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BMC Surgery Mar 2021Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported...
BACKGROUND
Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far.
CASE PRESENTATION
This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up.
CONCLUSION
To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).
Topics: Abdomen; Aged; Cerebrospinal Fluid; Cysts; Drainage; Female; Hemorrhage; Humans; Hydrocephalus; Laparoscopy; Postoperative Complications; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt
PubMed: 33743657
DOI: 10.1186/s12893-021-01161-y -
Acta Veterinaria Scandinavica Feb 2020Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations...
BACKGROUND
Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations have not been described previously in canine patients and neither has the use of immunohistochemistry to determine their origin, i.e. vascular versus lymphatic.
CASE PRESENTATION
An 8-year-old neutered female Cocker spaniel was referred for pollakiuria, dysuria and a painful abdomen. Computed tomography scanning of the abdomen showed a fluid filled structure adjacent to the urinary bladder. During surgical exploration, a thin walled cystic structure with sero-haemorrhagic fluid was found, extending from the retroperitoneal space into the abdomen. The mass was excised and submitted for histopathology, revealing a cystic mass lined by a fibrovascular capsule within the retroperitoneal/mesenteric adipose tissue. The inner surface of the cyst was lined by a single layer of bland, flattened spindle cells. Intramural blood vessels were well differentiated, with perivascular haemorrhage. On recurrence 11 months later, the mass was excised for the second time and a PleuralPort (Norfolk Animal products) was placed. Fifteen months after initial presentation, progression occurred with haemorrhagic fluid in the cystic space, pleural- and abdominal cavities and the owners opted for euthanasia. Histopathology and positive immunohistochemistry for lymphatic markers lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1) and prospero homeobox protein-1 (PROX-1) confirmed a lymphatic vascular origin of the cystic structure.
CONCLUSIONS
To our experience, a definitive diagnosis of retroperitoneal cystic malformation of lymphatic origin could be done only by combining the clinical presentation, advanced imaging, histopathology and LYVE-1 and PROX-1 immunohistochemistry. This is the first report of a vascular malformation in a dog where immunohistochemistry was used to make a final diagnosis. A lymphatic malformation, even if rare, should be added on the list of the differential diagnosis in a patient with a retroperitoneal cystic structure containing serohaemorrhagic fluid. Results of this case report can aid in diagnosis of future cases, however, further studies on therapy and management are needed to provide additional information about optimal treatment of these patients.
Topics: Animals; Dog Diseases; Dogs; Euthanasia, Animal; Female; Neoplasm Recurrence, Local; Retroperitoneal Neoplasms; Retroperitoneal Space; Tomography, X-Ray Computed
PubMed: 32007092
DOI: 10.1186/s13028-020-0506-9 -
BMJ Case Reports Sep 2018A gossypiboma is a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma. We describe an unusual presentation of a gossypiboma...
A gossypiboma is a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma. We describe an unusual presentation of a gossypiboma presenting in a 32-year-old man with acute epigastric pain and haematemesis. His surgical history revealed an emergency laparotomy following a road traffic accident 16 years ago. Initial gastroscopy showed extrinsic stomach compression. An abdominal ultrasound scan followed by a CT scan evidenced a large, well-defined, predominantly cystic mass with some solid areas occupying the left hypochondrium. Conservative management with insertion of a percutaneous drain proved to be inefficient. A laparotomy was performed; intraoperatively, the cyst was found to be ruptured and within it, a large surgical gauze was found. This was removed but required a distal pancreatectomy and gastrectomy for complete excision. He was discharged on day 74 of admission with outpatient follow-up.
Topics: Abdomen; Abdominal Pain; Adult; Diagnosis, Differential; Foreign Bodies; Humans; Male; Surgical Sponges; Tomography, X-Ray Computed
PubMed: 30257871
DOI: 10.1136/bcr-2017-221537 -
JSLS : Journal of the Society of... 2013To evaluate the operative outcomes between robotic, laparoscopic, and abdominal myomectomies performed by a private gynecologic oncology practice in a suburban community... (Comparative Study)
Comparative Study
BACKGROUND AND OBJECTIVES
To evaluate the operative outcomes between robotic, laparoscopic, and abdominal myomectomies performed by a private gynecologic oncology practice in a suburban community hospital.
