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The Anatomical Record Mar 1947
Topics: Colon, Transverse; Humans; Ileum; Intestines; Jejunum; Peritoneum
PubMed: 20289327
DOI: 10.1002/ar.1090970303 -
Pediatric Nephrology (Berlin, Germany) Oct 1995Continuous ambulatory peritoneal dialysis (CAPD) has come to be extensively used for the treatment of end-stage renal failure in children, and especially infants, such... (Review)
Review
Continuous ambulatory peritoneal dialysis (CAPD) has come to be extensively used for the treatment of end-stage renal failure in children, and especially infants, such that now more than half of children on dialysis worldwide receive treatment by this means. Peritonitis, however, is commoner in children than in adults receiving treatment, and is a major source of morbidity and treatment failure in children started on CAPD. Only recently has the immunology of the normal peritoneum been studied extensively, with the need to assess the impact of the installation of large volumes of fluid into the peritoneal sac during dialysis. The main phagocytic defences of the peritoneum depend upon a unique set of macrophages which are present free in the peritoneal fluid but also in the submesothelium and in perivascular collections together with B lymphocytes in the submesothelial area. Both the number of macrophages per unit volume and the concentration of opsonic proteins, such as IgG, complement and fibronectin, are reduced to between only 1% and 5% when dialysis fluid is continuously present in the peritoneal sac. In addition, the fluids used for CAPD are toxic to both macrophages and to mesothelial cells. Thus minor degrees of contamination frequently lead to peritonitis and in addition the majority of patients have catheters inserted in their peritoneum which become colonised with organisms capable of producing exopolysaccharide (slime), which promotes adhesion of the organism to the plastic and protects them against phagocytic attack and the penetration of antibiotics. Thus the peritoneum is in a state of continual inflammation, as well as being a markedly more vulnerable site than the normal peritoneum to the entry of organisms. Whether clinical peritonitis appears in this state of chronic contamination probably depends on perturbation in the balance between host defences and the organism. Whilst Staphylococcus epidermidis is the commonest cause of peritonitis, Staphylococcus aureus and Gram-negative organisms are much more serious and more frequently lead either to temporary catheter removal or discontinuation of dialysis altogether. This review describes the peritoneal defences in relation to the genesis of peritonitis.
Topics: Child; Humans; Kidney Failure, Chronic; Macrophages, Peritoneal; Opsonin Proteins; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Phagocytosis
PubMed: 8580033
DOI: 10.1007/BF00860966 -
Journal of Minimally Invasive Gynecology Feb 2021The objective of this video is to demonstrate different clinical presentations of peritoneal defects (peritoneal retraction pockets) and their anatomic relationships...
OBJECTIVE
The objective of this video is to demonstrate different clinical presentations of peritoneal defects (peritoneal retraction pockets) and their anatomic relationships with the pelvic innervation, justifying the occurrence of some neurologic symptoms in association with these diseases.
DESIGN
Surgical demonstration of complete excision of different types of peritoneal retraction pockets and a comparison with a laparoscopic retroperitoneal cadaveric dissection of the pelvic innervation.
SETTING
Private hospital in Curitiba, Paraná, Brazil.
INTERVENTIONS
A pelvic peritoneal pocket is a retraction defect in the surface of the peritoneum of variable size and shapes [1]. The origin of defects in the pelvic peritoneum is still unknown [2]. It has been postulated that it is the result of peritoneal irritation or invasion by endometriosis, with resultant scarring and retraction of the peritoneum [3,4]. It has also been suggested that a retraction pocket may be a cause of endometriosis, where the disease presumably settles in a previously altered peritoneal surface [5]. These defects are shown in many studies to be associated with pelvic pain, dyspareunia, and secondary dysmenorrhea [1-4]. Some studies have shown that the excision of these peritoneal defect improves pain symptoms and quality of life [5]. It is important to recognize peritoneal pockets as a potential manifestation of endometriosis because in some cases, the only evidence of endometriosis may be the presence of these peritoneal defects [6]. In this video, we demonstrate different types of peritoneal pockets and their close relationship with pelvic anatomic structures. Case 1 is a 29-year-old woman, gravida 0, with severe dysmenorrhea and catamenial bowel symptoms (bowel distension and diarrhea/constipation) that were unresponsive to medical treatment. Imaging studies were reported as normal, and a laparoscopy showed a posterior cul-de-sac peritoneal pocket infiltrating the pararectal fossa, with extension to the lateral border of the rectum. Case 2 is a cadaveric dissection of a posterior cul-de-sac peritoneal pocket infiltrating