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American Journal of Kidney Diseases :... Nov 2010Peritoneal dialysis outflow failure caused by omental wrapping is a serious complication that is difficult to diagnose noninvasively. We report a case of outflow failure...
Peritoneal dialysis outflow failure caused by omental wrapping is a serious complication that is difficult to diagnose noninvasively. We report a case of outflow failure in which catheterography showed several characteristics of omental wrapping: "pseudocele" formation, delayed catheter emptying, and uneven distribution of contrast in the abdominal cavity. A laparoscopic procedure was performed with identification of peritoneal adhesion and greater omental wrapping. The catheter was stripped from the omentum and repositioned in the Douglas peritoneal sac. Catheterography is a reliable, safe, noninvasive, and inexpensive alternative procedure to diagnose outflow failure caused by omental wrapping.
Topics: Catheters, Indwelling; Diagnosis, Differential; Equipment Failure; Humans; Kidney Failure, Chronic; Laparoscopy; Male; Middle Aged; Omentum; Peritoneal Cavity; Peritoneal Dialysis; Radiography, Abdominal; Tissue Adhesions
PubMed: 20630641
DOI: 10.1053/j.ajkd.2010.03.034 -
Surgical and Radiologic Anatomy : SRA May 2012Accessory peritoneal sac and cystoduodenal ligament as peritoneal variations were observed in a cadaver in our laboratory. Slender stomach, thin transverse colon,...
Accessory peritoneal sac and cystoduodenal ligament as peritoneal variations were observed in a cadaver in our laboratory. Slender stomach, thin transverse colon, redundant sigmoid colon, absent ascending colon and doubly distended gall bladder were also reported in the same cadaver. Relevant anatomical and clinical implications are discussed.
Topics: Adult; Cadaver; Gallbladder; Gastrointestinal Tract; Humans; Ligaments; Male; Peritoneal Cavity
PubMed: 21984195
DOI: 10.1007/s00276-011-0877-8 -
International Journal of Surgical... Aug 2021Atypical cells in peritoneal clefts are usually either reactive mesothelial cells or pT4 colonic adenocarcinoma in colon specimen removed for primary colon cancer....
Atypical cells in peritoneal clefts are usually either reactive mesothelial cells or pT4 colonic adenocarcinoma in colon specimen removed for primary colon cancer. However, rarely if ever are these atypical cells metastasis from other primary visceral malignancy due to "sac-like" anatomic structure of this area. We present a case where these atypical cells were determined to be metastasis of gynecological origin by judicious use of immunohistochemical stains. A final diagnosis of serous tubal intraepithelial carcinoma of right fallopian tube was diagnosed only after total abdominal hysterectomy bilateral salpingo-oophorectomy. To our knowledge, this is the first report of a serous tubal intraepithelial carcinoma presenting as stage 4 colonic adenocarcinoma. The importance of this interesting case is 2-fold. It highlights the peritoneal cleft as an anatomic region not often recognized or discussed as well as tumor presentation in this region. In addition, this example stresses the need for additional mesothelial markers in addition to WT-1 workup of atypical mesothelial proliferation.
Topics: Colorectal Neoplasms; Cystadenocarcinoma, Serous; Diagnosis, Differential; Fallopian Tube Neoplasms; Fallopian Tubes; Female; Humans; Hysterectomy; Incidental Findings; Middle Aged; Peritoneal Neoplasms; Peritoneum; Salpingo-oophorectomy
PubMed: 33455512
DOI: 10.1177/1066896920988346 -
Medical Ultrasonography Dec 2010
Topics: Diagnosis, Differential; Humans; Middle Aged; Neoplasms; Peritoneal Cavity; Ultrasonography
PubMed: 21210024
DOI: No ID Found -
American Journal of Clinical Pathology Jan 1994Two yolk sac tumors that arose in the mesentery of the jejunum and the mesentery of the transverse colon of two male patients, aged 2 and 17 years, are reported. Both... (Review)
Review
Two yolk sac tumors that arose in the mesentery of the jejunum and the mesentery of the transverse colon of two male patients, aged 2 and 17 years, are reported. Both patients had abdominal masses. The tumors measured 9 and 11 cm in maximum dimension. One of them grew into the bowel lumen. Microscopically, both neoplasms exhibited several of the typical patterns of yolk sac tumor and stained immunohistochemically for alpha-fetoprotein. Both patients received chemotherapy postoperatively and are alive, but follow-up is short. The subject of extragonadal yolk sac tumors is reviewed, and histogenetic implications of their occasional origin in the mesentery is discussed.
