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Gastrointestinal and genitourinary systems
Published in Helen Butler, Neel Sharma, Tiago Villanueva, Student Success in Anatomy - SBAs and EMQs, 2022
For each of the following questions, select the most appropriate answer from the above list of options. Each option may be used once, more than once or not at all. Which type of hernia occurs at the lateral edge of the rectus sheath?Which type of hernia is found above and medial to the pubic tubercle and herniates through a defect in the abdominal wall fascia?Which type of hernia is at risk of ischaemia due to an interruption in its blood supply?Which type of hernia passes through the internal inguinal ring?Which type of hernia is found lateral and inferior to the pubic tubercle?
Questions 1–20
Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021
A rectus sheath haematoma is the result of bleeding into the rectus sheath from the superior or inferior epigastric vessels or from a direct tear of the sheath itself. When derived from trauma, the initial incident could be quite minor. However, tight contraction of the recti in anticipation of the blow predisposes to rectus sheath haematoma formation.
Congenital diaphragmatic hernia
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Erin E. Perrone, George B. Mychaliska
Treatment of Morgagni hernias in asymptomatic patients is considered by some to be controversial. Repair can be performed transthoracically or transabdominally, however, transabdominal repair is advocated because it allows for repair of bilateral hernias, which are often only diagnosed intraoperatively. Repair consists of suturing the diaphragm to the underside of the posterior rectus sheath at the costal margin after reduction of the hernia. Most surgeons also advocate for resection of the sac, although this may increase the risk of pneumopericardium or pneumothorax. Patients with Morgagni hernias are typically more stable preoperatively than patients with Bochdalek hernia and are better candidates for minimally invasive approaches to repair.
Modified minimally invasive laparoscopic peritoneal dialysis catheter insertion with internal fixation
Published in Renal Failure, 2023
Xingzhe Gao, Zhiguo Peng, Engang Li, Jun Tian
Local anesthesia was performed with 5 mL 2% lidocaine. The left paramidline incision was made through the skin, subcutaneous tissues, and anterior rectus sheath. The rectus muscle fibers were separated by blunt dissection to expose the posterior rectus sheath. An incision was made through the posterior sheath and peritoneum by sharp dissection, then a purse-string suture was placed around the opening. The catheter was inserted blindly into the peritoneal cavity with the help of a metal guidewire, and the catheter tip was pointed toward the bladder. After satisfactory placement has been achieved, the guidewire was withdrawn and the purse-string suture was tied. 500 mL normal saline was used to test the patency of the catheter. The inner cuff was placed within the rectus muscle and below the anterior rectus muscle sheath. A subcutaneous tunnel was established on the left abdomen. The outer cuff rested on the site 2 cm from the skin opening.
Systematic review and meta-analysis of the inter-recti distance on ultrasound measurement in nulliparas
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Three included studies carried out a methodological evaluation of measurements. The results indicated that the intra-rater agreement of measurement of the inter-recti distance demonstrated good to excellent reliability for at rest or during crunch, for measurement at the location of both the epigastric and infraumbilical areas. There were no significant differences between the novice and experienced sonographers’ measurements. The intra-rater intraclass correlation coefficients of the infraumbilical area were excellent (0.89–0.98) but slightly lower than those of epigastric measurements. This decreased accuracy at the infraumbilical area has been suggested to be due to the constitution of the rectus sheath affecting the formation of the linea alba and making identification of the borders more challenging. It has also been suggested that in the infraumbilical area, there is a reduced definition of the posterior layer of recti muscles and the presence of sizeable abdominal laxity. In addition, there is typically more subcutaneous fat in this region. The fatty deposits at the infraumbilical area may attenuate the sound beam to a greater extent, which can lead to reduced image clarity.
Traumatic abdominal wall hernia and Morel-Lavallee lesion in a pediatric patient
Published in Baylor University Medical Center Proceedings, 2023
Simón Esteva, Lucas Fair, Dianne Srinilta, Neil Mauskar, Tanner Matthews, Brandon Rabeler, Katherine Wright, Rosemarie Robledo, Steven Leeds, Marc Ward, Bola Aladegbami
Two days later, the patient was brought back to the operating room for reexploration and abdominal wall reconstruction. The right-sided musculature was reapproximated en masse with #1 PDS sutures in a simple interrupted fashion. The left side musculature was reapproximated en masse with interrupted #1 PDS sutures in a figure-of-eight fashion. Reapproximation of the midline fascia was attempted, but there was significant tension. Therefore, a bilateral posterior rectus sheath release was performed to aid fascial closure. Despite this, there was still significant tension in the area of tissue loss. A 30 × 30 cm intraperitoneal Strattice mesh secured with multiple #1 PDS transfascial sutures was placed to reinforce the repair and bridge the area of tissue loss. Craniocaudally, the mesh extended from the xiphoid process to Cooper’s ligament. On the right side, the mesh extended through the previous retroperitoneal dissection down to the psoas muscle, while on the left side the mesh extended to cover the lateral extent of a left abdominal wall musculature repair (Figure 3a). The fascia superior and inferior to the area of suprapubic tissue loss was reapproximated with #1 PDS sutures in a continuous fashion. The fascia in the area of suprapubic tissue loss could not be approximated without tension. The skin was not closed, and a 3M Vacuum Assisted Closure (V.A.C.) Ulta Therapy System was then applied.