the pararectal fossa, with extension to the pelvic sidewall. After dissection of the obturator fossa, we can observe that the pocket is close to the sacrospinous ligament, pudendal nerve, and some sacral roots. Case 3 is a 31-year-old woman, gravida 1, para 1, with severe dysmenorrhea that was unresponsive to medical treatment and catamenial bowel symptoms (catamenial bowel distention and diarrhea). Imaging studies were reported as normal and a laparoscopy showed left uterosacral peritoneal pocket infiltrating the pararectal fossa in close proximity to the rectal wall. Case 4 is a cadaveric dissection of the ovarian fossa and the obturator fossa showing the proximity between these structures. Case 5 is a 35-year-old woman, gravida 0, with severe dysmenorrhea that was unresponsive to medical treatment, referring difficulty, and pain when walking only during menstruation. A neurologic physical examination revealed weakness in thigh adduction, and the magnetic resonance imaging showed no signs of endometriosis. During laparoscopy, we found a peritoneal pocket infiltrating the ovarian fossa, with involvement in the area between the umbilical ligament and the uterine artery. This type of pocket can easily reach the obturator nerve. Because the obturator nerve and its branches supply the muscle and skin of the medial thigh [7,8], patients may present with thigh adduction weakness or difficulty ambulating [9,10]. Case 6 is a cadaveric dissection of the sacrospinous ligament and the pudendal nerve from a medial approach, between the umbilical artery and the iliac vessels. Case 7 is a 34-year-old woman, gravida 1, para 1, with severe dysmenorrhea and catamenial bowel symptoms as well as deep dyspareunia. The transvaginal ultrasound showed focal adenomyosis and a 2-cm nodule, 9-cm apart from the anal verge, affecting 30% of the bowel circumference. In the laparoscopy, we found a posterior cul-de-sac retraction pocket associated with a large deep endometriosis nodule affecting the vagina and the rectum. In all cases, endometriosis was confirmed by histopathology, and in a 6-month follow-up, all patients showed improvement of bowel, pain, and neurologic symptoms.
CONCLUSION
Peritoneal pockets can have different clinical presentations. Depending on the topography and deepness of infiltration, they can be the cause of some neurologic symptoms associated with endometriosis pain. With this video, we try to encourage surgeons to totally excise these lesions and raise awareness about the adjacent key anatomic structures that can be affected.
Topics: Adult; Autopsy; Brazil; Dissection; Dysmenorrhea; Dyspareunia; Endometriosis; Female; Humans; Laparoscopy; Obturator Nerve; Pelvic Pain; Pelvis; Peritoneal Diseases; Peritoneum; Quality of Life
PubMed: 32474173
DOI: 10.1016/j.jmig.2020.05.020 -
Updates in Surgery Dec 2023Congenital inguinal hernia [CIH] can be treated laparoscopically using various methods documented in the literature. Many authors have recommended dividing the sac and... (Randomized Controlled Trial)
Randomized Controlled Trial
Congenital inguinal hernia [CIH] can be treated laparoscopically using various methods documented in the literature. Many authors have recommended dividing the sac and stitching peritoneal defects. Other studies claimed that peritoneal disconnection alone is sufficient. In this study, the feasibility, operative time, recurrence rate, and other postoperative complications of needlescopic disconnection of the CIH sac with or without peritoneal defect suturing were compared. A prospective controlled randomized trial was conducted between January 2020 and December 2022. Two hundred and thirty patients who met the study requirements were included. Patients were assigned at random to either Group A or Group B. A group of 116 patients (Group A) had needlescopic separation of the neck of the sac and peritoneal defect closure. The remaining 114 patients (Group B) underwent needlescopic separation without peritoneal defect closure (Sutureless group). A total of 260 hernial defects in 230 patients were repaired using needlescopic disconnection with or without suturing of the defect. There were 89 females (38.7%) and 141 males (61.3%), with a mean age of 5.14 ± 2.79 years. In Group A, the mean operation time was 27.98 ± 2.89 for a unilateral hernia and 37.29 ± 4.68 for a bilateral one, whereas, in Group B, the mean operation time was 20.37 ± 2.37 and 23.38 ± 2.22 for a unilateral and bilateral hernia, respectively. In terms of the operating time, whether unilateral or bilateral, there was a significant difference between the groups. There was no significant difference between groups A and B in the mean Internal Ring Diameter [IRD], which was 1.21 ± 0.18 cm in group A and 1.19 ± 0.11 cm in group B. Throughout the follow-up period, there was no postoperative hydrocele formation, recurrence, iatrogenic ascending of the testes, or testicular atrophy. All patients had nearly invisible scars with no keloid development at 3 months follow-up. Needlescopically separating the hernia sac without stitching the peritoneal defect is feasible, safe, and less invasive. It provides outstanding cosmetic results with a short operative time and no recurrence.
