.0107 -
Journal of Minimally Invasive Gynecology May 2022To describe the anatomy of the nerves during a laparoscopic retroperitoneal para-aortic lymphadenectomy with prioritization of their preservation.
STUDY OBJECTIVE
To describe the anatomy of the nerves during a laparoscopic retroperitoneal para-aortic lymphadenectomy with prioritization of their preservation.
DESIGN
Demonstration of a nerve-preserving para-aortic lymphadenectomy.
SETTING
A 65-year-old woman with no significant medical history underwent diagnostic laparoscopy for evaluation of a right ovarian mass. In the absence of peritoneal carcinomatosis, bilateral adnexectomy wasperformed with pathology revealing a high-grade tubo-ovarian serous carcinoma. In accordance with French Guidelines for management of ovarian cancer, operative staging including pelvic and para-aortic lymphadenectomy was recommended [1]. Final pathology following staging surgery was consistent with stage IA high-grade serous ovarian cancer prompting administration of adjuvant chemotherapy postoperatively.
INTERVENTIONS
We performed a lumbo-aortic lymphadenectomy with preservation of the following nerves: the superior hypogastric plexus, the lumbar splanchnic nerves and the sympathetic trunk.
CONCLUSION
Although there are conflicting data as to the benefit of staging lymphadenectomy in women with presumed early stage high-grade serous ovarian cancer, current French Guidelines recommend its performance. When doing so, effort should be made to avoid injury to adjacent normal structures, and in doing so, minimize potential morbidity. The neural structures preserved in this case are part of the sympathetic contingent and participate in the innervation of the abdomen and pelvic viscera. The sympathetic contingent is responsible for the vasomotricity but is also involved in the contraction of the internal genitalia during orgasm and in the inhibition of the peristaltic contractions of the rectum. As such, its preservation may avoid certain postoperative complaints. When possible to do so without compromising essential elements of a cancer surgery, preservation of nerves should be considered.
Topics: Aged; Carcinoma, Ovarian Epithelial; Female; Humans; Hypogastric Plexus; Laparoscopy; Lymph Node Excision; Male; Neoplasm Staging; Ovarian Neoplasms; Urinary Bladder Diseases
PubMed: 35151878
DOI: 10.1016/j.jmig.2022.02.002 -
Animals : An Open Access Journal From... Jul 2019Leonardo da Vinci was one of the most influencing personalities of his time, the perfect representation of the ideal Renaissance man, an expert painter, engineer and... (Review)
Review
Leonardo da Vinci was one of the most influencing personalities of his time, the perfect representation of the ideal Renaissance man, an expert painter, engineer and anatomist. Regarding Leonardo's anatomical drawings, apart from human anatomy, he also depicted some animal species. This comparative study focused only on two species: Bears and horses. He produced some anatomical drawings to illustrate the dissection of "a bear's foot" (Royal Collection Trust), previously described as "the left leg and foot of a bear", but considering some anatomical details, we concluded that they depict the bear's right pelvic limb. This misconception was due to the assumption that the bear's (1st toe) was the largest one, as in humans. We also analyzed a rough sketch (not previously reported), on the same page, and we concluded that it depicts the left (forearm) and (hand) of a dog/wolf. Regarding Leonardo's drawing representing the horse anatomy "The viscera of a horse", the blood vessel arrangement and other anatomical structures are not consistent with the structure of the horse, but are more in accordance with the anatomy of a dog. In addition, other drawings comparing the anatomy of human leg muscles to that of horse pelvic limbs were also discussed in motion.
PubMed: 31295863
DOI: 10.3390/ani9070435 -
International Urogynecology Journal Jul 2015The female bony pelvis has to fulfil opposing functions: it has to be sufficiently closed to support the pelvic viscera in the upright position, while remaining... (Comparative Study)
Comparative Study
INTRODUCTION AND HYPOTHESIS
The female bony pelvis has to fulfil opposing functions: it has to be sufficiently closed to support the pelvic viscera in the upright position, while remaining sufficiently open to allow vaginal delivery. We aim to give an evolutionary perspective and the possible evolution of the bony pelvis from Lucy to the modern female with the implications in terms of genital prolapse.
METHODS
Thirteen pelvimetric measurements were performed on 178 bony pelves: 1 fossil pelvis from Australopithecus Lucy, 128 female Caucasian modern adult pelves and 49 female Catarrhine pelves (29 gorillas and 20 chimpanzees).
RESULTS
Lucy's pelvis shape was the most transversely oval, short and broad, termed platypelloid. Modern female pelves were transversely oval only at the inlet. A protruding ischial spine, fairly small ischial tuberosities and a sacral concavity made Lucy closer to Homo sapiens and less like the great apes. In the last group, pelvic planes were anteroposteriorly oval, except in the gorilla, where the outlet was round or slightly transversely oval. The subpubic angle was narrowest in Lucy, whereas it was greater than 90° in the great apes.
CONCLUSIONS
The female pelvis is involved in both visceral support and parturition and represents a compromise. The narrower pelvis of Australopithecus Lucy provided protection against genital prolapse, but resulted in complex obstetrical mechanics. From an evolutionary perspective, the pelvis of Homo sapiens became modified to make parturition easier, but increased the risk of genital prolapse: the ilia became wide open laterally and the sacrum broadened with a shorter distance between the sacroiliac and coxofemoral joints.
