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Journal of Clinical Medicine May 2024Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and... (Review)
Review
Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and mortality rates vary depending on the underlying cause, with intestinal volvulus being just one potential acute cause. Despite its rarity, our case series highlights chyloperitoneum associated with non-ischemic small bowel volvulus. The aims of our study include assessing the incidence of this association and evaluating diagnostic and therapeutic approaches. We present two cases of acute abdominal peritonitis with suspected small bowel volvulus identified via contrast-enhanced computed tomography (CT). Emergency laparotomy revealed milky-free fluid and bowel volvulus. Additionally, we conducted a systematic review up to 31 October 2023, identifying 15 previously reported cases of small bowel volvulus and chyloperitoneum in adults (via the PRISMA scheme). Clarifying the etiopathogenetic mechanism of chyloperitoneum requires specific diagnostic tools. Magnetic resonance imaging (MRI) may be useful in non-emergency situations, while contrast-enhanced CT is employed in emergencies. Although small bowel volvulus infrequently causes chyloperitoneum, prompt treatment is necessary. The volvulus determines lymphatic flow obstruction at the base of the mesentery, with exudation and chyle accumulation in the abdominal cavity. Derotation of the volvulus alone may resolve chyloperitoneum without intestinal ischemia.
PubMed: 38792360
DOI: 10.3390/jcm13102816 -
European Radiology Jun 2015Our aim was to assess the diagnostic performance in determining strangulation in small bowel obstruction (SBO) for five CT findings commonly considered in published... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Our aim was to assess the diagnostic performance in determining strangulation in small bowel obstruction (SBO) for five CT findings commonly considered in published small bowel obstruction (SBO) management guidelines.
MATERIALS AND METHODS
Medical databases were searched for "bowel obstruction", "computed tomography", "strangulation", and related terms. Two reviewers independently selected articles for CT findings investigated with surgical or histological reference standards for strangulation. Bivariate random-effects meta-analytical methods were used.
RESULTS
A total of 768 patients, including 205 with strangulation from nine studies, were evaluated. The reduced bowel wall enhancement CT sign had the highest specificity (95 %, CI 75-99), with a positive LR of 11.07 (2.27-53.88) and DOR of 22.86 (4.99-104.61). The mesenteric fluid sign had the highest sensitivity (89 %, CI 75-96) with a negative LR of 0.16 (0.07-0.39) and a DOR of 13.9 (5.73-33.75). The bowel wall thickness had a sensitivity of 48 % (CI 41-54), a specificity of 83 % (CI 74-89), a positive LR of 2.84 (1.83-4.41) and a negative LR of 0.62 (0.53-0.72). The other CT findings had lower diagnostic performance.
CONCLUSION
Two CT findings should be used in clinical practice: reduced enhanced bowel wall is highly predictive of ischemia, and absence of mesenteric fluid is a reliable finding to rule out strangulation.
KEY POINTS
• Reduced bowel wall enhancement on CT increases the probability of strangulation 11-fold. • Absence of mesenteric fluid on CT decreases the probability of strangulation 6-fold. • The clinical reliability of other CT signs is doubtful for predicting strangulation.
Topics: Body Fluids; Humans; Intestinal Obstruction; Intestine, Small; Ischemia; Mesentery; Physical Examination; Probability; Reference Standards; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 25850889
DOI: 10.1007/s00330-014-3440-2 -
The Journal of Surgical Research Jun 2021Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management...
BACKGROUND
Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management of these rare cases. We performed a systematic review of the literature to describe injuries, management, and outcomes.
MATERIALS AND METHODS
Following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed, Web of Science, Embase, and Google Scholar was performed to identify English-language publications of blunt TAWH in patients <18 y old. Conflicts were resolved by consensus. Data were collected on demographics, associated injuries, management, and outcomes.
RESULTS
A total of 71 articles were reviewed with 100 cases of TAWH. A total of 82.5% of patients were male, and the median age was 9 y old (range 2-15). Injury by bicycle handlebars was most common (72%) followed by motor vehicle collision (14%). Forty patients had intraabdominal injuries, most commonly bowel (70%) or mesentery (37.5%). Rate of intraabdominal injury was significantly higher in patients with injuries due to nonbicycle handlebar injuries when compared with bicycle handlebar injuries (60.7% versus 33.3%, P = 0.02). Most patients were managed operatively (85%), most commonly via laparotomy (68/85, 80%), with six laparoscopic repairs and five laparoscopic converted to open repairs. There were three reported complications and no recurrences over a median of follow-up of 5 mo in patients who underwent repair.
