scholarly journals Morphology of the peritoneal cavity and pathophysiological consequences

2016 ◽  
Vol 1 (4) ◽  
pp. 193-201 ◽  
Author(s):  
Wiebke Solass ◽  
Florian Struller ◽  
Philipp Horvath ◽  
Alfred Königsrainer ◽  
Bence Sipos ◽  
...  
Keyword(s):  
Peritoneal Cavity ◽  
Greater Omentum ◽  
Peritoneal Disease ◽  
Paracolic Gutter ◽  
Functional Regions ◽  
Internal Hernias ◽  
Abdominal Organs ◽  
The Right ◽  
Bowel Segments ◽  
Peritoneal Morphology

AbstractThe peritoneal cavity (cavum peritonei) is incompletely divided into spaces and recessus (or fossae), which are playing an important role in health and disease. Peritoneal subspaces are determined by the parietal attachments of the abdominal organs, the ligaments and mesenteries. These include the splenorenal, the falciform, the triangular, the gastrosplenic, the phrenicocolic and the gastrocolic ligaments; the greater omentum and the lesser omentum (formed by the gastrohepatic and hepatoduodenal ligaments); the small bowel mesenterium and the mesocolon. These ligaments and mesenteries divide the peritoneal cavity into several distinct anatomic and functional regions. The supramesocolic compartment is divided into a bilateral subphrenic space and a subhepatic space continuing into the lesser sac (bursa omentalis). The inframesolic compartment is divided into a left and right region by the mesentery. The right paracolic gutter communicates with the pelvis and with the right suphrenic space. The left paracolic gutter is separated from the left subphrenic space by the phrenocolic ligament. The peritoneal space is virtual, is completely occupied by the intraabdominal organs and can only be visualized by radiological means in the presence of air (organ perforation), liquid (ascites, pus, bile, gastrointestinal fluids) or tumor invasion. Peritoneal morphology has numerous pathophysiological implications: it impacts on the propagation of intraabdominal infections, determines the spreading of peritoneal metastasis and can cause bowel volvulus. Internal hernias can arise at the junction between intraperitoneal and extraperitoneal bowel segments, in particular into the left paraduodenal recessus. Knowledge of peritoneal morphology is a precondition for developing locoregional therapeutic strategies in peritoneal disease and for effective peritoneal dialysis.

scholarly journals Small Intestinal Strangulation Due to a Rare Type of Primary Internal Hernia

2013 ◽  
Vol 98 (4) ◽  
pp. 409-411 ◽  
Author(s):  
Makoto Takeda ◽  
Yoshinori Ohnuki ◽  
Takashi Uchiyama ◽  
Osamu Kubota ◽  
Kousuke Ohishi
Keyword(s):  
Internal Hernia ◽  
Epigastric Pain ◽  
Past History ◽  
Hepatic Flexure ◽  
Rare Type ◽  
Paracolic Gutter ◽  
Internal Hernias ◽  
History Of ◽  
The Right ◽  
Severe Epigastric Pain

Abstract Internal hernias in which the gate is located in the paracolic gutter are rare. A 75-year-old man was admitted to our hospital with severe epigastric pain without past history of laparotomy and/or trauma. He was diagnosed with strangulation of the ileum by the findings of computed tomography, and the operation was performed. During laparotomy, the small intestine was found to be strangulated and to enter the retroperitoneum from the right paracolic gutter near the hepatic flexure. The patient was diagnosed with an internal hernia, which differed from a pericecal hernia in that the hernia gate was located along the paracolic gutter near the hepatic flexure far from the cecum. Hence, it was considered to be a rare type of internal hernia. We report the clinical presentation and imaging findings of this rare internal hernia.

scholarly journals Recurrence hernia in the broad ligament of the uterus: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Yoshifumi Hashimoto ◽  
Tatsuo Kanda ◽  
Tadasu Chida ◽  
Kazuyoshi Suda
Keyword(s):  
Small Bowel ◽  
Rare Disease ◽  
Broad Ligament ◽  
Significant Risk ◽  
Disease Recurrence ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Bowel Segments ◽  
Hernia Orifice ◽  
Bowel Herniation

