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Obstetrics and Gynecology Clinics of... Jun 2022Abdominal wall endometriosis (AWE) is a rare type of endometriosis defined as endometrial glands and stroma located within the abdominal wall. Patients with a history of... (Review)
Review
Abdominal wall endometriosis (AWE) is a rare type of endometriosis defined as endometrial glands and stroma located within the abdominal wall. Patients with a history of prior abdominal surgery classically present with cyclic abdominal pain and a palpable mass. Definitive diagnosis is made by pathologic tissue examination, but preoperative imaging with ultrasonography or MRI helps narrow the differential and informs surgical management. Surgical management is traditionally via an open approach; however, laparoscopic removal of AWE is recommended for subfascial or rectus lesions. Following surgical excision, more than 90% of patients experience complete symptom relief.
Topics: Abdominal Wall; Endometriosis; Endometrium; Female; Humans; Magnetic Resonance Imaging; Ultrasonography
PubMed: 35636814
DOI: 10.1016/j.ogc.2022.02.013 -
American Family Physician Oct 2018Abdominal wall pain is often mistaken for intra-abdominal visceral pain, resulting in expensive and unnecessary laboratory tests, imaging studies, consultations, and... (Review)
Review
Abdominal wall pain is often mistaken for intra-abdominal visceral pain, resulting in expensive and unnecessary laboratory tests, imaging studies, consultations, and invasive procedures. Those evaluations generally are nondiagnostic, and lingering pain can become frustrating to the patient and clinician. Common causes of abdominal wall pain include nerve entrapment, hernia, and surgical or procedural complications. Anterior cutaneous nerve entrapment syndrome is the most common and frequently missed type of abdominal wall pain. This condition typically presents with acute or chronic localized pain at the lateral edge of the rectus abdominis that worsens with position changes or increased abdominal muscle tension. Abdominal wall pain should be suspected in patients with no symptoms or signs of visceral etiology and a localized small tender spot. A positive Carnett test, in which tenderness stays the same or worsens when the patient tenses the abdominal muscles, suggests abdominal wall pain. A local anesthetic injection can confirm the diagnosis when there is 50% postprocedural pain improvement. Point-of-care ultrasonography may help rule out other abdominal wall pathologies and guide injections. The management of abdominal wall pain depends on the etiology. Reassurance and patient education can be helpful. Local injection with an anesthetic and a corticosteroid is an effective treatment for anterior cutaneous nerve entrapment syndrome, with an overall response rate of 70% to 99%. For refractory cases that require more than two injections, surgical neurectomy generally resolves the pain.
Topics: Abdominal Pain; Abdominal Wall; Diagnosis, Differential; Humans; Physical Examination; Point-of-Care Systems; Ultrasonography
PubMed: 30252418
DOI: No ID Found -
Journal of Ultrasound Sep 2020The anterior abdominal wall, which is composed of three layers (skin and adipose tissues; the myofascial layer; and the deep layer, consisting of the transversalis... (Review)
Review
The anterior abdominal wall, which is composed of three layers (skin and adipose tissues; the myofascial layer; and the deep layer, consisting of the transversalis fascia, preperitoneal fat, and the parietal peritoneum), has many functions: containment, support and protection for the intraperitoneal contents, and involvement in movement and breathing. While hernias are often encountered and well reviewed in the literature, the other abdominal wall pathologies are less commonly described. In this pictorial review, we briefly discuss the normal anatomy of the anterior abdominal wall, describe the normal ultrasonographic anatomy, and present a wide range of pathologic abnormalities beyond hernias. Sonography emerges as the diagnostic imaging of first choice for assessing abdominal wall disorders, thus representing a valuable tool for ensuring appropriate management and limiting functional impairment.
Topics: Abdominal Muscles; Abdominal Wall; Atrophy; Diastasis, Muscle; Endometriosis; Female; Hernia, Abdominal; Humans; Ultrasonography
PubMed: 32125676
DOI: 10.1007/s40477-020-00435-0 -
Clinics (Sao Paulo, Brazil) 2021The practice of regional anesthesia is in a state of progressive evolution, mainly due to the advent of ultrasound as an anesthesiologist's instrument. Alternative... (Review)
Review
The practice of regional anesthesia is in a state of progressive evolution, mainly due to the advent of ultrasound as an anesthesiologist's instrument. Alternative techniques for postoperative analgesia of abdominal surgeries, such as transversus abdominis plane block, oblique subcostal transversus abdominis plane block, rectus abdominis muscle sheath block, ilioinguinal and iliohypogastric nerve block, and quadratus lumborum plane block, have proven useful, with good analgesic efficacy, especially when neuroaxial techniques (spinal anesthesia or epidural anesthesia) are not possible. This review discusses such blockades in detail, including the anatomical principles, indications, techniques, and potential complications.
Topics: Abdominal Muscles; Abdominal Wall; Humans; Nerve Block; Pain, Postoperative; Ultrasonography, Interventional
PubMed: 33503184
DOI: 10.6061/clinics/2021/e2170 -
The Surgical Clinics of North America Oct 2023A wide array of mesh choices is available for abdominal wall reconstruction, making mesh selection confusing. Understanding mesh properties can make mesh choice simpler.... (Review)
Review
A wide array of mesh choices is available for abdominal wall reconstruction, making mesh selection confusing. Understanding mesh properties can make mesh choice simpler. Each mesh has characteristics that determine its durability, ability to clear an infection, and optimal position of placement in the abdominal wall. For clean retromuscular hernia repairs, we prefer bare, heavy weight, permanent synthetic mesh. For contaminated retromuscular abdominal wall reconstruction cases, such as parastomal hernia repairs, we typically use bare, medium weight, permanent synthetic mesh. Biologic and biosynthetic meshes also have acceptable wound event and hernia recurrence rates when used in contaminated cases.
