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Frontiers in Surgery 2023Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal...
BACKGROUND
Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal trauma, or congenital disorders. Here, we describe the microsurgical technique of multivisceral transplantation of pelvic organs, including the pelvic floor, in rats.
DONOR OPERATION
We performed a perineal (including the genitalia, anus, muscles, and ligaments) and abdominal incision. The dissection progressed near the pelvic ring, dividing ligaments, muscles, external iliac vessels, and pudendal nerves, allowing pelvic floor mobilization. The aorta and vena cava were isolated distally, preserving the internal iliac and gonadal vessels. The graft containing the skin, muscles, ligaments, bladder, ureter, rectum, anus and vagina, uterus and ovarian (female), or penile, testis and its ducts (male) was removed , flushed, and cold-stored.
RECIPIENT OPERATION
The infrarenal aorta and vena cava were isolated and donor/recipient aorta-aorta and cava-cava end-to-side microanastomoses were performed. After pelvic floor and viscera removal, we performed microanastomoses between the donor and the recipient ureter, and the rectum and pudenda nerves. The pelvic floor was repositioned in its original position (orthotopic model) or the abdominal wall (heterotopic model). We sacrificed the animals 2 h after surgery.
RESULTS
We performed seven orthotopic and four heterotopic transplantations. One animal from the orthotopic model and one from the heterotopic model died because of technical failure. Six orthotopic and three heterotopic recipients survived up to 2 h after transplantation.
CONCLUSION
The microsurgical technique for pelvic floor transplantation in rats is feasible, achieving an early survival rate of 81.82%.
PubMed: 37151860
DOI: 10.3389/fsurg.2023.1086651 -
Cureus Mar 2023Gallbladder volvulus is a very rare complication of a congenital defect in gallbladder development also known as a "floating" gallbladder and often presents in the...
Gallbladder volvulus is a very rare complication of a congenital defect in gallbladder development also known as a "floating" gallbladder and often presents in the elderly. Proposed aetiologies include loss of abdominal fat and kyphoscoliosis. We present a patient with severe lumbar scoliosis centred on L2, producing a lumbar vertebral distortion of about 30 degrees concave to the right, resulting in right hemiabdomen volume loss. The mechanical interaction between the gallbladder fundus and compressed viscera transmits abnormal ambulatory forces from the distorted right pelvic brim into the abdomen predisposing to gallbladder torsion. Laparoscopic cholecystectomy was performed without complication and the patient had an uneventful recovery. This case demonstrates the challenges of diagnosing gallbladder torsion preoperatively. A high level of clinical suspicion is vital especially in elderly patients to enable timely surgical intervention to reduce morbidity and mortality.
PubMed: 37065367
DOI: 10.7759/cureus.36256 -
Cureus Feb 2023Seat belts with shoulder restraints have decreased the frequency of life-threatening severe chest trauma caused by car accidents. However, the introduction of seat belt...
Seat belts with shoulder restraints have decreased the frequency of life-threatening severe chest trauma caused by car accidents. However, the introduction of seat belt legislation has led to an increase in a specific pattern of blunt trauma known as seat belt syndrome, which includes rib, clavicle, spine, and sternum fractures, as well as rupture of hollow pelvic and abdominal viscera, mesenteric tears, and major vessel injuries. The shoulder restraint part of the three-point seat belt commonly rests near or over the female and male breast. A 54-year-old female presented to our emergency department complaining of swelling and pain in her left breast immediately after a traffic accident. The patient had used a seat belt with a shoulder restraint. Bruising was noted along her chest where there had been seat belt contact. Her breast hematoma was most likely caused by breast tissue compression between her rib and the seat belt. Contrast-enhanced computed tomography demonstrated a sizable breast hematoma with active arterial contrast material extravasation, as well as multiple left rib fractures. The patient was conservatively treated with analgesic and anti-inflammatory drugs. Complete resolution was achieved, and her breast returned to its normal appearance. Although endovascular treatment and surgical hemostasis have been proposed for the treatment of breast injuries with active bleeding, conservative treatment such as compression hemostasis may be feasible.
PubMed: 36994269
DOI: 10.7759/cureus.35440 -
Bioengineering (Basel, Switzerland) Mar 2023The pelvic floor is a bowl-shaped complex of multiple muscles and fascia, which functions to support the pelvic organs, and it aids in controlling continence. In pelvic...
BACKGROUND
The pelvic floor is a bowl-shaped complex of multiple muscles and fascia, which functions to support the pelvic organs, and it aids in controlling continence. In pelvic floor disease, this complex becomes weakened or damaged leading to urinary, fecal incontinence, and pelvic organ prolapse. It is unclear whether the position of the body impacts the forces on the pelvic floor.
