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Anaesthesiology Intensive Therapy 2015Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open... (Review)
Review
Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure.
Topics: Abdomen; Abdominal Cavity; Humans; Intra-Abdominal Hypertension; Laparotomy; Lower Body Negative Pressure
PubMed: 25973658
DOI: 10.5603/AIT.a2015.0023 -
California Medicine Apr 1949Spontaneous pneumoperitoneum most often occurs following ruptured peptic ulcer. In 80 to 85 per cent of cases of perforated ulcers, free intraperitoneal air is...
Spontaneous pneumoperitoneum most often occurs following ruptured peptic ulcer. In 80 to 85 per cent of cases of perforated ulcers, free intraperitoneal air is demonstrable. There have been reported three cases in which air was present without demonstrable cause, without peritoneal irritation or peritonitis. This presentation adds a fourth. Examination of a patient with acute disease of the abdomen should include not only a roentgenogram with the patient supine but films made in the left lateral decubitus position and/or upright position to demonstrate free air. The radiologist should be ready and willing to consult with the surgeon at the time of examination. Attention is called to a sign described recently by Rigler in supine films, namely, the visibility of both the inside and the outside of the intestinal lumen. Another sign in the supine film, namely the contrast of air against the peritoneal reflections, is described.
Topics: Abdomen; Abdominal Cavity; Acute Disease; Humans; Injections, Intraperitoneal; Peptic Ulcer; Peritoneum; Peritonitis; Physical Examination; Pneumoperitoneum
PubMed: 18116231
DOI: No ID Found -
Abdominal Imaging Apr 2015Many diseases cause substantial changes in the mechanical properties of tissue, and this provides motivation for developing methods to noninvasively assess the stiffness... (Review)
Review
Many diseases cause substantial changes in the mechanical properties of tissue, and this provides motivation for developing methods to noninvasively assess the stiffness of tissue using imaging technology. Magnetic resonance elastography (MRE) has emerged as a versatile MRI-based technique, based on direct visualization of propagating shear waves in the tissues. The most established clinical application of MRE in the abdomen is in chronic liver disease. MRE is currently regarded as the most accurate noninvasive technique for detection and staging of liver fibrosis. Increasing experience and ongoing research is leading to exploration of applications in other abdominal organs. In this review article, the current use of MRE in liver disease and the potential future applications of this technology in other parts of the abdomen are surveyed.
Topics: Abdominal Cavity; Digestive System Diseases; Elasticity Imaging Techniques; Female; Humans; Kidney; Kidney Diseases; Liver; Liver Cirrhosis; Liver Diseases; Magnetic Resonance Imaging; Pancreas; Pancreatic Diseases; Spleen; Splenic Diseases; Uterine Diseases; Uterus
PubMed: 25488346
DOI: 10.1007/s00261-014-0315-6 -
World Journal of Surgery Dec 2020Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid... (Observational Study)
Observational Study
BACKGROUND
Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen.
MATERIALS AND METHODS
A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed.
RESULTS
A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero-atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non-NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non-NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non-NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively.
CONCLUSION
We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero-atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.
Topics: Abdomen; Abdominal Cavity; Abdominal Wound Closure Techniques; Adult; Aged; Digestive System Surgical Procedures; Female; Fluid Therapy; Humans; Male; Middle Aged; Negative-Pressure Wound Therapy; Prospective Studies; Sepsis; Surgical Wound Infection; Treatment Outcome
PubMed: 32833107
DOI: 10.1007/s00268-020-05728-3 -
Radiographics : a Review Publication of... 2017Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most... (Review)
Review
Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most common in the extremities, trunk wall, retroperitoneum, and head and neck. In the adult population, soft-tissue sarcomas arising in the abdomen and pelvis are often large masses at the time of diagnosis because they are usually clinically silent or cause vague or mild symptoms until they invade or compress vital organs. In contrast, soft-tissue sarcomas arising from the abdominal wall come to clinical attention earlier in the course of disease because they cause a palpable mass, abdominal wall deformity, or pain that is more clinically apparent. The imaging features of abdominal and pelvic sarcomas and abdominal wall sarcomas can be nonspecific and overlap with more common pathologic conditions, making diagnosis difficult or, in some cases, delaying diagnosis. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor (GIST) are the most common intra-abdominal primary sarcomas. Any soft-tissue sarcoma can arise in the abdominal wall. Knowledge of the classification and pathologic features of soft-tissue sarcomas, the anatomic locations where they occur, and their cross-sectional imaging features helps the radiologist establish the diagnosis or differential diagnosis so that patients with soft-tissue sarcomas can receive optimal treatment and management. In part 1 of this article, the most common soft-tissue sarcomas (liposarcoma, leiomyosarcoma, and GIST) are reviewed, with a discussion on anatomic locations, classification, clinical considerations, and differential diagnosis. Part 2 will focus on the remainder of the soft-tissue sarcomas occurring in the abdomen and pelvis.