CONCLUSIONS
Pediatric TAWH is a rare injury with a high rate of intraabdominal injuries, particularly when due to high-impact mechanisms such as motor vehicle collision. Although open repair is more commonly performed, laparoscopic repair has been described with success. Recurrence rates appear low, but follow-up has been short term.
Topics: Abdominal Injuries; Adolescent; Child; Child, Preschool; Female; Hernia, Abdominal; Humans; Laparoscopy; Male; Postoperative Complications; Recurrence
PubMed: 33601272
DOI: 10.1016/j.jss.2020.12.068 -
Asian Journal of Surgery Jul 2016A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the... (Review)
Review
A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. A case report of a patient with mesenteric cyst is presented. In addition, a systematic review was performed of English language literature on chylous mesenteric cysts in adult humans. Of the 18 articles included in the review, there were 19 cases of chylous mesenteric cysts reported. Male to female ratio was 1.4:1 with a median age of 46 years. A preoperative diagnosis of mesenteric cyst was made in four patients based on computed tomography. All patients underwent surgery and there were no reports of recurrence on follow up. Chylous mesenteric cyst is a rare entity that needs to be recognized whenever a preliminary diagnosis of intra-abdominal cystic mass is made.
Topics: Adult; Diagnosis, Differential; Female; Humans; Laparoscopy; Mesenteric Cyst
PubMed: 23769746
DOI: 10.1016/j.asjsur.2013.04.009 -
The International Journal of... 2006The cellular and developmental analysis of evolutionary-conserved genes directing bilaterian mesodermal and myogenic cell fate previously identified the hydromedusan... (Comparative Study)
Comparative Study Review
The cellular and developmental analysis of evolutionary-conserved genes directing bilaterian mesodermal and myogenic cell fate previously identified the hydromedusan entocodon and its differentiation product, the striated muscle, as mesodermal derivatives. In view of these findings we presented a hypothesis disputing the diploblast classification of cnidarians without providing further explanations for the apparent diploblasty of the polyp stage and the formation of the subepidermal striated muscle in those Medusozoa lacking the entocodon nodule (Seipel and Schmid, 2005). Hence we carried out a systematic review of the histological and experimental evidence for mesodermal differentiations in cnidarians. In anthozoan and scyphozoan but not in hydrozoan polyps the presumptive mesodermal elements include amoeboid cells, the mesentery retractor muscles and scleroblasts, all of which are embedded or deeply rooted in the extracellular matrix (mesoglea) and derive from the ectoblastemal cells invading the extracellular matrix from the gastrulation site during or shortly after endoderm formation. These data lend further support to the cnidarian mesodermate hypothesis, whereby cnidarians and bilaterians share a common triploblast ancestor, the Urtriploblast, a small, motile, possibly medusa-like organism that did not feature a sessile polyp stage in its life cycle. As a consequence the diploblasty of the hydrozoan polyps may represent a derived morphology resulting from heterochronic modulations of the gastrulation process after endoderm formation.
Topics: Animals; Cell Differentiation; Cnidaria; Germ Layers; Life Cycle Stages; Mesoderm; Models, Biological; Muscle, Skeletal
PubMed: 16892172
DOI: 10.1387/ijdb.062150ks -
Surgical Innovation Apr 2020. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport... (Meta-Analysis)
Meta-Analysis
. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport laparoscopic CME (MPL CME) colectomy. . MEDLINE (PubMed), Scopus, EMBASE, Ovid, and the Cochrane library were searched. Studies comparing the SILS CME with MPL CME in adults with colon adenocarcinoma were included. The Jadad and Newcastle Ottawa Scales were used to critically appraise the studies. The presence of statistical heterogeneity or publication bias was examined. . Seven studies (3 randomized) with a total number of 1344 patients were included (546 SILS CME and 798 MPL CME). No difference was found in anastomotic leakage (odds ratio [OR] = 0.79 [0.31 to 2.03]; = .63), number of lymph nodes (weighted mean difference [WMD] = 0.85 [-0.97 to 2.66]; = .36), hospital stay (WMD = 0.01 [-0.19 to 0.20]; = .96), overall survival (hazard ratio [HR] = 1.19 [0.29 to 4.80]; = .81), and disease-free survival (HR = 1.30 [0.30 to 5.61]; = .72). Skin incision was shorter in SILS CME group (WMD = -3.02 [-3.25 to -2.80]; < .00001) but with no difference in pain reported in postoperative day 1 (standardized mean difference [SMD] = -0.21 [-0.50 to 0.09]; = .17) or day 2 (SMD = 0.16 [-0.52 to 0.84]; = .64). . SILS CME, although technically more demanding, has equivalent short- and long-term outcomes when compared with MPL CME. Potential benefits in cosmesis or postoperative pain need to be further explored by high-quality randomized controlled trials.