Topics: Humans; Abdominal Wall; Biocompatible Materials; Surgical Mesh; Herniorrhaphy; Prostheses and Implants
PubMed: 37709387
DOI: 10.1016/j.suc.2023.04.010 -
Current Opinion in Obstetrics &... Aug 2021Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis,... (Review)
Review
PURPOSE OF REVIEW
Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of AWE.
RECENT FINDINGS
Recent studies further characterize presenting symptoms and locations of AWE. Prior abdominal surgery remains the greatest risk factor for the development of AWE. Newer evidence suggests that increasing BMI may also be a risk factor. Ultrasound is first-line imaging for diagnosis. Magnetic resonance image is preferred for surgical planning for deep or extensive lesions. Laparotomy with wide local excision is considered standard treatment for AWE with great success. Novel techniques in minimally invasive surgery have been described as effective for the treatment of AWE. A multidisciplinary surgical approach is often warranted for successful excision and reapproximation of skin and/or fascial defects. Noninvasive therapies including ultrasonic ablation or cryotherapy are also emerging as promising treatment strategies in select patients.
SUMMARY
Recent studies provide further evidence to guide diagnosis through physical exam and imaging as well as pretreatment planning. Treatment options for AWE are rapidly expanding with novel approaches in minimally invasive and noninvasive therapies now available.
Topics: Abdominal Wall; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Physical Examination; Ultrasonography
PubMed: 34054100
DOI: 10.1097/GCO.0000000000000714 -
Plastic and Reconstructive Surgery Jan 2018After reviewing this article, the participant should be able to: 1. List major risk factors for hernia formation and for failure of primary repair. 2. Outline an... (Review)
Review
LEARNING OBJECTIVES
After reviewing this article, the participant should be able to: 1. List major risk factors for hernia formation and for failure of primary repair. 2. Outline an algorithmic approach to anterior abdominal wall reconstruction based on the degree of contamination, components involved in the deficit, and width of the hernia defect. 3. Describe appropriate indications for synthetic and biological mesh products. 4. List common flaps used in anterior abdominal wall reconstruction, including functional restoration strategies. 5. Describe the current state of the art of vascularized composite tissue allotransplantation strategies for abdominal wall reconstruction.
SUMMARY
Plastic surgeons have an increasingly important role in abdominal wall reconstruction-from recalcitrant, large incisional hernias to complete loss of abdominal wall domain. A review of current algorithms is warranted to match evolving surgical techniques and a growing number of available implant materials. The purpose of this article is to provide an updated review of treatment strategies to provide an approach to the full spectrum of abdominal wall deficits encountered in the modern plastic surgery practice.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Bariatric Surgery; Composite Tissue Allografts; Hernia, Ventral; Herniorrhaphy; Humans; Reoperation; Skin Transplantation; Surgical Flaps; Surgical Mesh
PubMed: 29280882
DOI: 10.1097/PRS.0000000000003976 -
Seminars in Fetal & Neonatal Medicine Jun 2011Gastroschisis and omphalocele are the two most common congenital abdominal wall defects. Both are frequently detected prenatally due to routine maternal serum screening... (Review)
Review
Gastroschisis and omphalocele are the two most common congenital abdominal wall defects. Both are frequently detected prenatally due to routine maternal serum screening and fetal ultrasound. Prenatal diagnosis may influence timing, mode and location of delivery. Prognosis for gastroschisis is primarily determined by the degree of bowel injury, whereas prognosis for omphalocele is related to the number and severity of associated anomalies. The surgical management of both conditions consists of closure of the abdominal wall defect, while minimizing the risk of injury to the abdominal viscera either through direct trauma or due to increased intra-abdominal pressure. Options include primary closure or a variety of staged approaches. Long-term outcome is favorable in most cases; however, significant associated anomalies (in the case of omphalocele) or intestinal dysfunction (in the case of gastroschisis) may result in morbidity and mortality.
Topics: Abdominal Wall; Gastroschisis; Hernia, Umbilical; Humans; Infant, Newborn; Prenatal Diagnosis; Prognosis
PubMed: 21474399
DOI: 10.1016/j.siny.2011.02.003 -
Cirugia Espanola May 2023
Topics: Humans; Abdominal Wall; Minimally Invasive Surgical Procedures; Herniorrhaphy
PubMed: 37951468
DOI: 10.1016/j.cireng.2023.01.009 -
Medical Ultrasonography Nov 2017Abdominal wall endometriosis (AWE) is a rare condition defined by the presence of endometrial tissue in the subcutaneous fatty layer and the muscles of the abdominal... (Review)
Review
Abdominal wall endometriosis (AWE) is a rare condition defined by the presence of endometrial tissue in the subcutaneous fatty layer and the muscles of the abdominal wall. It is usually caused by the dissemination of endometrial tissue in the wound at the time of obstetrical and gynecological surgeries. AWE is rare and difficult to diagnose. The most frequent clinical presentation is that of a palpable subcutaneous mass near surgical scars associated with cyclic pain and swelling during menses. AWE may be an underreported pathology partly because it has scarcely received attention in the radiologic literature. Its frequency is expected to rise along with the increasing rate of cesarean deliveries; thus, it is important that physicians or sonographers are familiar with this pathology. The purpose of our review is to present the latest data regarding risk factors, clinical and imagisticfindings, and management of AWE.
Topics: Abdominal Wall; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Ultrasonography
PubMed: 29197920
DOI: 10.11152/mu-1248