Topics: Abdominal Cavity; Diagnosis, Differential; Humans; Pelvis; Sarcoma; Soft Tissue Neoplasms
PubMed: 28287938
DOI: 10.1148/rg.2017160157 -
Aesthetic Surgery Journal May 2023Abdominal high-definition liposuction has been practiced for many years. However, problems such as low-lying, "sad-looking" umbilici and lower abdominal "pooches" remain...
BACKGROUND
Abdominal high-definition liposuction has been practiced for many years. However, problems such as low-lying, "sad-looking" umbilici and lower abdominal "pooches" remain unresolved. Additionally, the waistline, as the pivotal point connecting the chest and hips, deserves more attention and improvement.
OBJECTIVES
The aim of this study was to use polydioxanone (PDO) threads after liposuction: (1) to improve the shape and position of the umbilicus permanently; (2) to tighten the lower abdomen permanently; and (3) to redefine "high-definition" liposuction.
METHODS
All patients underwent high-definition liposuction of the abdomen and waist. After liposuction, bidirectional, barbed PDO threads were placed in the upper central abdomen. The threads were pulled to cinch the upper abdominal skin and then tied. The resulting umbilicus elevation was measured for up to 12 months. Higher waistlines were also created to match higher-positioned umbilici.
RESULTS
Fifty-two female subjects were included. The range of umbilicus elevation at 12 months was 0.8 to 3.6 cm. Most umbilici were converted to vertical orientation, and lower abdomens became lengthened, flattened, and tightened. Moreover, the enhanced waistlines and body curves created better body proportions.
CONCLUSIONS
This technique results in permanent elevation and shape enhancement of both umbilicus and lower abdomen. In addition, because the umbilicus is raised, a higher waistline can be created without any discordance, making the lower limbs appear longer. Overall, the maneuvers contributed to the restoration/rejuvenation of the abdomen and created a better overall body shape and proportion.
Topics: Humans; Female; Umbilicus; Lipectomy; Polydioxanone; Abdomen; Abdominal Cavity; Abdominal Wall
PubMed: 35977112
DOI: 10.1093/asj/sjac232 -
Einstein (Sao Paulo, Brazil) 2016There is a growing request for measuring intra-abdominal pressure in critically ill patients with acute abdominal pain to be clarified. Summarizing the research results... (Review)
Review
There is a growing request for measuring intra-abdominal pressure in critically ill patients with acute abdominal pain to be clarified. Summarizing the research results on measurement of vesical intra-abdominal pressure and analyzing the level of evidence were the purposes of this integrative literature review, carried out based on the databases LILACS, MEDLINE and PubMed, from 2005 to July 2012. Twenty articles were identified, in that, 12 literature reviews, 4 descriptive and exploratory studies, 2 expert opinions, one prospective cohort study and one was an experience report. The vesical intra-abdominal pressure measurement was considered gold standard. There are variations in the technique however, but some common points were identified: complete supine position, in absence of abdominal contracture, in the end of expiration and expressed in mmHg. Most research results indicate keeping the transducer zeroed at the level of the mid-axillary line at the iliac crest level, and instill 25mL of sterile saline. Strong evidence must be developed. RESUMO Em pacientes críticos com quadros abdominais agudos a esclarecer é crescente a solicitação da aferição da pressão intra-abdominal. Sintetizar resultados de pesquisas sobre a mensuração da pressão intra-abdominal pela via vesical e analisar o nível de evidência foram os objetivos desta revisão integrativa da literatura, realizada nas bases LILACS, MEDLINE e PubMed, no período de 2005 a julho de 2012. Identificaram-se 20 artigos, sendo 12 revisões de literatura, 4 estudos exploratório-descritivos, 2 opiniões de especialistas, 1 estudo de coorte prospectivo e 1 relato de experiência. O método vesical para mensuração da pressão intra-abdominal foi considerado padrão-ouro. Existem variações na técnica, entretanto pontos em comum foram identificados: posição supina completa, na ausência de contratura abdominal, ao final da expiração e expressa em mmHg. A maioria indica posicionar o ponto zero do transdutor na linha axilar média, ao nível da crista ilíaca e instilar 25ml de solução salina estéril. Evidências fortes precisam ser desenvolvidas.