METHODS
The medical records of 322 consecutive robotic, laparoscopic, and abdominal myomectomies performed from January 2007 through December 2009 were reviewed. The outcomes were collected from a retrospective review of patient medical records.
RESULTS
Records for 14/322 (4.3%) patients were incomplete. Complete data were available for 308 patients, including 169 (54.9%) abdominal, 73 (23.7%) laparoscopic, and 66 (21.4%) robotic-assisted laparoscopic myomectomies. Patients were similar in age, body mass index, parity, and previous abdominopelvic surgery. Median operative time for robotic surgery (140 min) was significantly longer (P<.005) compared to laparoscopic (70 min) and abdominal (72 min) myomectomies. Robotic and laparoscopic myomectomies had significantly less estimated blood loss and hospital stay compared to abdominal myomectomies. There was no significant difference in complications or in the median size of the largest myoma removed between the different modalities. However, the median aggregate weight of myomas removed abdominally (200g; range, 1.4 to 2682) was significantly larger than that seen laparoscopically (115g; range, 1 to 602) and robotically (129g; range 9.4 to 935). Postoperative transfusion was significantly less frequent in robotic myomectomies compared to laparoscopic and abdominal myomectomies.
CONCLUSION
While robotic-assisted laparoscopic myomectomies had longer operative times, laparoscopic and robotic assisted laparoscopic myomectomies demonstrated shorter hospital stays, less blood loss, and fewer transfusions than abdominal myomectomies. Robotic myomectomy offers a minimally invasive alternative for management of symptomatic myoma in a community hospital setting.
Topics: Abdomen; Adult; Clinical Competence; Female; Hospitals, Community; Humans; Laparoscopy; Leiomyoma; Robotics; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms
PubMed: 23743382
DOI: 10.4293/108680812X13517013317473 -
European Radiology Apr 2021Dual-energy computed tomography allows for an accurate and reliable quantification of iodine. However, data on physiological distribution of iodine concentration (IC) is...
OBJECTIVES
Dual-energy computed tomography allows for an accurate and reliable quantification of iodine. However, data on physiological distribution of iodine concentration (IC) is still sparse. This study aims to establish guidance for IC in abdominal organs and important anatomical landmarks using a large cohort of individuals without radiological tumor burden.
METHODS
Five hundred seventy-one oncologic, portal venous phase dual-layer spectral detector CT studies of the chest and abdomen without tumor burden at time point of imaging confirmed by > 3-month follow-up were included. ROI were placed in parenchymatous organs (n = 25), lymph nodes (n = 6), and vessels (n = 3) with a minimum of two measurements per landmark. ROI were placed on conventional images and pasted to iodine maps to retrieve absolute IC. Normalization to the abdominal aorta was conducted to obtain iodine perfusion ratios. Bivariate regression analysis, t tests, and ANOVA with Tukey-Kramer post hoc test were used for statistical analysis.
RESULTS
Absolute IC showed a broad scatter and varied with body mass index, between different age groups and between the sexes in parenchymatous organs, lymph nodes, and vessels (range 0.0 ± 0.0 mg/ml-6.6 ± 1.3 mg/ml). Unlike absolute IC, iodine perfusion ratios did not show dependency on body mass index; however, significant differences between the sexes and age groups persisted, showing a tendency towards decreased perfusion ratios in elderly patients (e.g., liver 18-44 years/≥ 64 years: 0.50 ± 0.11/0.43 ± 0.10, p ≤ 0.05).
CONCLUSIONS
Distribution of IC obtained from a large-scale cohort is provided. As significant differences between sexes and age groups were found, this should be taken into account when obtaining quantitative iodine concentrations and applying iodine thresholds.
