The abdominal wall, hernias and the umbilicus
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
The abdominal wall has a complex structure, and many of the surgical conditions affecting it are embryological in origin. It develops laterally from the vertebral column, envelops the intestinal tract, and finally fuses in the midline to form a seam-like fibrous cord, the linea alba. This is pierced at the umbilicus by the umbilical cord, which in early embryonic life contains the yolk sac and the entire mid-gut. A hernia is the protrusion of an organ or part of an organ through its containing wall. For an organ or tissue to herniate, there must be a weakness in the retaining wall. This may be caused by a congenital abnormality, may be related to the normal anatomy, such as a place where a vessel or viscus enters or leaves the abdomen, or may be acquired as a result of trauma or disease. All hernias that are related to the umbilicus may be called umbilical hernias.
Cletus
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner in The Integrated Nervous System, 2017
The clinical examination of Cletus indicated weakness of all muscles on both sides below the umbilicus. A word of caution about describing localization of spinal levels of dysfunction: often, the spinal cord level is used to describe the level of dysfunction based on clinical exam. Using the Expanded Localization Matrix, we see that, in any given patient with a spinal cord lesion, the probable major clinical findings are, variously, loss of sensation to pinprick and temperature; loss of sensation to vibration, proprioception and discriminative touch; weakness, reflex changes and changes in muscle tone. Several terms are used to describe spinal cord injury and level. The observation of fasciculations in the tongue is very significant in that it shows lower motor neuron damage located above the level of the cervical spine. The lateral sclerosis (LS) part of the name refers to the lateral columns or lateral funiculi in which the corticospinal tracts run.
Anatomy
Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury in OSCEs for the MRCS Part B, 2017
Many students find preparing for the anatomy part of the examination a daunting task. It has been many years since you were last in the dissection room and it feels like there is a vast amount of material to learn in a short space of time. It is all too easy to spend all your revision time on anatomy alone, at the expense of other areas of the exam. During embryonic and fetal life, the testes and the ovaries both descend from their original position at the 10th thoracic level. This explains the long course taken by the gonadal arteries and the site of referred pain from the gonads to the umbilicus (T10 dermatome). Afferent nerve fibres concerned with the conduction of visceral pain from the appendix accompany the sympathetic nerves and enter the spinal cord at the level of T10.
A review of the open laparoscopic Hasson technique and retrieval of adnexal specimen via umbilicus
Published in Journal of Obstetrics and Gynaecology, 2017
L. F. A. Wong, B. Anglim, N. A. Wahab, N. Gleeson
Laparoscopic entry techniques vary amongst surgeons and gynaecologists, with gynaecologists favouring Veress needle entry. Recent RCOG/BSGE recommendations have recommended retrieval of ovarian masses via the umbilical port with resultant less postoperative pain and a faster retrieval time than with retrieval through lateral ports of the same size. This is a prospective observational study reviewing the Hasson entry technique and the introduction of retrieval of specimens via the umbilicus in patients scheduled for a laparoscopy procedure at our day surgery unit. We found no immediate or major surgical complications and all specimens were successfully retrieved through the umbilicus. Pain scores were low. We recommend the technique for extirpative gynaecological surgery.Impact StatementThis study confirms that conversion from the closed Veress to the open Hasson technique is achievable in a university hospital setting. Operator confidence during the learning phase is enhanced by the use of ultrasound to locate and measure the depth of the umbilical ligament. Retrieval of benign adnexal specimens through the umbilicus was very satisfactory.
Antenatal sonographic features of persistent extrahepatic vitelline vein aneurysm confused with umbilical vein varix
Published in Fetal and Pediatric Pathology, 2019
Song-Hwa Chae, Il Woon Ji, Seung Hwa Hong, Jin Young Choi, Ho-chang Lee, Jung-Sun Kim, Bitna Kim, Ji-Hun Kim, KiHyeok Song
Background: The persistent vitelline vein is a portal venous system malformation arising during the embryonic period. These abnormal blood vessels frequently thrombose and can lead superior mesenteric vein obstruction or portal hypertension. Case report: We visualized a fetal intra-abdominal cystic mass with turbulent flow on prenatal ultrasound at 28 weeks’ gestation. Initially diagnosed as an umbilical vein varix, it was later determined to be an extrahepatic persistent vitelline vein with an internal thrombus by postnatal ultrasound. It was successfully surgically excised. Conclusion: When an abnormal abdominal vascular structure near the umbilicus is found during prenatal ultrasonography, the persistent vitelline vein should be included in the differential diagnosis to allow prompt evaluation and treatment after birth.
Relation between serum PAPP-A level and umbilical cord thickness during first trimester of pregnancy
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2014
Muzeyyen Duran, Aydın Köşüş, Nermin Köşüş, Nilgün Ö. Turhan
Purpose: To evaluate the relation between umbilical cord diameter versus pregnancy associated plasma protein-A (PAPP-A) level in first trimester women. Method: Cord diameter were measured and patients were divided into two groups according to frequency distribution analysis as below or above 3.7 mm for free loop diameter (FCD) and below or above 3.4 mm for cord measurement at umbilicus (ACD). Groups were compared with each other. Results: Strong correlations were found between ACD versus PAPP-A. Conclusion: By using strong correlation between ACD versus PAPP-A, it may be possible to reduce unnecessary amniocentesis due to false positive screening results.