-
International Journal of Radiation... Jul 2009To develop a Radiation Therapy Oncology Group (RTOG) atlas of the elective clinical target volume (CTV) definitions to be used for planning pelvic intensity-modulated...
PURPOSE
To develop a Radiation Therapy Oncology Group (RTOG) atlas of the elective clinical target volume (CTV) definitions to be used for planning pelvic intensity-modulated radiotherapy (IMRT) for anal and rectal cancers.
METHODS AND MATERIALS
The Gastrointestinal Committee of the RTOG established a task group (the nine physician co-authors) to develop this atlas. They responded to a questionnaire concerning three elective CTVs (CTVA: internal iliac, presacral, and perirectal nodal regions for both anal and rectal case planning; CTVB: external iliac nodal region for anal case planning and for selected rectal cases; CTVC: inguinal nodal region for anal case planning and for select rectal cases), and to outline these areas on individual computed tomographic images. The imaging files were shared via the Advanced Technology Consortium. A program developed by one of the co-authors (I.E.N.) used binomial maximum-likelihood estimates to generate a 95% group consensus contour. The computer-estimated consensus contours were then reviewed by the group and modified to provide a final contouring consensus atlas.
RESULTS
The panel achieved consensus CTV definitions to be used as guidelines for the adjuvant therapy of rectal cancer and definitive therapy for anal cancer. The most important difference from similar atlases for gynecologic or genitourinary cancer is mesorectal coverage. Detailed target volume contouring guidelines and images are discussed.
CONCLUSION
This report serves as a template for the definition of the elective CTVs to be used in IMRT planning for anal and rectal cancers, as part of prospective RTOG trials.
Topics: Anus Neoplasms; Humans; Ilium; Inguinal Canal; Likelihood Functions; Lymph Nodes; Medical Illustration; Pelvis; Radiation Oncology; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Rectal Neoplasms; Rectum; Tomography, X-Ray Computed
PubMed: 19117696
DOI: 10.1016/j.ijrobp.2008.08.070 -
Journal of ISAKOS : Joint Disorders &... Oct 2023Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing... (Review)
Review
Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing nomenclature. To solve this problem, three consensus statements have been already published in the literature: the Manchester Position Statement in 2014, the Doha agreement in 2015, and the Italian Consensus in 2016. However, when revisiting recent literature, it is evident that the use of non-anatomic terms remains common, and the diagnoses sports hernia, sportsman's hernia, sportsman's groin, Gilmore's groin, athletic pubalgia, and core muscle injury are still used by many authors. Why are they still in use although rejected? Are they considered synonyms, or they are used to describe different pathology? This current concepts review article aims to clarify the confusing terminology by examining to which anatomical structures authors refer when using each term, revisit the complex anatomy of the area, including the adductors, the flat and vertical abdominal muscles, the inguinal canal, and the adjacent nerve branches, and propose an anatomical approach, which will provide the basis for improved communication between healthcare professionals and evidence-based treatment decisions.
Topics: Humans; Groin; Hernia, Inguinal; Athletic Injuries; Inguinal Canal; Pelvic Pain
PubMed: 37308079
DOI: 10.1016/j.jisako.2023.05.006 -
Journal of Anatomy May 1979The flat muscles of the anterior abdominal wall pass down well in front of the pectineal ligament of Astley Cooper on the summit of the superior pubic rumus, thus...
The flat muscles of the anterior abdominal wall pass down well in front of the pectineal ligament of Astley Cooper on the summit of the superior pubic rumus, thus providing space for the spermatic cord and the great vessels of the lower limb to leave the abdomen. The abdominal wall layers turn back lower down to close the gap on the medial side of the external iliac vein. The external oblique aponeurosis turns back to form a strong inguinal ligament, and the attached fascia lata turns back as the lacunar ligament to meet and fuse with the pectineus muscle fascia 1-1.5 cm below Cooper's ligament. This leaves a deep trough, between Cooper's ligament behind and the posterior inguinal wall in front, which houses the transversely placed femoral canal. The transversalis fascia of the floor of the femoral canal turns down to form the medial wall of the venous compartment of the femoral sheath, and has the support of the curved edge of the lacunar ligament which effectively bars the femoral canal from entering the thigh. It is usually taught, however, that the lower end of the femoral canal passes unprotected into the thigh as the medial or third compartment of the femoral sheath, to lie between the femoral vein in its sheath and the curved edge of the lacunar ligament. If this were the case there would be no hindrance to the descent of a process of parietal peritoneum containing omentum or gut into and distending the femoral canal in the thigh. Would such a swelling, before the process of peritoneum had broken through the walls of the canal into the subcutaneous tissues of the groin, pass for a femoral hernia? Fortunately this problem does not arise. A study of the posterior aspect of the anterior abdominal wall, removed with the attached anterior half of the bony pelvis, reveals many details of the design and attachments of the deep inguinal ring, the femoral trough and canals and the femoral sheath.