KEY POINTS
• Absolute iodine concentration showed a broad variation and differed between body mass index, age groups, and between the sexes in parenchymatous organs, lymph nodes, and vessels. • The iodine perfusion ratios did not show dependency on body mass index while significant differences between sexes and age groups persisted. • Provided guidance values may serve as reference when aiming to differentiate healthy and abnormal tissue based on iodine perfusion ratios.
Topics: Abdomen; Adolescent; Adult; Aged; Contrast Media; Humans; Iodine; Iodine Compounds; Tomography, X-Ray Computed; Young Adult
PubMed: 32997173
DOI: 10.1007/s00330-020-07298-3 -
Journal of Clinical Lipidology 2020Loss of muscle mass with age may be a key player in metabolic dysregulation. We examined the associations between abdominal muscle area and density with lipids and...
BACKGROUND
Loss of muscle mass with age may be a key player in metabolic dysregulation. We examined the associations between abdominal muscle area and density with lipids and lipoproteins.
METHODS
One thousand eight hundred and sixty eight adults completed health history and physical activity questionnaires, provided venous blood samples for lipids and inflammatory biomarkers, and underwent computed tomography to quantify body composition. Associations between muscle area and density with multiple lipid measures were assessed with multivariable linear and logistic regression.
RESULTS
The mean age and body mass index of participants was 65 years and 28 kg/m, respectively, and 50% were female. After adjustment for demographics, cardiovascular disease risk factors, lipid-lowering medications, physical activity, sedentary behavior, inflammatory biomarkers, and central obesity, a 1-standard deviation increase in total abdominal, stability, and locomotor muscle areas was associated with a 13%, 11%, and 8% lower high-density lipoprotein cholesterol level, respectively (P < .05). With similar adjustment, a 1-standard deviation increase in total abdominal and stability muscle area was associated with a 13% and 12% lower total cholesterol level, respectively (P < .01). Compared to the lowest quartiles of total, stability, and locomotor muscle area, those in the higher quartiles of muscle area had over a 40% reduction in the odds of triglyceride levels greater than 150 mg/dL (P < .05). Total abdominal muscle density was positively associated with total cholesterol (P < .05) but was not associated with the other lipid outcomes.
CONCLUSION
Maintaining adequate skeletal muscle mass with age may decrease specific lipid levels related to hyperlipidemia and development of cardiometabolic disease.
Topics: Abdomen; Aged; Aged, 80 and over; Atherosclerosis; Biomarkers; Body Mass Index; Cholesterol; Exercise; Female; Humans; Lipids; Lipoproteins; Male; Middle Aged; Muscle, Skeletal
PubMed: 32061531
DOI: 10.1016/j.jacl.2020.01.002 -
Critical Care (London, England) Apr 2016The time course of plasma albumin concentration (P-alb) and cumulative perioperative albumin shift as a measure of albumin extravasation in major abdominal surgery is...
BACKGROUND
The time course of plasma albumin concentration (P-alb) and cumulative perioperative albumin shift as a measure of albumin extravasation in major abdominal surgery is not well described. Knowledge of these indices of the vascular barrier and vascular content are important for our understanding of fluid physiology during surgery and anesthesia.
METHODS
Patients (n = 10) were studied during esophageal or pancreatic surgery. P-alb was repeatedly measured over 72 h, and the mass balance of albumin and hemoglobin were obtained from measures of P-alb, blood hemoglobin and hematocrit.
RESULTS
P-alb decreased rapidly from baseline (32.8 ± 4.8 g/L) until the start of surgical reconstruction (18.7 ± 4.8 g/L; p < 0.001), and was thereafter stable until postoperative day 3. Cumulative perioperative albumin shift increased until 1 h after the end of surgery, when 24 ± 17 g (p < 0.001) had been lost from the circulation.
CONCLUSIONS
The rapid fall in P-alb of more than 40 % consistently occurred during the first part of the surgical procedure, but albumin leakage progressed until 1 h after the end of surgery. After the initial drop, P-alb was stable for 72 h.
