Malignant triton tumor in the abdominal wall:A case report

BACKGROUND Malignant triton tumors(MTTs)comprise a subgroup of malignant peripheral nerve sheath tumors(MPNSTs)that exhibits rhabdomyosarcomatous differen-tiation and follow an aggressive course.MTTs are primarily located along peripheral nerves.Cases of MTTs in the abdominal wall have not been reported.MTT has a poorer prognosis than classic MPNSTs,and accurate diagnosis necessitates a keen understanding of the clinical history and knowledge of its differential diagnosis intricacies.Treatment for MTTs mirrors that for MPNSTs and is predominantly surgical.CASE SUMMARY A 49-year-old woman presented with a subcutaneous mass in her lower abdo-minal wall and a pre-existing surgical scar that had grown slowly over 3-4 months before the consultation.She had previously undergone radical hysterectomy and concurrent chemo-radiotherapy for cervical cancer approximately 5 years prior to the consultation.Abdominal computed tomography(CT)showed a 1.3 cm midline mass in the lower abdomen with infiltration into the rectus abdominis muscle.There was no sign of metastasis(T1N0M0).An incisional biopsy identified sporadic MTT of the lower abdomen.A comprehensive surgical excision with a 3 cm margin inclusive of the peritoneum was executed.Subse-quently,the general surgeon utilized an approach akin to the open peritoneal onlay mesh technique.The patient underwent additional treatment with an excision shaped as a mini-abdominoplasty for the skin defect.No complications arose,and annual follow-up CTs did not show signs of recurrence or metastasis.CONCLUSION An abdominal MTT was efficaciously treated with extensive excision and abdominal wall reconstruction,eliminating the need for postoperative radiotherapy.

Reinforced tissue matrix to strengthen the abdominal wall following reversal of temporary ostomies or to treat incisional hernias

BACKGROUND Abdominal wall deficiencies or weakness are a common complication of tem-porary ostomies,and incisional hernias frequently develop after colostomy or ileostomy takedown.The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence.Biologic meshes have also been used to enhance healing,particularly in contaminated conditions.Reinforced tissue matrices(R-TMs),which include a biologic scaffold of native extracellular matrix and a syn-thetic component for added strength/durability,are designed to take advantage of aspects of both synthetic and biologic materials.To date,RTMs have not been reported to reinforce the abdominal wall following stoma reversal.METHODS Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma.Following hernia repair and proximal stoma closure,RTM(OviTex®1S permanent or OviTex®LPR)was placed to reinforce the abdominal wall using a laparoscopic,robotic,or open surgical approach.Post-operative follow-up was performed at 1 month and 1 year.Hernia recurrence was determined by physical examination and,when necessary,via computed tomo-graphy scan.Secondary endpoints included length of hospital stay,time to return to work,and hospital readmissions.Evaluated complications of the wound/repair site included presence of surgical site infection,seroma,hematoma,wound dehiscence,or fistula formation.RESULTS The observational study cohort included 16 male and 12 female patients with average age of 58.5 years±16.3 years and average body mass index of 26.2 kg/m^(2)±4.1 kg/m^(2).Patients presented with a parastomal hernia(75.0%),in-cisional hernia(14.3%),or combined parastomal/incisional hernia(10.7%).Using a laparoscopic(53.6%),robotic(35.7%),or open(10.7%)technique,RTMs(OviTex®LPR:82.1%,OviTex®1S:17.9%)were placed using sublay(82.1%)or intraperitoneal onlay(IPOM;17.9%)mesh positioning.At 1-month and 1-year follow-ups,there were no hernia recurrences(0%).Average hospital stays were 2.1 d±1.2 d and return to work occurred at 8.3 post-operative days±3.0 post-operative days.Three patients(10.7%)were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues.Fistula and mesh infection were observed in two patients each(7.1%),leading to partial mesh removal in one patient(3.6%).There were no complications between 1 month and 1 year(0%).CONCLUSION RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal,with no hernia recurrences and favorable outcomes after 1-month and 1-year.

Coinfection with hepatic cystic and alveolar echinococcosis with abdominal wall abscess and sinus tract formation:A case report

BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.