PURPOSE
The primary objective of this work is to measure force applied to the pelvic floor of a cadaver in sitting, standing, supine, and control positions. The secondary objective is to map the forces across the pelvic floor.
METHODS
An un-embalmed female cadaver without pelvic floor dysfunction was prepared for pelvic floor pressure measurement using a pressure sensory array placed on top of the pelvic floor, and urodynamic catheters were placed in the hollow of the sacrum, the retropubic space, and at the vaginal apex. Pressure measurements were recorded with the cadaver in the supine position, sitting cushioned without external pelvic floor support, and standing. Pressure array data were analyzed along with imaging of the cadaver. Together, these data were mapped into a three-dimensional reconstruction of the pressure points in pelvic floor and corresponding pelvic organs.
RESULTS
pressures were higher at the symphysis than in the hollow of the sacrum in the standing position. Pressure array measurements were lowest in the standing position and highest in the sitting position. Three-dimensional reconstruction confirmed the location and accuracy of our measurements.
CONCLUSIONS
The findings of increased pressures behind the symphysis are in line with the higher incidence of anterior compartment prolapse. Our findings support our hypothesis that the natural shape and orientation of the pelvis in the standing position shields the pelvic floor from downward forces of the viscera.
PubMed: 36978720
DOI: 10.3390/bioengineering10030329 -
Anatomical Science International Jul 2023The purpose of this review is to present our researches on the pelvic outlet muscles, including the pelvic floor and perineal muscles, which are responsible for urinary... (Review)
Review
The purpose of this review is to present our researches on the pelvic outlet muscles, including the pelvic floor and perineal muscles, which are responsible for urinary function, defecation, sexual function, and core stability, and to discuss the insights into the mechanism of pelvic floor stabilization based on the findings. Our studies are conducted using a combination of macroscopic examination, immunohistological analysis, 3D reconstruction, and imaging. Unlike most previous reports, this article describes not only on skeletal muscle but also on smooth muscle structures in the pelvic floor and perineum to encourage new understanding. The skeletal muscles of the pelvic outlet are continuous, which means that they share muscle bundles. They form three muscle slings that pass anterior and posterior to the anal canal, thus serving as the foundation of pelvic floor support. The smooth muscle of the pelvic outlet, in addition to forming the walls of the viscera, also extends in three dimensions. This continuous smooth muscle occupies the central region of the pelvic floor and perineum, thus revising the conventional understanding of the perineal body. At the interface between the levator ani and pelvic viscera, smooth muscle forms characteristic structures that transfer the lifting power of the levator ani to the pelvic viscera. The findings suggest new concepts of pelvic floor stabilization mechanisms, such as dynamic coordination between skeletal and smooth muscles. These two types of muscles possibly coordinate the direction and force of muscle contraction with each other.
Topics: Pelvic Floor; Perineum; Muscle, Skeletal; Muscle, Smooth; Anal Canal
PubMed: 36961619
DOI: 10.1007/s12565-023-00717-7 -
Cureus Feb 2023Internal hernias result from abdominal viscera protruding through a congenital or acquired defect in the peritoneum or the mesentery of the abdominal cavity. They are...
Internal hernias result from abdominal viscera protruding through a congenital or acquired defect in the peritoneum or the mesentery of the abdominal cavity. They are less common than external hernias, and the overall incidence is rare. Internal hernias carry a high mortality rate if there is no immediate surgical intervention and can lead to complications such as bowel perforation, ischemia, and necrosis. There are multiple classifications, and a rare subtype identified in only a select few cases involves the fallopian tube. This case documents the development of a cecal volvulus due to the cecum herniating through an aperture created by a normal-appearing fallopian tube attaching to the retroperitoneum. A 78-year-old female with multiple comorbidities was admitted for abdominal pain lasting 3-4 days, nausea, emesis, and poor oral tolerance. Computerized tomography imaging revealed a complete large bowel obstruction secondary to a cecal volvulus, and she was taken emergently for an exploratory laparotomy. Intra-operatively, a distended cecum was noted, herniated through a loop created by the right fallopian tube tethering its free end to the left pelvis. Upon decompression of the bowel, the fallopian tube released itself from the retroperitoneum. The cecum and right fallopian tube were noted to be ischemic and resected with an ileo-transverse anastomosis. Internal hernias that involve the fallopian tubes are a rare variation of an already uncommon condition. However, they should be included in the differential diagnosis when evaluating a female patient for intestinal obstruction since it can develop into a life-threatening condition that requires prompt surgical attention.
PubMed: 36938219
DOI: 10.7759/cureus.34943