Topics: Male; Female; Humans; Child, Preschool; Child; Hernia, Inguinal; Laparoscopy; Prospective Studies; Sutureless Surgical Procedures; Peritoneum; Herniorrhaphy; Retrospective Studies; Recurrence; Treatment Outcome
PubMed: 37341905
DOI: 10.1007/s13304-023-01566-9 -
Chirurgia (Bucharest, Romania : 1990) 2014Minimally invasive approach for groin hernia treatment is still controversial, but in the last decade, it tends to become the standard procedure for one day surgery. We...
UNLABELLED
Minimally invasive approach for groin hernia treatment is still controversial, but in the last decade, it tends to become the standard procedure for one day surgery. We present herein the technique of laparoscopic Trans Abdominal Pre Peritoneal approach (TAPP). The surgical technique is presented step-by step;the different procedures key points (e.g. anatomic landmarks recognition, diagnosis of "occult" hernias, preperitoneal and hernia sac dissection, mesh placement and peritoneal closure) are described and discussed in detail, several tips and tricks being noted and highlighted.
CONCLUSIONS
TAPP is a feasible method for treating groin hernia associated with low rate of postoperative morbidity and recurrence. The anatomic landmarks are easily recognizable. The laparoscopic exploration allows for the treatment of incarcerated strangulated hernias and the intraoperative diagnosis of occult hernias.
Topics: Ambulatory Surgical Procedures; Feasibility Studies; Hernia, Inguinal; Humans; Laparoscopy; Peritoneum; Surgical Mesh; Treatment Outcome
PubMed: 24956350
DOI: No ID Found -
Obstetrics and Gynecology Sep 2011Endometriosis is a relatively common chronic gynecologic disorder that usually presents with chronic pelvic pain or infertility. The societal effect of this disorder is... (Review)
Review
Endometriosis is a relatively common chronic gynecologic disorder that usually presents with chronic pelvic pain or infertility. The societal effect of this disorder is enormous both in monetary costs and in quality of life. The diagnosis of the disease can only be definitively made with surgical intervention. Fertility may be enhanced with surgical intervention, but medical suppressive therapy has no role apart from in vitro fertilization. Assisted reproductive technology is associated with excellent outcomes. Management of endometriomas is particularly complex because surgical intervention may reduce ovarian reserve. Both medical and surgical treatment of endometriosis-associated chronic pelvic pain are effective in the short-term. Recurrence is common with both modalities. Recurrence after surgical intervention can be decreased with the use of postoperative suppressive medical therapy such as hormonal contraceptives. This article presents the different types of peritoneal disease found in endometriosis patients. The technique used to safely and completely remove the disease is discussed. The specific areas of involvement include the pelvic side wall, the cul-de-sac, and bladder peritoneum.
Topics: Adult; Drug Therapy, Combination; Endometriosis; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Laparoscopy; Pelvic Pain; Peritoneum; Pregnancy; Pregnancy Rate; Progestins
PubMed: 21860303
DOI: 10.1097/AOG.0b013e31822adfd1 -
Radiology Oct 1981Computed tomography (CT) was the primary diagnostic modality used in the evaluation of 14 patients with 15 surgically proved lesions of the lesser peritoneal sac. CT...
Computed tomography (CT) was the primary diagnostic modality used in the evaluation of 14 patients with 15 surgically proved lesions of the lesser peritoneal sac. CT accurately localized 14 of the 15 abnormalities to the lesser sac. When combined with clinical information, CT correctly suggested the preoperative diagnosis of 13 of 15 lesions. The lesser sac abnormalities included a variety of pathologic entities: pseudocysts, abscesses, hematomas, a perforated gastric ulcer, a biloma, and a malignant neoplasm. The CT anatomy of the normal and abnormal lesser sac is discussed, with emphasis on its various compartments and recesses.
Topics: Humans; Peritoneal Diseases; Peritoneum; Tomography, X-Ray Computed
PubMed: 7291515
DOI: 10.1148/radiology.141.1.7291515 -
Chirurgia (Bucharest, Romania : 1990) 2019Peritoneal encapsulation (PE) is a rare anatomic anomaly which occurs due to an accessory peritoneal sac covering the small bowel which can cause chronic recurrent...