Topics: Adolescent; Child, Preschool; Endodermal Sinus Tumor; Humans; Male; Mesentery; Peritoneal Neoplasms; alpha-Fetoproteins
PubMed: 7506478
DOI: 10.1093/ajcp/101.1.42 -
Okajimas Folia Anatomica Japonica Apr 1962
Topics: Humans; Intestine, Small; Intestines; Peritoneum
PubMed: 13964150
DOI: 10.2535/ofaj1936.38.3-4_175 -
Journal of Minimally Invasive Gynecology 2009Pelvic pain is a common symptom in women of reproductive age. Acute pelvic pain with rapid onset demands prompt diagnosis and treatment. We report the case of a patient...
Pelvic pain is a common symptom in women of reproductive age. Acute pelvic pain with rapid onset demands prompt diagnosis and treatment. We report the case of a patient with ovarian incarceration of acute onset. To our knowledge, this is the first report of ovarian incarceration into the pelvic peritoneal sac in a woman of reproductive age. In the present case, laparoscopy was useful in establishing the cause of pelvic pain. The patient reported severe lower right quadrant abdominal pain of sudden onset. At laparoscopic examination, the right fallopian tube was normal; however, the right ovary was not initially visible at the normal site. After the swollen right ovarian ligament was pulled aside using nontraumatic laparoscopic forceps, we were able to detect incarceration of the right ovary into the peritoneal sac in the medial to right uterosacral ligament. This case is unique because of ovarian incarceration into the peritoneal fenestration. We believe this condition was congenital because there was no other cause such as previous surgery, severe endometriosis, or pelvic inflammatory diseases.
Topics: Abdomen, Acute; Adult; Female; Hernia; Humans; Laparoscopy; Ovarian Diseases; Pelvic Pain; Peritoneum; Tomography, X-Ray Computed; Torsion Abnormality
PubMed: 19835814
DOI: 10.1016/j.jmig.2009.06.006 -
Journal of Pediatric Urology Jun 2018Inguinal hernias are common in infants and children. While the gold standard for hernia repair in the pediatric period has been via an open inguinal incision with...
INTRODUCTION
Inguinal hernias are common in infants and children. While the gold standard for hernia repair in the pediatric period has been via an open inguinal incision with dissection and high ligation of the hernia sac, over the past two decades laparoscopic herniorrhaphy has increased in popularity. The advantages of laparoscopy include decreased post-operative pain, improved cosmetic results, ability to easily assess the contralateral side for an open internal inguinal ring, and decreased risk of metachronous hernias. Herein, we describe a modified laparoscopic herniorrhaphy using a peritoneal leaflet closure and report our operative experience with intermediate-term results.
METHODS
We retrospectively reviewed our IRB-approved registry for all children who underwent initial laparoscopic herniorrhaphy at our tertiary care center over a 2.5-year period. All surgeries were performed by a single surgeon using a technique we have termed the peritoneal leaflet closure. This technique involves incising the peritoneum circumferentially around the open internal ring and developing peritoneal leaflets which are then closed together over the ring with a running non-absorbable barbed stitch (Figure). Intraoperative findings and complications, operative times, and post-operative complications were reviewed for all children.
RESULTS
A total of 50 initial laparoscopic hernia repairs (4 bilateral, 42 unilateral) were performed in 46 children (43 boys, 3 girls) at a median age of 5.9 years (range 0.5-16.7). Median operative time was 73 min (range 48-138) for unilateral and 106 min (range 104-135) for bilateral herniorrhaphy. No patient had an intraoperative complication. Two children (4%) had contralateral open rings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. All patients went home on the same day as the procedure and three children (6%) had minor post-operative complaints (umbilical bulge, thigh pain, and urine holding) that all self-resolved. Thirty-nine children had follow-up data available. Intermediate-term complications occurred in two children (5%): one boy developed a contralateral hydrocele (despite a closed ring at surgery) and one boy had a hernia recurrence that required open repair. Overall, operative success with the modified peritoneal leaflet closure technique was therefore 97% (38 of 39 children with follow-up). All 37 boys who followed up had bilateral descended testes of normal size and consistency.
CONCLUSIONS
Laparoscopic herniorrhaphy using a peritoneal leaflet closure technique is safe and effective when used in infants and children to close an indirect hernia (i.e. patent processus vaginalis). No intraoperative complications occurred in this cohort and success rate was 97%.
Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Laparoscopy; Male; Operative Time; Peritoneum; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 29958645
DOI: 10.1016/j.jpurol.2018.02.015 -
The Journal of Emergency Medicine Aug 2018Evisceration of umbilical hernias is an uncommon occurrence whereby the hernial contents break through the skin overlying the sac and skin. Irrespective of cause, sudden... (Review)
Review
BACKGROUND
Evisceration of umbilical hernias is an uncommon occurrence whereby the hernial contents break through the skin overlying the sac and skin. Irrespective of cause, sudden evisceration of an umbilical hernia is associated with deterioration and a poor outcome.
CASE REPORTS
Our first case was a 42-year-old woman who presented with sudden outpouring of fluid from the umbilicus with omental evisceration. Further evaluation revealed hepatic decompensation caused by hepatitis C infection belonging to Child-Turcotte-Pugh class C. After stabilizing her hemodynamically, she underwent a partial omentectomy with primary repair of umbilical defect. The patient's postoperative course was challenging. She died of septicemia and acute renal failure after 5 days. Our second case was a 40-year-old man who suffered from alcohol-induced cirrhosis, presenting with omental evisceration, belonging to Child-Turcotte-Pugh class C. We performed a primary repair of the hernial defect with peritoneovenous shunting for his intractable ascites. Upper gastrointestinal endoscopy revealed grade I esophageal varices. The patient succumbed to acute variceal hemorrhage with acute renal failure 18 days later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In an emergent setting with multiple factors influencing final surgical outcome, it is imperative that management be tailored for each patient. Those with severe encephalopathy or cardiovascular instability must be stabilized before surgical intervention. Central venous and blood pressures need to be closely monitored during resuscitation, as fervent fluid administration may predispose to variceal hemorrhage. It may be prudent to follow the principle of hypotensive resuscitation as in acute trauma cases.
Topics: Adult; Female; Hernia, Umbilical; Humans; Male; Omentum; Rupture, Spontaneous
PubMed: 29793813
DOI: 10.1016/j.jemermed.2018.04.036 -
Radiology Mar 2005To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging in depicting posterior cul-de-sac obliteration in patients with endometriosis.
PURPOSE
To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging in depicting posterior cul-de-sac obliteration in patients with endometriosis.
MATERIALS AND METHODS
Institutional review board approval was not required for this retrospective study, but informed consent was obtained from all patients. MR images obtained between January 1989 and December 2000 in 57 women (mean age, 39 years; age range, 26-52 years) with histologically confirmed endometriosis were retrospectively evaluated by four radiologists independently. All patients underwent laparotomy or laparoscopy less than 1 month after MR imaging. MR images were evaluated for the presence and location of endometrial implants and adhesions. MR images were also scored for the presence of five findings: retroflexed uterus, elevated posterior vaginal fornix, intestinal tethering or tethered appearance of rectum in direction of uterus, faint strands between uterus and intestine, and fibrotic plaque or nodule covering serosal surface of the uterus. Interobserver agreement for each of the five findings and for the overall diagnosis of cul-de-sac obliteration was calculated. Sensitivity, specificity, accuracy, positive and negative predictive values, and kappa statistics were determined.
RESULTS
Laparotomy or laparoscopy revealed posterior cul-de-sac obliteration in 30 patients. Overall, the four radiologists had mean accuracies of 89.0% and 76.3% for diagnosing endometrial implants and adhesions, respectively, at MR imaging. Overall, the radiologists achieved mean sensitivity, specificity, accuracy, and positive and negative predictive values of 68.4%, 76.0%, 71.9%, 76.6%, and 68.5%, respectively, in diagnosing posterior cul-de-sac obliteration. The best accuracy (mean value, 64.5%) was obtained with the finding of fibrotic plaque in the uterine serosal surface. Readers agreed on the observations 63.2%-91.2% of the time. For the impression of the presence or absence of posterior cul-de-sac obliteration, interobserver agreement varied between substantial and moderate: Mean interobserver agreement was 78.4% (range, 70.2%-84.2%), and mean kappa was 0.57 (range, 0.40-0.67). Mean accuracy of MR imaging for diagnosing posterior cul-de-sac obliteration was 71.9%.
CONCLUSION
These results suggest that use of the described MR imaging findings may enable diagnosis of posterior cul-de-sac obliteration.
Topics: Adult; Contrast Media; Douglas' Pouch; Endometriosis; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Middle Aged; Peritoneal Diseases; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity
PubMed: 15665220
DOI: 10.1148/radiol.2343031366