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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Given the age and examination findings of this child, my primary diagnosis would be an umbilical hernia. I would confirm this by performing a full clinical examination of the abdomen. Other possibilities are limited, although an epigastric hernia would present similarly at the upper abdomen, however defects can be multiple. An omphalocele is seen at birth, and involves the protrusion of the abdominal contents through an umbilical defect with a thin layer of amnion externally, and peritoneum internally.
The male reproductive system and hernias
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Umbilical/para-umbilical, epigastric and other ventral herniasAn umbilical hernia is a congenital abnormality resulting from failure of the umbilicus to close in early life. Umbilical hernias in children do not cause pain and never strangulate; most close spontaneously by the age of 3–6 years. The main cause for concern is parental anxiety over the peculiar appearance and surgical closure if the hernia persists beyond the age of 3 may be justified for this reason. Umbilical hernias in adults rarely cause complications but may be uncomfortable and should be repaired if symptomatic.Para-umbilical hernias are congenital or acquired defects immediately superior to the umbilicus that are most often seen in obese adults. These hernias are liable to enlarge with the passage of time and may cause complications. Elective repair should be undertaken unless the patient is very unfit.An epigastric hernia may present in childhood as a small tender lump in the midline. Occasionally, the hernia cannot be felt at all, and the child complains only of epigastric pain, which is commonly made worse by exercise. Epigastric hernias are small congenital defects in the linea alba through which preperitoneal fat protrudes. Surgical repair is justified by the symptoms.Adults may also develop midline (ventral) abdominal hernias, although the bulge that the patient has noticed is often due to separation of the rectus abdominis muscles and attenuation of the linea alba (‘divarication of the recti’). A midline hernia with a distinct neck that has fibrous margins should be repaired, as these hernias tend to enlarge, may become massive and may strangulate the intestine. Divarication of the recti is a harmless condition, however, and the results of surgical treatment are often poor.Incisional hernias are most common following long midline abdominal incisions, although they may occur at other sites. Postoperative wound infection and obesity are the main predisposing causes (along with poor surgical technique). Herniation is due to separation or attenuation of the musculofascial layer at the site of the previous incision. Incisional hernias tend to enlarge, sometimes to massive proportions, and may strangulate. Early surgical repair should therefore be undertaken.
Inferior pancreaticoduodenal artery aneurysms and Dunbar syndrome. Experience with the open surgery
Published in Acta Chirurgica Belgica, 2021
Predrag Pavić, Inga Đaković Bacalja, Ali Allouch, Tomislav Meštrović
After careful examination of the digital subtraction angiography (DSA), an open surgical approach was applied. Due to inexperience in laparoscopic dealing with this anatomic region in our institution and the one-act resolution of both crural compression of the CTr and the IPDAA through upper medial laparotomy we have decided to undertake an open procedure. Since there are some reports of the IPDAA rupture risk regardless of its size, we have decided to repair the IPDAA as well [4]. An arcuate ligament discision and a CTr decompression were accomplished. The inferior pancreaticoduodenal artery aneurysm (IPDAA) found in mesentery measured 30 mm. The aneurysm was saccular, highly fragile with a wide base and therefore excluded from the circulation by aneurysmorrhaphy. A week after the operation, a control multislice computed tomography (MSCT) verified a 40% residual CTr stenosis, there was no previously seen IPDAA. In a follow up examination 5 months later, the patient was with significant relief. Postprandial pains were appearing seldom, gaining weight and a small epigastric hernia was observed. An interval MSCTA showed insignificant celiac trunk stenosis (Figures 1 and 2).
Efficacy of ultrasound-guided transversus abdominis plane block versus erector spinae plane block for postoperative analgesia in patients undergoing emergency laparotomies: A randomized, double-blinded, controlled study
Published in Egyptian Journal of Anaesthesia, 2022
Abeer Ahmed Mohammed Hassanin, Nagy Sayed Ali, Hassan Mokhtar Elshorbagy
Our results are consistent with Abu Elyazed et al., 2019 who assessed 60 patients who were randomly split into two equal groups to determine the impact of an ESPB on postoperative pain after open epigastric hernia repair. The ESPB group received 20 ml of bupivacaine 0.25% on every side, whereas the control group received a bilateral sham ESPB using 1 mL of regular saline. They concluded that ultrasound-guided bilateral ESPB led to lower postoperative visual analog scale pain ratings as well as lower use of both intraoperative fentanyl and postoperative rescuing analgesics [18].
The effects of the muscular contraction on the abdominal biomechanics: a numerical investigation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Piero G. Pavan, Silvia Todros, Paola Pachera, Silvia Pianigiani, Arturo N. Natali
From data reported in Figure 6, at a IAP of 100 mmHg it is possible to compute a membrane force reduction of 67% in the craniocaudal direction and 19% in the transversal direction when considering active behavior. A comparison between the membrane forces computed in passive and active condition in regions subjected to possible regions of herniation highlights a decrease of 90% in craniocaudal direction and of 22% in transversal direction for the epigastric hernia. The same calculation performed in the region of the umbilical hernia highlights a reduction of the membrane force of about 54% in craniocaudal direction and of 7% in transversal direction. With the muscular contraction, the percentage reduction of membrane force on the fasciae differs in craniocaudal and transversal directions. Numerical results show that this reduction depends on the specific location considered. This behavior can be related to the specific spatial orientation of muscular fibers that is region-dependent. Furthermore, a different variation of the abdominal wall curvature is induced after muscular contraction in the different regions along craniocaudal and transversal direction. This modification can also affect the membrane force reduction on the fasciae. In general, membrane force in the transversal direction is higher than the one computed in the craniocaudal direction, both in active and passive conditions. This reflects the anisotropic characteristics of abdominal wall, which is stiffer along the transversal direction. Moreover, Figure 6 shows that the spatial distribution of membrane force in linea alba and rectus sheath is similar for the two analyzed conditions, while membrane force magnitude is lower for the active condition. This comparable spatial distribution extends also to the other fascial structures. Consequently, the same trend is found for stress fields too.