Abstract Background Bowel herniation through a defect in the broad ligament of the uterus is a rare disease and few cases of recurrence have been reported. We report herein a recurrence case of a patient with broad ligament hernia (BLH), along with a review of the literature. Case presentation A 53-year-old woman complaining of abdominal pain was transported to our hospital. She had a history of laparotomy for small-bowel obstruction associated with hernia in the broad ligament of the uterus 10 years ago at a local hospital. Abdominal pelvic contrast-enhanced computed tomography revealed that the mesentery of the dilated bowels converged at a thick band in the pelvis, suggesting closed loop obstruction of the small bowel. The patient underwent urgent laparotomy and was diagnosed with bowel herniation through an opening in the broad ligament of the uterus on the right side, which was ipsilateral with the previous surgery. The hernia orifice was widened by incision and incarcerated bowel segments were released and preserved because ischemia was reversible. The membranous defect of BLH was closed by suture with braded silk strings. Conclusions Although BLH is a rare disease, patients face a significant risk of disease recurrence. Nonabsorbable suture may be advisable for closure of the hernia orifice in BLH.

scholarly journals Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

2005 ◽  
Vol 20 (5) ◽  
pp. 347-352 ◽  
Author(s):  
Alberto Goldenberg ◽  
Jacques Matone ◽  
Wagner Marcondes ◽  
Fernando Augusto Mardiros Herbella ◽  
José Francisco de Mattos Farah
Keyword(s):  
Inflammatory Response ◽  
Abdominal Wall ◽  
Peritoneal Cavity ◽  
Abdominal Cavity ◽  
Mesh Fixation ◽  
Rabbit Model ◽  
Laparoscopic Approach ◽  
Preperitoneal Space ◽  
Similar Amount ◽  
The Right

PURPOSE: Compare, in a rabbit model, the inflammatory response and adhesions formation following surgical fixation of polypropilene and Vypro mesh in the inguinal preperitoneal space. METHODS: Fourteen male New Zealand rabbits, weighing between 2.000 to 2.500 g were used. A midline incision was made and the peritoneal cavity was exposed. The 2,0X1,0 cm polypropylene mesh was fixed in the left flank and secured to the margins with 3-0 prolene in a separate pattern. In the right flank, a 2,0X1,0 cm Vypro II mesh was sewn in the same way. After the post surgical period, the animals were again anesthetized and underwent laparoscopic approach, in order to identify and evaluate adhesions degree. Both fixed prosthesis were excised bilaterally with the abdominal wall segment, including peritoneum, aponeurosis and muscle and sent to a pathologist RESULTS: Operative time ranged from 15 to 25 minutes and no difficulties in applying the mesh were found. From the 14 polypropylene meshes fixed to the intact peritoneum, 11 had adhesions to the abdominal cavity (78,6%). Concerning Vypro mesh, 12 animals developed adhesions from the 14 with mesh fixation (85,7%). Histological examination of tissues harvested revealed fibroblasts, collagen, macrophages and lymphocytes between the threads of the mesh. CONCLUSION: Polypropylene and Vypro mesh, when implanted in the peritoneal cavity of rabbits provoke similar amount of adhesions. Vypro mesh tissues had higher fibrosis resulting in better mesh incorporation to the abdominal wall.

scholarly journals Autotransplantacija slezine

2002 ◽  
Vol 49 (3) ◽  
pp. 101-106 ◽  
Author(s):  
S. Knezevic ◽  
D. Stefanovic ◽  
M. Petrovic ◽  
Z. Djordjevic ◽  
Slavko Matic ◽  
...  
Keyword(s):  
Splenic Rupture ◽  
Left Kidney ◽  
The Other ◽  
Traumatic Rupture ◽  
Target Cells ◽  
Sodium Potassium ◽  
Abdominal Organs ◽  
The Right ◽  
Rupture Of The Spleen ◽  
Previous Disease

