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Annals of Surgery Mar 1997The aim of this investigation was to establish the association between left-sided gallbladders and right-sided round ligaments. (Review)
Review
OBJECTIVE
The aim of this investigation was to establish the association between left-sided gallbladders and right-sided round ligaments.
SUMMARY BACKGROUND DATA
The left-sided gallbladder is a rare anomaly and has been classified into two types: 1) gallbladder migration to the left side and 2) development of a second gallbladder with atrophy of the original one. Recently, left-sided gallbladders were reported to be associated with right-sided round ligaments.
METHODS
The authors reviewed 3 patients treated in their departments and 15 patients reported in the literature diagnosed as having left-sided gallbladders accompanied by right-sided round ligaments.
RESULTS
Although the gallbladders of all 18 patients were located at the normal site, they were diagnosed as being left sided because of the right-sided round ligaments. This anomaly was accompanied by abnormal intrahepatic portal venous branching, which could be classified into two types. In eight patients, the first branch of the portal vein ran to the posterior segment and then the portal vein formed a trunk of the left and right anterior portal veins. The latter portal vein formed the umbilical portion and finally joined the right-sided round ligament (trifurcation type). In five, the portal vein diverged normally to form the left and right portal veins, then the latter branched to form the anterior and posterior segments, and finally the anterior branch joined the round ligament (bifurcation type). In the other five, the branching type could not be determined.
CONCLUSIONS
A right-sided round ligament causes a gallbladder at the normal site to be located on the left side. This anomaly should not be diagnosed as a left-sided gallbladder but as a right-sided round ligament. Recognition of this anomaly clinically is important when performing hepatectomy, because it is always associated with abnormal intrahepatic portal venous branching.
Topics: Adult; Aged; Female; Gallbladder; Humans; Ligaments; Male; Retrospective Studies
PubMed: 9060583
DOI: 10.1097/00000658-199703000-00006 -
Gland Surgery Nov 2021At present, the materials commonly used for venous reconstruction in radical surgery for pancreatic cancer combined with vascular reconstruction include artificial blood...
BACKGROUND
At present, the materials commonly used for venous reconstruction in radical surgery for pancreatic cancer combined with vascular reconstruction include artificial blood vessels, autologous veins, and allogeneic blood vessels, but these materials all have their own disadvantages. In contrast, the use of the peritoneum and the round ligament of the liver for radical surgery for pancreatic cancer combined with vascular reconstruction provides new options.
METHODS
A retrospective descriptive study was performed. Clinical data were collected from 11 patients (5 males and 6 females with a median age of 62 years and an age range of 48-72 years) who underwent pancreatic cancer surgery combined with resection and reconstruction of the portal vein (PV) and superior mesenteric vein (SMV) using the peritoneum (including the round ligament of the liver) from November 2018 to November 2020 in the Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, and the Department of General Surgery, Affiliated Hospital of Shaoxing University. Intraoperative conditions and postoperative conditions were observed. Data were analyzed using SPSS 19.0 Normally distributed measurement data are expressed as the mean ± SD, whereas nonnormally distributed measurement data are expressed as the median (range). Count data are expressed as absolute numbers.
RESULTS
(I) Intraoperative condition: all 11 patients completed the operation successfully, including total pancreatectomy (TP) in 4 patients and pancreatoduodenectomy (PD) in 7 patients. In the 11 patients, the duration of surgery was 503±183 min, and the volume of intraoperative bleeding was 332±268 mL. (II) Postoperative condition: of the 11 patients, 5 presented with complications, including pancreatic leak in 3 patients, bleeding in 1 patient, and thrombosis in 1 patient. Postoperative pathological examination showed that 10 of the 11 patients had adenocarcinoma, and 1 had a neuroendocrine tumor.
CONCLUSIONS
The peritoneum and the round ligament of the liver are feasible materials and provide clinical options for reconstruction of the PV and SMV.
PubMed: 34926223
DOI: 10.21037/gs-21-712 -
European Radiology Dec 2021The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi...
OBJECTIVES
The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.
METHODS
Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of '0', '5' and '10' reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of '8' or higher for 80% or more of the panellists.