Peritoneal encapsulation (PE) is a rare anatomic anomaly which occurs due to an accessory peritoneal sac covering the small bowel which can cause chronic recurrent abdominal pain and even small bowel obstruction, most often in children or patients with no previous surgical history. The diagnosis is usually made during surgery, but recently it has been suggested that mindful examination of the abdominal CT may be helpful in considering PE beforehand. We present the case of a 21-year old patient who was admitted due to intense abdominal pain, asymmetrical abdominal distension, air fluid levels on the abdominal X-ray, but no specific findings on the abdominal CT. He underwent emergency surgery and PE was found and the peritoneal sac was excised. The postoperative course was uneventful. Histopathologic examination of the specimen confirmed the diagnosis. PE is often misdiagnosed as abdominal cocoon or sclerosing encapsulating peritonitis, but it is a pathology with a much lower rate of recurrence and postoperative complications, which can be treated successfully if the surgeon is aware of this pathology when making the differential diagnosis.
Topics: Humans; Intestinal Obstruction; Intestine, Small; Male; Peritoneal Diseases; Peritoneum; Treatment Outcome; Young Adult
PubMed: 31060663
DOI: 10.21614/chirurgia.114.2.290 -
La Radiologia Medica 1988The peritoneum of the great abdominal cavity and its recesses are a blind radiographical area which can however be easily outlined by US when it contains fluid. The... (Review)
Review
The peritoneum of the great abdominal cavity and its recesses are a blind radiographical area which can however be easily outlined by US when it contains fluid. The anatomical study of these usually virtual cavities represents the purpose of this paper. The natural contrast of the peritoneal fluid as amplified by the mechanical effect produced by an adequate amount of fluid, allows a clear visualization of the anatomy of various peritoneal structures in either upper (subphrenic, subhepatic, lesser sac, etc.) or lower (pelvic) areas. The sovramesocolic and the infracolic compartments are in communication through the two external paracolic gutters which are the main passageways for the fluids between upper and lower compartments. In fact, peritoneal fluids are in constant movement due to different factors, such as gravity, statics, which causes the peritoneal fluids to flow into the lowest part of the peritoneal cavity, and hydrostatic pressure. Pressure differences are thought to convey fluids from various sites of the abdomen into different areas. In the lower abdomen, pressure is 3 times as much as in the upper abdomen, which causes the fluids to move into the subhepatic and subphrenic regions. The redistribution of fluids can be influenced by particular anatomical causes. The phrenicocolic ligament, eg, is a barrier to the advancing of fluids along the left paracolic gutter, which makes the right paracolic gutter the main passageway for the fluids. This pattern explains why abscesses are more frequent in the right than in the upper left abdominal regions. Another example is the tiny Winslow opening, which does not allow inflammatory material to pass into the lesser sac in case of inflammatory processes of the great peritoneal cavity and vice versa. Moreover, pointing out fluid collections and abscesses is important, since an early diagnosis and a topographic map are essential in order to plan treatment.
Topics: Humans; Peritoneal Cavity; Peritoneum; Ultrasonography
PubMed: 3279472
DOI: No ID Found -
Radiation Medicine 1994We evaluated the preoperative CT findings in 10 patients with colon carcinoma in whom peritoneal metastases had been surgically confirmed. Seven patients lacked ascites....
We evaluated the preoperative CT findings in 10 patients with colon carcinoma in whom peritoneal metastases had been surgically confirmed. Seven patients lacked ascites. No CT findings suggestive of peritoneal metastasis were observed in two patients without ascites even by retrospective evaluation. A large mass was observed in the cul-de-sac in another. In the remaining four patients, small peritoneal metastases ranging from 8 to 11 mm in diameter were observed at the omentum in two, along the falciform ligament in one, and at both the omentum and the iliac fossa in one; three of these patients had received no prospective diagnosis of peritoneal metastasis prior to the surgery. In patients with advanced colon carcinoma with suspected serosal invasion, the entire peritoneal cavity should be carefully examined and interpreted using CT in order to detect small peritoneal implants even when ascites is absent.
Topics: Aged; Ascites; Carcinoma; Colonic Neoplasms; Contrast Media; Diatrizoate Meglumine; Female; Humans; Incidence; Iodides; Ligaments; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Omentum; Peritoneal Cavity; Peritoneal Neoplasms; Preoperative Care; Prospective Studies; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 7863026
DOI: No ID Found