Topics: Animals; Biological Evolution; Female; Fossils; Hominidae; Humans; Pelvic Bones; Pelvic Organ Prolapse
PubMed: 25681037
DOI: 10.1007/s00192-015-2635-7 -
Chirurgia (Bucharest, Romania : 1990) 2015Perineal hernia is the protrusion of intra-abdominal viscera through the pelvic floor. We present a patient with recurrent perineal hernia - 12x9 cm with a palpable... (Review)
Review
Perineal hernia is the protrusion of intra-abdominal viscera through the pelvic floor. We present a patient with recurrent perineal hernia - 12x9 cm with a palpable soft, hardly adjustable in the pelvic tunnel formation and attenuated skin over it. The patient was operated by abdominoperineal approach. We performed two layer Titanium mesh plasty of the pelvic floor with the use of the omentum and the pelvic muscles.
Topics: Aged; Hernia, Abdominal; Herniorrhaphy; Humans; Male; Pelvic Floor; Perineum; Rectal Neoplasms; Recurrence; Reoperation; Surgical Mesh; Titanium; Treatment Outcome
PubMed: 25800322
DOI: No ID Found -
Wiener Klinische Wochenschrift Jun 2016The aim of the present study was to evaluate the effect of crizotinib on visceral organs in an experimental rat model.
AIM
The aim of the present study was to evaluate the effect of crizotinib on visceral organs in an experimental rat model.
METHODS
Eighteen Wistar albino rats were divided into three groups: experimental toxicity was induced with crizotinib (10 mg/kg) administered for 28 days (Group 1), 42 days (Group 2) orally by gavage. Control group received only distilled water. Rats in Group 1 and Group 2 were sacrificed after the collection of blood and tissue samples on the 28th and 42nd days, respectively.
RESULTS
Subjects in Group 1 and Group 2 had abnormal histology mainly in lung and liver. There were intraalveolar hemorrhage in lungs; mild portal inflammation, perivenular focal and confluent necrosis in liver; inflammatory reaction in renal pelvis and periureteral areas, and focal pancreatitis in pancreas.
CONCLUSION
This study is the first to evaluate the histopathological features of toxicity of crizotinib in a rat model.
Topics: Administration, Oral; Animals; Antineoplastic Agents; Crizotinib; Disease Models, Animal; Dose-Response Relationship, Drug; Male; Organ Specificity; Pyrazoles; Pyridines; Rats; Rats, Wistar; Treatment Outcome; Viscera
PubMed: 26975454
DOI: 10.1007/s00508-016-0984-y -
Polish Journal of Veterinary Sciences Mar 2017Cocaine- and amphetamine-regulated transcript (CART) peptides are widely expressed not only in the brain but also in numerous endocrine/neuroendocrine cells as well as...
Cocaine- and amphetamine-regulated transcript (CART) peptides are widely expressed not only in the brain but also in numerous endocrine/neuroendocrine cells as well as in neurons of the peripheral nervous system. The present study investigated the distribution patterns of CART-like immunoreactivity in the pelvic plexus (PP) of the female pig. The co-expression of CART with principal neurotransmitter markers: choline acetyltransferase (ChAT), tyrosine hydroxylase (TH), serotonin (5-HT) or biologically active neuropeptides: pituitary adenylate cyclase-activating polypeptide (PACAP), substance P (SP), calbindin was analyzed using double immunohistochemical stainings. Amongst neurons immunopositive to Hu C/D panneuronal marker as many as 4.1 ± 1.2% in right and 4.4 ± 1.6% in left pelvic ganglia were found to express CART. The vast majority of CART-IR ganglionic neurons were predominantly small in size and were evenly scattered throughout particular ganglia. Immunoreactivity to CART was also detected in numerous nerve terminals (which frequently formed pericellular formations around CART-negative perikarya) as well as in numerous nerve fibres within nerve branches interconnecting the unilateral pelvic ganglia. Immunohistochemistry revealed that virtually all CART-IR neurons were cholinergic in nature and CART-IR basket-like formations frequently encircled TH-positive/CART-negative perikarya. None of CART-IR ganglionic neurons showed immunoreactivity to SP, PACAP, 5-HT or calbindin. CART-IR nerve fibres ran in a close vicinity to serotonin-containing cells or faintly labelled SP-expressing neurons. On the other hand, PACAP-IR, SP-IR (but not 5-HT-positive) nerve terminals were found to run in close proximity to CART-IR neurons. Our results indicate that: 1) CART present in PP may influence the activity of pelvic ganglionic neurons/SIF cells, 2) PP should be considered as a potential source of CART-like supply to pelvic viscera and 3) functional interactions between CART and SP or PACAP are possible at the periphery.
Topics: Animals; Female; Ganglia; Gene Expression Regulation; Immunohistochemistry; Nerve Tissue Proteins; Protein Transport; Swine
PubMed: 28525332
DOI: 10.1515/pjvs-2017-0022