Topics: Abdomen; Aged; Capillary Permeability; Female; Fluid Shifts; Humans; Male; Middle Aged; Serum Albumin
PubMed: 27117323
DOI: 10.1186/s13054-016-1283-8 -
BioMed Research International 2020To correlate body weight, body mass index (BMI), and water-equivalent diameter ( ) and to assess size-specific dose estimates (SSDEs) based on body weight and BMI for...
BACKGROUND
To correlate body weight, body mass index (BMI), and water-equivalent diameter ( ) and to assess size-specific dose estimates (SSDEs) based on body weight and BMI for chest and abdomen-pelvic CT examinations.
METHODS
An in-house program was used to calculate , size-dependent conversion factor (), and SSDE for 1178 consecutive patients undergoing chest and abdomen-pelvic CT examinations. Associations among body weight, BMI, and were determined, and linear equations were generated using linear regression analysis of the first 50% of the patient population. SSDEs (SSDE and SSDE) were calculated based on body weight and BMI as surrogates on the second 50% of the patient population. Mean root-mean-square errors of SSDE and SSDE were computed with SSDE from the axial images as reference values.
RESULTS
Both body weight and BMI correlated strongly with for the chest ( = 0.85, 0.87, all < 0.001) and abdomen-pelvis ( = 0.85, 0.86, all < 0.001). Mean values of SSDE and SSDE based on the linear equations for body weight, BMI, and were in close agreement with SSDE from the axial images, with overall mean root-mean-square errors of 0.62 mGy (6.10%) and 0.57 mGy (5.65%), for chest, and 0.76 mGy (5.61%) and 0.71 mGy (5.22%), for abdomen-pelvis, respectively.
CONCLUSIONS
Both body weight and BMI, serving as surrogates, can be used to calculate SSDEs in the chest and abdomen-pelvis CT examinations, providing values comparable to SSDEs from the axial images, with an overall mean root-mean-square error of less than 0.76 mGy or 6.10%.
Topics: Abdomen; Body Mass Index; Body Size; Body Weight; Dose-Response Relationship, Radiation; Female; Humans; Male; Middle Aged; Pelvis; Radiation; Thorax; Tomography, X-Ray Computed
PubMed: 32733946
DOI: 10.1155/2020/6046501 -
BMJ Case Reports Mar 2022A 74-year-old man was being investigated for a pancreatic insulinoma when an incidental mesenteric mass measuring 2.6 cm x 2.5 cm was noticed on CT imaging. A...
A 74-year-old man was being investigated for a pancreatic insulinoma when an incidental mesenteric mass measuring 2.6 cm x 2.5 cm was noticed on CT imaging. A wait-and-see approach was decided on. Thirty-nine months later, the patient presented with symptoms of abdominal obstruction. CT images revealed the mesenteric mass filled majority of the abdominal cavity and measured 29 cm x 26 cm x 16 cm. The patient underwent an open bypass gastrojejunostomy which stopped working a few weeks later due to further compression by the tumour. A debulking surgery was performed: a right hemicolectomy and small bowel resection with excision of the desmoid tumour and bypass gastrojejunostomy. The tumour measured 12.6 kg and was macroscopically visualised to have a white cut surface with a focal translucent area. Microscopic analysis revealed bland spindle cells with pale eosinophilic cytoplasm showing no cytological atypia, in keeping with a mesenteric desmoid tumour. Currently, two and a half years from the debulking surgery, the patient remains well and in remission with planned surveillance.
Topics: Aged; Colectomy; Fibromatosis, Abdominal; Fibromatosis, Aggressive; Humans; Male; Mesentery
PubMed: 35236693
DOI: 10.1136/bcr-2021-247935 -
British Journal of Haematology Feb 2003
Topics: Abdomen; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Female; Humans; Thrombocytopenia; Tomography, X-Ray Computed
PubMed: 12580950
DOI: 10.1046/j.1365-2141.2003.04031.x