Topics: Aged; Aged, 80 and over; Colectomy; Colonic Neoplasms; Disease-Free Survival; Female; Humans; Laparoscopy; Lymph Nodes; Male; Mesocolon; Middle Aged; Postoperative Complications
PubMed: 31854262
DOI: 10.1177/1553350619893232 -
Rozhledy V Chirurgii : Mesicnik... Nov 2015Accurate detection of hepatic pseudolesions using multi-detector CT and MRI examinations is crucial for the differentiation of benign alterations from primary and... (Review)
Review
INTRODUCTION
Accurate detection of hepatic pseudolesions using multi-detector CT and MRI examinations is crucial for the differentiation of benign alterations from primary and secondary malignant lesions in hepatic parenchyma.
METHOD
The authors conducted a systematic literature review in PubMed. "Liver" and "pseudolesion" were used as keywords in English and Czech, and papers/articles published from 2000 to 2014 were retrieved.
RESULTS
The authors presented a literature review. In addition, the authors performed a retrospective evaluation of a group of patients treated for liver disease at University Hospital Ostrava where this anomaly was encountered in 7 cases.In 3 of the patients, diagnostic laparoscopy was done, with visual examination of the lesion accompanied by intraoperative ultrasound exam (IOUS) and partial excision, to establish the diagnosis. Subsequent histological assessment of the specimens confirmed the diagnosis of a steatotic lesion in each of these 3 patients. Additional 2 of the 7 patients underwent liver surgery for concurrent metastatic lesions of colorectal cancer and an open-access revision of the suspected lesions was performed. Visual inspection and intraoperative ultrasound (IOUS) was followed by excisional biopsy. The histology revealed macro- and micro-vesicular steatosis and excluded malignant changes. The last 2 patients still continue to be followed-up regularly on a 6-month routine check-up basis at our hepatology unit.
CONCLUSION
The authors presented their own experience gained through inter-disciplinary cooperation at Multidisciplinary conferences. A literature overview of this unusual subject is also included. Particularly in oncologic patients, correct interpretation of these pseudolesions may help to avoid unnecessary biopsies, further imaging examinations and diagnostic laparoscopies and/or explorative laparotomies.
Topics: Adult; Aged; Colorectal Neoplasms; Diagnosis, Differential; Female; Humans; Laparoscopy; Laparotomy; Ligaments; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Mesentery; Middle Aged; Retrospective Studies
PubMed: 26766151
DOI: No ID Found -
ANZ Journal of Surgery Jan 2021While complete mesocolic excision (CME) has been shown to have an oncological benefit as compared to conventional colonic surgery for colon surgery, this benefit must be... (Meta-Analysis)
Meta-Analysis
BACKGROUND
While complete mesocolic excision (CME) has been shown to have an oncological benefit as compared to conventional colonic surgery for colon surgery, this benefit must be weighed up against the risk of major intra-abdominal complications. This paper aimed to assess the comparative oncological benefits of CME.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature until May 2020 was performed. Comparative studies assessing CME versus conventional colonic surgery for colon cancer were compared, and outcomes were pooled.
RESULTS
A total of 700 publications were identified, of which 19 were found to meet the inclusion criteria. A total of 25 886 patients were compared, with 14 431 patients in the CME arm. CME was associated with a significantly higher rate of vascular injury (odds ratio 3, P < 0.001). Rates of local and distant recurrence were lower in the CME group (odds ratio 0.66 and 0.73, respectively, both P < 0.001). CME patients had a significantly higher lymph node yield (P < 0.001). While no significant differences were noted between the two groups in terms of pooled 3- or 5-year disease-free survival, pooled 5-year overall survival was significantly higher in the CME group (relative risk 0.82, P < 0.001).
CONCLUSION
Based on the available evidence, CME is associated with improved oncologic outcomes at the expense of higher complication rates, including vascular injury. The oncological benefits need to weighed up against a multitude of factors including the level of hospital support, surgeon experience, patient age, and associated comorbidities.