Topics: Fascia Lata; Femoral Artery; Femoral Vein; Humans; Inguinal Canal; Ligaments; Male
PubMed: 468709
DOI: No ID Found -
Taiwanese Journal of Obstetrics &... Jan 2022Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize... (Review)
Review
Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize published literature on the diagnosis and treatment of this condition. Thus, a systematic literature search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library. An effort was made to numerically analyze all parameters included in case reports and retrospective analyses, as well. The typical and atypical features of this condition, investigations used, type of treatment and histopathology were recorded. More specifications about the surgical treatment, such as operations previously performed, type of surgery and treatment after surgery have been acknowledged. Other sites of endometriosis, the presence of pelvic endometriosis and the follow-up and recurrence have been also documented. Overall, the search yielded 61 eligible studies including 133 cases of inguinal endometriosis. The typical clinical presentation includes a unilateral inguinal mass, with or without catamenial pain. Transabdominal or transvaginal ultrasound was typically used as the first line method of diagnosis. Groin incision and exploratory surgery was the treatment indicated by the majority of the authors, while excision of part of the round ligament was reported in about half of the cases. Chemotherapy and radiotherapy were initiated in cases of coexisting endometriosis-related neoplasia. Inguinal recurrence or malignant transformation was rarely reported. The treatment of inguinal endometriosis is surgical and a long-term follow-up is needed. More research is needed on the effectiveness of suppressive hormonal therapy, recurrence rate and its relationship with endometriosis-associated malignancies.
Topics: Endometriosis; Female; Groin; Humans; Inguinal Canal; Round Ligament of Uterus; Treatment Outcome; Ultrasonography
PubMed: 35181041
DOI: 10.1016/j.tjog.2021.11.007 -
The British Journal of Radiology Dec 2018Inguinal canal-related groin pain is common in athletes and may involve numerous structures such as the conjoint tendon and the transversalis fascia. Ultrasound is the... (Review)
Review
Inguinal canal-related groin pain is common in athletes and may involve numerous structures such as the conjoint tendon and the transversalis fascia. Ultrasound is the only dynamic tool that shows the passage of preperitoneal fat at the level of the Hesselbach triangle and allows excluding true inguinal hernias. Fascia transversalis bulging and inguinal ring dilatation may also be described. MRI assesses injuries of rectus abdominis and adductor longus enthesis and osteitis symphysis but its accuracy for the diagnosis of inguinal-related groin pain remains debated.
Topics: Adult; Athletes; Athletic Injuries; Diagnosis, Differential; Female; Groin; Hernia, Inguinal; Humans; Inguinal Canal; Magnetic Resonance Imaging; Male; Pelvic Pain; Ultrasonography
PubMed: 29947268
DOI: 10.1259/bjr.20170856 -
Annals of the Royal College of Surgeons... Feb 2020Gynaecological structures such as the ovaries, fallopian tubes, ligaments and uterus are rarely encountered inside a hernial sac. The prevalence of groin hernias...
INTRODUCTION
Gynaecological structures such as the ovaries, fallopian tubes, ligaments and uterus are rarely encountered inside a hernial sac. The prevalence of groin hernias containing parts of female genitalia remains unknown. The aim of this review was to summarise the existing evidence on inguinal hernias containing ovaries with or without the other female adnexa.
METHODS
A systematic search was conducted for literature published up to February 2018 using the MEDLINE, Scopus and Google Scholar™ databases along with the references of the full-text articles retrieved. Papers on observational studies and case reports concerning women who were diagnosed with an ovarian inguinal hernia (pre or intraoperatively) were considered eligible for inclusion in the review.