Auto transplantation of the spleen can be performed in the patients with traumatic rupture of the spleen, in whom spleen could not be conserved in the other way. The right indication for this method is isolated rupture of the spleen (concvasation or complete devascularisation). This method is not recommended in the endangered patients, patients with previous disease of the spleen as well as in the patients with the perforation of the other abdominal organs at the same time. Auto transplantation was performed in 12 patients with isolated splenic rupture and hematoperitoneum, 11 men and one woman. The majority of patients are younger. In 8 patients, autotransplantat was placed into big omentum, in three into lipomatous tissue surrounding left kidney, and in one into anterior abdominal wall. In all the patients from this group, following analysis were taken: MCV (middle volume of erythrocytes), HTC, Hb, Le, Glucose, urea, creatinin, sodium, potassium, alkali phosphatasis, target cells, Howell Jolly's bodies, Heinz's bodies, IgG, IgA, igM, C3, C4, T3, T4, T8, B, segmentated, eosinophiles, lymphocytes, reticulocytes, thrombocytes, fibrinogen, PT, APTT, aggregation of thrombocytes and aggregation of thrombocytes on collagen. The same parameters were taken in 12 patients with surgery similar to splenectomy and in 12 after splenectomy. After splenectomy, there was decrease of the immunologic defending abilities of the organism because of the loss of the clirens function of the spleen, decreased level of the opsonines and tutsin, which leads to the impaired phagocytosis, decreased concentration of IgM and T and B lymphocytes, while in patients after auto transplantation the results were physiological. The most important thing in the assessment of the function of the autotransplantated spleen is scintigraphic investigation using 99mTc-denaturated red blood cells. In our study, auto transplant function was assessed in 10/12 patients by scintigraphy. Five years after surgery no one patient was proved to have postsplenectomic sepsis.

scholarly journals An Incidental Finding of Situs Ambiguus with Polysplenia in an Asymptomatic 70-Year-Old Male

2021 ◽  
pp. 1-3
Author(s):  
Christopher Ambrogi ◽  
◽  
Madina Ndoye ◽  
Keyword(s):  
Prostate Cancer ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Incidental Finding ◽  
Anatomical Variation ◽  
Rare Condition ◽  
Situs Ambiguus ◽  
Abdominal Organs ◽  
The Right ◽  
Thoracic And Abdominal

The term “Situs ambiguus” describes the configuration when some, but not all thoracic and abdominal organs are abnormally positioned. It is commonly associated with polysplenia, or multiple spleens. 50-100% of situs ambiguus with polysplenia have associated cardiac malformations [1]. We present a 70 year old male who came to our hospital for complete, acute, urinary retention, and was found to have invasive prostate cancer. Incidentally, the liver was positioned on the left side, and the spleen was located on the right side. There were multiple perisplenic nodular formations with peripheral calcifications that had enhancement kinetics similar to those of the spleen, suggesting polysplenia. In low thoracic cuts, the tip of the heart was clearly on the left side. The presence of situs ambiguus with polysplenia in the absence of cardiac abnormalities makes this case a unique presentation of an already rare condition. Clinicians should regularly consider the possibilities of anatomical variation in their medical and surgical practices.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

scholarly journals Pericardial hernias in adults: a systematic review of the literature

2019 ◽  
Vol 30 (3) ◽  
pp. 353-358
Author(s):  
Dimitrios Schizas ◽  
Ioannis Katsaros ◽  
Elli Karatza ◽  
Nikoletta A Theochari ◽  
Stylianos Kykalos ◽  
...  
Keyword(s):  
Adult Population ◽  
Clinical Manifestations ◽  
Laparoscopic Approach ◽  
Health Care Facilities ◽  
Greater Omentum ◽  
Morbidity Rate ◽  
Abdominal Organs ◽  
Pericardial Hernia ◽  
Surgical Treatments ◽  
High Degree