RESULTS
Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.
CONCLUSIONS
Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.
KEY POINTS
• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.
Topics: Arthrography; Consensus; Humans; Joint Instability; Ligaments, Articular; Wrist Injuries; Wrist Joint
PubMed: 34100996
DOI: 10.1007/s00330-021-08073-8 -
Annals of Surgery Apr 2002To determine the incidence, significance, and anatomy of spermatic cord and round ligament lipomas.
OBJECTIVE
To determine the incidence, significance, and anatomy of spermatic cord and round ligament lipomas.
METHODS
This was a retrospective review of 280 hernia repairs on 217 patients performed by a single surgeon (M.E.A.) from January 1996 to January 2000. The incidence of cord lipoma and relationship to inguinal hernia were evaluated. Further, when identified at the time of laparoscopic preperitoneal hernia repair, the anatomy of the lipomas was studied both at the time of surgery and again on review of videotapes.
RESULTS
One hundred ninety-nine laparoscopic and 81 open inguinal hernia repairs were performed on 192 male patients and 25 female patients. Sixty-three lipomas of the cord were identified for an incidence of 22.5%. Overall, 18 cord lipomas were found in groins without hernias, and these were identified before surgery in 10 (2 by physical examination, 7 by groin ultrasound, and 1 by magnetic resonance imaging). The remaining nine were misidentified as a hernia before surgery. Fourteen of these patients presented with groin pain and four were asymptomatic. Forty-five lipomas were associated with hernias and were characterized as a hernia by examination in 43 instances. There were 32 (51%) cord lipomas associated with indirect hernias, 11 (17%) with direct hernias, and 1 each with pantaloon and femoral hernias. Nine lipomas were found in women, seven presenting with groin pain and six found without an associated peritoneal defect. Two patients presented with symptomatic cord lipomas after laparoscopic hernia repair. A lipoma of the cord is herniated fat that appears to originate from the retroperitoneal fat outside and posterior to the internal spermatic fascia and protrudes through the internal ring lateral to the cord. They are generally not visible by transperitoneal inspection unless manually reduced.
CONCLUSIONS
Lipomas of the cord and round ligament occur with a significant incidence. They can cause hernia-type symptoms in the absence of a true hernia (associated with a peritoneal defect). They should be considered in the patient with groin pain and normal examination results. They can be easily overlooked at the time of laparoscopic hernia repair, and this can lead to an unsatisfactory result.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Hernia; Herniorrhaphy; Humans; Incidence; Lipoma; Male; Middle Aged; Retrospective Studies; Round Ligament of Uterus; Spermatic Cord
PubMed: 11923616
DOI: 10.1097/00000658-200204000-00018 -
Ultrasonography (Seoul, Korea) Apr 2020Groin lesions can be classified as neoplastic or non-neoplastic. Neoplastic lesions include lipoma, epidermoid cyst, angiomyofibroblastoma-like tumor, liposarcoma, and...
Groin lesions can be classified as neoplastic or non-neoplastic. Neoplastic lesions include lipoma, epidermoid cyst, angiomyofibroblastoma-like tumor, liposarcoma, and synovial sarcoma, as well as metastases from lymphoma, neuroendocrine carcinoma, and carcinomas of the lung, breast, urinary bladder, ovary, vulva, and colon. Non-neoplastic lesions include hernias, round ligament varices, endometriosis, Kimura disease, Castleman disease, hematoma, and inflammation. Because the clinical implications and therapeutic strategies for groin lesions vary depending on the cause, the ability to noninvasively differentiate among etiologies is very important. Although there is substantial overlap in ultrasonographic findings across various groin lesions, some ultrasonographic features, along with clinical characteristics, may suggest a specific diagnosis. Familiarity with the ultrasonographic and clinical features of various groin lesions facilitates accurate diagnosis and treatment.
PubMed: 31786905
DOI: 10.14366/usg.19041 -
Case Reports in Gastroenterology 2022A 62-year-old man was referred to our hospital because of abdominal pain. Computed tomography revealed an approximately 7-cm-diameter tumor in the left abdomen with...