RESULTS
Fifteen papers (13 case reports, 2 case series) comprising seventeen patients (mean age 47.9 years) were evaluated. A left-sided hernia was noted in 13 cases (77%) whereas 4 patients had a right-sided hernia. Eight patients underwent preoperative imaging with computed tomography, ultrasonography or both. This was diagnostic in five cases. In 11 patients, hernia contents were repositioned, 2 had a salpingo-oophorectomy and 2 an oophorectomy. Eight patients underwent hernia repair with mesh placement while three had a herniorrhaphy.
CONCLUSIONS
Ovarian inguinal hernias should be considered among the differential diagnoses of a groin mass or swelling. In women of reproductive age, repair of the hernia with the intent to preserve fertility is of critical importance.
Topics: Female; Hernia, Inguinal; Herniorrhaphy; Humans; Inguinal Canal; Ovarian Diseases; Ovariectomy; Ovary; Prevalence; Salpingo-oophorectomy; Surgical Mesh; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31696731
DOI: 10.1308/rcsann.2019.0137 -
International Braz J Urol : Official... 2021Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. (Review)
Review
PURPOSE
Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer.
MATERIAL AND METHODS
We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research.
RESULTS
A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure.
CONCLUSIONS
The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.
Topics: Humans; Inguinal Canal; Lymph Node Excision; Lymphatic Metastasis; Male; Penile Neoplasms; Penis; Surgical Flaps
PubMed: 34115457
DOI: 10.1590/S1677-5538.IBJU.2021.99.14 -
International Braz J Urol : Official... 2021This review aims to study the role of the abdominal wall in testicular migration process during the human fetal period. (Review)
Review
OBJECTIVES
This review aims to study the role of the abdominal wall in testicular migration process during the human fetal period.
MATERIALS AND METHODS
We performed a descriptive review of the literature about the role of the abdominal wall in testicular migration during the human fetal period.
RESULTS
The rise in intra-abdominal pressure is a supporting factor for testicular migration. This process has two phases: the abdominal and the inguinal-scrotal stages. The passage of the testis through the inguinal canal occurs very quickly between 21 and 25 WPC. Bilateral cryptorchidism in Prune Belly syndrome is explained by the impaired contraction of the muscles of the abdominal wall; mechanical obstruction due to bladder distention and structural alteration of the inguinal canal, which hampers the passage of the testis during the inguinoscrotal stage of testicular migration. Abdominal wall defects as gastroschisis and omphaloceles are associated with undescended testes in around 30 to 40% of the cases.
CONCLUSIONS
Abdominal pressure wound is an auxiliary force in testicular migration. Patients with abdominal wall defects are associated with undescendend testis in more than 30% of the cases probably due to mechanical factors; the Prune Belly Syndrome has anatomical changes in the anterior abdominal wall that hinder the increase of intra-abdominal pressure which could be the cause of cryptorchidism in this syndrome.
Topics: Cryptorchidism; Humans; Inguinal Canal; Male; Prune Belly Syndrome; Scrotum; Testis
PubMed: 32758302
DOI: 10.1590/S1677-5538.IBJU.2021.99.03 -
Radiologia 2020The groin is a complex anatomic region that has traditionally been ignored by radiologists because most lesions can be diagnosed from clinical data and physical...
OBJECTIVES
The groin is a complex anatomic region that has traditionally been ignored by radiologists because most lesions can be diagnosed from clinical data and physical examination. Nevertheless, ultrasound examinations of the groin are increasingly being requested to confirm injury or to resolve diagnostic uncertainty. On the other hand, some conditions involving the groin are found only in pediatric patients. This article describes the key imaging findings in pediatric groin injuries, placing special emphasis on the ultrasound appearance.
CONCLUSIONS
Knowledge about conditions that can affect the groin in pediatric patients and the key imaging findings associated with them helps improve the diagnostic performance of ultrasound.
Topics: Adolescent; Aneurysm, False; Child; Child, Preschool; Cryptorchidism; Female; Femoral Artery; Hamartoma; Hernia, Inguinal; Humans; Infant; Infant, Newborn; Inguinal Canal; Lipoma; Magnetic Resonance Imaging; Male; Sarcoma; Spermatic Cord; Testicular Hydrocele; Ultrasonography; Veins
PubMed: 32165019
DOI: 10.1016/j.rx.2020.01.005 -
Annals of Surgery Jun 1960
Topics: Endometriosis; Female; Humans; Inguinal Canal; Neoplasms
PubMed: 14407289
DOI: 10.1097/00000658-196006000-00014