Topics: Colectomy; Colonic Neoplasms; Humans; Laparoscopy; Lymph Node Excision; Lymph Nodes; Mesocolon; Neoplasm Recurrence, Local
PubMed: 33400369
DOI: 10.1111/ans.16518 -
Journal of Robotic Surgery Apr 2023Robotically assisted operations are the state of the art in laparoscopic general surgery. They are established predominantly for elective operations. Since laparoscopy... (Review)
Review
Robotically assisted operations are the state of the art in laparoscopic general surgery. They are established predominantly for elective operations. Since laparoscopy is widely used in urgent general surgery, the significance of robotic assistance in urgent operations is of interest. Currently, there are few data on robotic-assisted operations in urgent surgery. The aim of this study was to collect and classify the existing studies. A two-stage, PRISMA-compliant literature search of PubMed and the Cochrane Library was conducted. We analyzed all articles on robotic surgery associated with urgent general surgery resp. acute surgical diseases of the abdomen. Gynecological and urological diseases so as vascular surgery, except mesenterial ischemia, were excluded. Studies and case reports/series published between 1980 and 2021 were eligible for inclusion. In addition to a descriptive synopsis, various outcome parameters were systematically recorded. Fifty-two studies of operations for acute appendicitis and cholecystitis, hernias and acute conditions of the gastrointestinal tract were included. The level of evidence is low. Surgical robots in the narrow sense and robotic camera mounts were used. All narrow-sense robots are nonautonomous systems; in 82%, the Da Vinci system was used. The most frequently published emergency operations were urgent cholecystectomies (30 studies, 703 patients) followed by incarcerated hernias (9 studies, 199 patients). Feasibility of robotic operations was demonstrated for all indications. Neither robotic-specific problems nor extensive complication rates were reported. Various urgent operations in general surgery can be performed robotically without increased risk. The available data do not allow a final evidence-based assessment.
Topics: Humans; Robotic Surgical Procedures; Robotics; Laparoscopy; Cholecystectomy; Hernia
PubMed: 35727485
DOI: 10.1007/s11701-022-01425-6 -
Medicine Jul 2016Perivascular epithelioid cell tumor (PEComa) is a rare entity with distinctive morphology and of expressing myomelanocytic markers. Gastrointestinal tract (GI) is one of... (Review)
Review
Perivascular epithelioid cell tumor (PEComa) is a rare entity with distinctive morphology and of expressing myomelanocytic markers. Gastrointestinal tract (GI) is one of the most common anatomic sites of origin and counts for 20% to 25% of all reported cases of perivascular epithelioid cell tumors not otherwise specified (PEComas-NOS). However, the biologic behavior of perivascular epithelioid cell tumors of gastrointestinal tract (GI PEComas-NOS) is still unclear. The aim of conducting this systematic review is to sum up what is known so far of the epidemiology, natural history, management and prognosis of GI PEComas-NOS.A systematic research was performed on PubMed and EMBASE using the following terms: ("perivascular epithelioid cell tumor" or "PEComa") and ("gastrointestinal tract" or "GI" or "oral " or "mouth" or "esophagus" or "gullet" or "gastric" or "stomach" or "duodenum" or "jejunum" or "ileum" or "cecum" or "colon" or "colorectal" or "sigmoid" or "rectum" or "anus" or "mesentery") up to December 1, 2015. Retrieved GI PEComas-NOS publications, which included these terms, contains case reports, case series to case characteristic researches.A total of 168 articles were reviewed, 41 GI PEComa-NOS English studies among which were retrieved for analysis. We reviewed epidemiology, natural history, management and prognosis of GI PEComa-NOS. Generally GI PEComa-NOS is believed to have women predomination. The most frequently involved location is colon with non-specific clinical signs. Pathologically, GI PEComas-NOS shows epithelioid predominance (70%), meanwhile coexpresses melanocytic and muscle markers characteristically, while immunohistochemistry is a useful tool for identify, which indicates that HMB-45 is regarded as the most sensitive reagent. Complete resection served as mainstay of treatment, while chemotherapy should be unanimously considered to apply in malignant cases. Eventually, it is necessary for closed and long-term follow-up with endoscope and imaging for ruling out local recurrence or distant metastasis of this tumor.GI PEComas-NOS lives with unclear behavior. There are still many unverified clinicopathological issues of GI PEComas-NOS that needs to be clarified. Further studies and analyses concerning this rare entity should be brought out. Thus, the randomized clinical researches (RCTs) are required to be conducted.
Topics: Biomarkers, Tumor; Diagnosis, Differential; Gastrointestinal Neoplasms; Humans; Perivascular Epithelioid Cell Neoplasms; Prognosis
PubMed: 27428182
DOI: 10.1097/MD.0000000000003890