A 62-year-old man was referred to our hospital because of abdominal pain. Computed tomography revealed an approximately 7-cm-diameter tumor in the left abdomen with metastatic lymph nodes, an approximately 1-cm-diameter round tumor in contact with the subclavian artery in the apical lobe of the right lung, and mediastinal lymph node enlargement in contact with the superior vena cava. Esophagogastroduodenoscopy and colonoscopy revealed no abnormalities. Double-balloon endoscopy revealed a whole circumferential ulcer in the jejunum approximately 20 cm from the ligament of Treitz. Biopsy analysis of an ulcer specimen revealed a poorly differentiated carcinoma. Immunohistochemical staining of the specimen showed that it was positive for thyroid transcription factor 1 and cytokeratin 7 and negative for cytokeratin 20, GATA-binding protein 3, caudal-type homeobox protein 2, and paired box 8. Positron emission tomography revealed positive findings in the small-intestinal tumor, nearby mesenteric lymph nodes, lymph nodes around the abdominal aorta, lung tumor, and mediastinal lymph node in the apical lobe of the right lung. Accordingly, the patient was diagnosed as having a lung carcinoma with small-intestinal metastasis (T1b, N3, M1c; cStage IVB). Pathological examination helped distinguish the primary small-intestinal tumor from the metastatic small-intestinal tumor and detect the tumor origin.
PubMed: 35528768
DOI: 10.1159/000523663 -
African Health Sciences Mar 2022Endometriosis is the existence of endometrial tissue outside the endometrial cavity. It has high prevalence in women living in developed countries but is believed to be...
INTRODUCTION
Endometriosis is the existence of endometrial tissue outside the endometrial cavity. It has high prevalence in women living in developed countries but is believed to be rare among indigenous African women.
OBJECTIVES
This study aimed to determine the prevalence and characteristics of endometriosis in an indigenous African women population.
METHODS
Gynaecological specimens received and diagnosed as endometriosis in a teaching hospital's Histopathology laboratory over a 5-year period was retrospectively reviewed. Data obtained were analysed by simple statistical methods.
RESULTS
There were 25 diagnosed cases of endometriosis representing 0.9% of gynaecological specimens received in the period. Patients' average age is 38.4±8.4 years; peak age was 31- 40 years (n=10; 40%). Myometrium is the most common site (n=16; 64%), other sites include umbilicus and round ligament etc. Pelvic pain, 36% and irregular uterine bleeding, 28% are most common symptoms. There was primary and secondary infertility in 20% and 16% of cases respectively. The umbilical and suprapubic masses had symptoms that synchronised with the patient's menstrual cycle.
CONCLUSION
Endometriosis has low prevalence in our population. Women presenting with chronic pelvic pain, infertility and menstrual disorders should be evaluated for endometriosis. Population-based study is required to further characterize the condition in our population.
Topics: Adult; Black People; Endometriosis; Female; Humans; Infertility; Middle Aged; Pelvic Pain; Retrospective Studies
PubMed: 36032462
DOI: 10.4314/ahs.v22i1.17 -
BMJ Case Reports Nov 2017Round ligament tumours represent a rare entity that can present similarly to an incarcerated hernia. Basic understanding and appropriate preoperative management is... (Review)
Review
Round ligament tumours represent a rare entity that can present similarly to an incarcerated hernia. Basic understanding and appropriate preoperative management is imperative in order to differentiate between the two diagnoses. Leiomyoma is the most common type of round ligament tumour. It is associated with oestrogen exposure and is more common in the presence of uterine leiomyomas. Here we discuss a 68-year-old woman who presented with a palpable left inguinal mass that progressively grew in size, associated with pelvic pressure and discomfort. On surgical resection, the mass was found to be derived from the round ligament at the entrance of the external inguinal ring. Pathology confirmed a round ligament leiomyoma, measuring 25×9×8.5 cm. This case is the largest round ligament leiomyoma recorded to date and the first to exhibit carneous degeneration. A review of the current literature is also provided.
Topics: Aged; Female; Humans; Inguinal Canal; Leiomyoma; Round Ligament of Uterus; Uterine Neoplasms
PubMed: 29170184
DOI: 10.1136/bcr-2017-222454