Abstract OBJECTIVES A pericardial hernia is defined as the protrusion of abdominal viscera through the central tendon of the diaphragm into the pericardial sac. It is a rare clinical entity whose symptoms vary considerably. The objective of this study was to evaluate the clinical manifestations of and the optimal surgical treatments for pericardial hernias. METHODS PubMed and the Cochrane bibliographical databases were searched (last search: 20 April 2019) for studies on pericardial diaphragmatic hernias in the adult population. RESULTS Eighty studies met our inclusion criteria and reported on 85 patients (62 men and 23 women) with a mean age of 55.86 ± 15.79 years (mean ± standard deviation) presenting with a pericardial hernia at health care facilities. The leading aetiology was trauma (56.5%) followed by iatrogenic interventions (30.6%). The most common herniated organs were the transverse colon (49.4%) and the greater omentum (48.2%). Seventy-one patients (83.5%) underwent an open surgical repair, whereas 14 (16.5%) had a laparoscopic approach. Mesh or a patch was applied in 41.9% of cases. A postoperative morbidity rate of 16.9% was recorded, whereas the mortality rate reached 2.4%. CONCLUSIONS Pericardial hernia is a rare disease characterized by abdominal organs herniating into the pericardium. It requires a high degree of suspicion for early diagnosis, and all medical professionals should be encouraged to report such cases to clarify the best available therapeutic approach.

Normal Body Perception despite the Loss of Right Fusiform Gyrus

2015 ◽  
Vol 27 (3) ◽  
pp. 614-622 ◽  
Author(s):  
Tirta Susilo ◽  
Hua Yang ◽  
Zachary Potter ◽  
Rachel Robbins ◽  
Bradley Duchaine
Keyword(s):  
Fusiform Gyrus ◽  
Extrastriate Cortex ◽  
Body Perception ◽  
Body Area ◽  
Normal Body ◽  
Functional Regions ◽  
The Right ◽  
Normal Performance ◽  
Normal Perception

Human extrastriate cortex contains functional regions that are selective for particular categories such as faces, bodies, and places, but it is unclear whether these category-selective regions are necessary for normal perception of their preferred stimuli. One of these regions is the right fusiform body area (FBA), which is selectively involved in body perception. Do loss of the right fusiform gyrus and the absence of the right FBA necessarily lead to deficits in body perception? Here we report the performance of Galen, a brain-damaged patient who lost the right fusiform gyrus and has no right FBA, on eight tasks of body perception. Despite his lesion, Galen showed normal performance on all tasks. Galen's results demonstrate that damage to the right fusiform gyrus and the lack of the right FBA do not necessarily lead to persisting deficits in body perception.

Full Robotic Colorectal Resections for Cancer Combined With Other Major Surgical Procedures: Early Experience With the da Vinci Xi

2017 ◽  
Vol 24 (4) ◽  
pp. 321-327 ◽  
Author(s):  
Luca Morelli ◽  
Gregorio Di Franco ◽  
Simone Guadagni ◽  
Matteo Palmeri ◽  
Desirée Gianardi ◽  
...  
Keyword(s):  
Da Vinci ◽  
Da Vinci Xi ◽  
Port Placement ◽  
Synchronous Tumors ◽  
Lower Quadrant ◽  
Surgical Interventions ◽  
Abdominal Organs ◽  
Simultaneous Procedures ◽  
The Mean ◽  
The Right

Background. The da Vinci Xi has been developed to overcome some of the limitations of the previous platform, thereby increasing the acceptance of its use in robotic multiorgan surgery. Methods. Between January 2015 and October 2015, 10 patients with synchronous tumors of the colorectum and others abdominal organs underwent robotic combined resections with the da Vinci Xi. Trocar positions respected the Universal Port Placement Guidelines provided by Intuitive Surgical for “left lower quadrant,” with trocars centered on the umbilical area, or shifted 2 to 3 cm to the right or to the left, depending on the type of combined surgical procedure. Results. All procedures were completed with the full robotic technique. Simultaneous procedures in same quadrant or left quadrant and pelvis, or left/right and upper, were performed with a single docking/single targeting approach; in cases of left/right quadrant or right quadrant/pelvis, we performed a dual-targeting operation. No external collisions or problems related to trocar positions were noted. No patient experienced postoperative surgical complications and the mean hospital stay was 6 days. Conclusions. The high success rate of full robotic colorectal resection combined with other surgical interventions for synchronous tumors, suggest the efficacy of the da Vinci Xi in this setting.

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