Topics: Abdominal Cavity; Humans; Intra-Abdominal Hypertension; Medical Illustration; Monitoring, Physiologic; Pressure; Sodium Chloride; Urinary Catheterization
PubMed: 26958978
DOI: 10.1590/S1679-45082016RW3088 -
Journal of Leukocyte Biology Apr 2021The peritoneal cavity is a fluid filled space that holds most of the abdominal organs, including the omentum, a visceral adipose tissue that contains milky spots or... (Review)
Review
The peritoneal cavity is a fluid filled space that holds most of the abdominal organs, including the omentum, a visceral adipose tissue that contains milky spots or clusters of leukocytes that are organized similar to those in conventional lymphoid tissues. A unique assortment of leukocytes patrol the peritoneal cavity and migrate in and out of the milky spots, where they encounter Ags or pathogens from the peritoneal fluid and respond accordingly. The principal role of leukocytes in the peritoneal cavity is to preserve tissue homeostasis and secure tissue repair. However, when peritoneal homeostasis is disturbed by inflammation, infection, obesity, or tumor metastasis, specialized fibroblastic stromal cells and mesothelial cells in the omentum regulate the recruitment of peritoneal leukocytes and steer their activation in unique ways. In this review, the types of cells that reside in the peritoneal cavity, the role of the omentum in their maintenance and activation, and how these processes function in response to pathogens and malignancy will be discussed.
Topics: Adaptive Immunity; Animals; Humans; Immunity; Immunity, Innate; Omentum; Peritoneal Cavity
PubMed: 32881077
DOI: 10.1002/JLB.5MIR0720-271RR -
The Lancet. Child & Adolescent Health Jun 2021This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and... (Comparative Study)
Comparative Study Review
This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging.
Topics: Abdominal Cavity; Clinical Decision-Making; Congenital Abnormalities; Female; Gestational Age; Head and Neck Neoplasms; Humans; Imaging, Three-Dimensional; Infant; Infant, Newborn; Magnetic Resonance Imaging; Pregnancy; Prenatal Care; Prenatal Diagnosis; Prognosis; Radiology; Spinal Diseases; Thoracic Diseases; Ultrasonography, Prenatal; Urologic Diseases; Video Recording
PubMed: 33721554
DOI: 10.1016/S2352-4642(20)30313-8 -
Anaesthesiology Intensive Therapy 2015The intra-abdominal pressure (IAP) measurement is a key to diagnosing and managing critically ill medical and surgical patients. There are an increasing number of... (Review)
Review
The intra-abdominal pressure (IAP) measurement is a key to diagnosing and managing critically ill medical and surgical patients. There are an increasing number of techniques that allow us to measure the IAP at the bedside. This paper reviews these techniques. IAP should be measured at end-expiration, with the patient in the supine position and ensuring that there is no abdominal muscle activity. The intravesicular IAP measurement is convenient and considered the gold standard. The level where the mid-axillary line crosses the iliac crest is the recommended zero reference for the transvesicular IAP measurement; moreover, marking this level on the patient increases reproducibility. Protocols for IAP measurement should be developed for each ICU based on the locally available tools and equipment. IAP measurement techniques are safe, reproducible and accurate and do not increase the risk of urinary tract infection. Continuous IAP measurement may offer benefits in specific situations in the future. In conclusion, the IAP measurement is a reliable and essential adjunct to the management of patients at risk of intra-abdominal hypertension.
Topics: Abdominal Cavity; Critical Illness; Humans; Intensive Care Units; Intra-Abdominal Hypertension; Patient Positioning; Point-of-Care Systems; Reproducibility of Results
PubMed: 25973661
DOI: 10.5603/AIT.a2015.0025