Evaluation of the Clinical Advantages of Laparoscopic Transverse Abdominal Wall Suspension in the Treatment of Pelvic Organ Prolapse

Objective:To evaluate the clinical advantages of laparoscopic transverse abdominal wall suspension in treating pelvic organ prolapse.Methods:Sixty patients diagnosed with moderate to severe pelvic organ prolapse and underwent surgical treatment in our hospital between January 2022 and December 2023 were selected.According to different surgical methods,they were divided into an observation group(given laparoscopic transverse abdominal wall suspension)and a control group(given transvaginal mesh implantation),with 30 subjects/group.The data on perioperative-related indicators,quality of life scores,postoperative recurrence,and complications of the two groups of patients were collected.Results:The postoperative hospitalization days and intraoperative bleeding volume of the observation group were significantly lower than those of the control group,but had longer operation time than that of the control group(P<0.05).The differences between the two groups were statistically significant 6 months after surgery,and the Pelvic Floor Disease Quality of Life Impact Questionnaire(PFIQ-7)score of the observation group was significantly higher than the control group(P<0.05).Both groups of patients completed 12 months of follow-up without any postoperative recurrence.The number of complications in the observation group was slightly lower than that of the control group(P>0.05).Conclusion:Laparoscopic transverse abdominal wall suspension was more effective in treating pelvic organ prolapse and is an ideal surgical procedure.

Primary yolk sac tumor in the abdominal wall in a 20-year-old woman:A case report

BACKGROUND Extragonadal yolk sac tumors(YSTs)are rare,with only a low reported tumor occurrence outside the gonads locally and abroad.Extragonadal YSTs are usually a diagnostic challenge,because they are infrequent,but also because a thoughtful and detailed differential diagnostic process must be performed.CASE SUMMARY Here we present a case of an abdominal wall YST in a 20-year-old woman admitted with a tumor in the lower abdomen close to the umbilicus.The tumorectomy was performed.The histological examination revealed characteristic findings such as Schiller-Duval bodies,loose reticular structures,papillary structures,and eosinophilic globules.According to the immunohistochemical staining,the tumor tissue was positive for broad-spectrum cytokeratin,Spalt-like transcription factor 4,glypican-3,CD117,and epithelial membrane antigen.Based on the clinical information,histological features,and immunohistochemical staining profile,the tumor was diagnosed as a YST present in the abdominal wall.CONCLUSION Based on the clinical information,histological features,and immunohistochemical staining profile described above,the tumor was diagnosed as a primary YST in the abdominal wall.

Gasless Laparoscopic Surgery plus Abdominal Wall Lifting for Giant Hiatal Hernia——Our Single-center Experience

Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is characteristic of more invasion and more complications.Although laparoscopic repair as a minimally invasive surgery is accepted,a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation.The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia.We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution.The GHH was defined as greater than one-third of the stomach in the chest.Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients.Mean age was 67 years.The results showed that there were no conversions to open surgery and no intraoperative deaths.The mean duration of operation was 100 min（range：90–130 min）.One-side pleura was injured in 4 cases（14.8%）.The mean postoperative length of stay was 4 days（range：3–7 days）.Median follow-up was 26 months（range：6–38 months）.Transient dysphagia for solid food occurred in three patients（11.1%）,and this symptom disappeared within three months.There was one patient with recurrent hiatal hernia who was reoperated on.Two patients still complained of heartburn three months after surgery.Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient.Totally,satisfactory outcome was reported in 88.9% patients.It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible,safe,and effective for the patients who cannot tolerate the pneumoperitoneum.

Influence of the abdominal wall on the nonlinear propagation of focused therapeutic ultrasound

This article theoretically studies the influence of inhomogeneous abdominal walls on focused therapeutic ultrasound based on the phase screen model. An inhomogeneous tissue is considered as a combination of a homogeneous medium and a phase aberration screen. Variations of acoustic parameters such as peak positive pressure, peak negative pressure, and acoustic intensity are discussed with respect to the phase screen statistics of human abdominal walls. Results indicate that the abdominal wall can result in energy loss of the sound in the focal plane. For a typical human abdominal wall with correlation length of 7.9 mm and variance of 0.36, the peak acoustic intensity radiated from a 1MHz transmitter with a radius of 30 mm can be reduced by about 14% at the focal plane.

Reconstructing abdominal wall defects with a free composite tissue flap:A case report

BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task.An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps,restoration of the abdominal wall integrity,and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia.When treating huge full-thickness defects,composite autologous tissue flaps are a good option for the repair.CASE SUMMARY This study reported the case of a 43-year-old male patient suffering from fullthickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen.After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels,reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure.The remaining 18 cm×15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap.The proposed method achieved the functional reconstruction of the abdominal wall.CONCLUSION This approach restored the abdominal wall integrity,maintained certain muscle tension,avoided abdominal hernia,reached satisfactory aesthetic effect,and resulted in no complications in the grafting regions.

Asynchronous abdominal wall and sigmoid metastases in clear cell renal cell carcinoma: A case report and literature review

Sigmoid metastasis of renal cell carcinoma(RCC)is very rare.Herein we report a case of pathologically proven asynchronous abdominal wall and sigmoid metastases after a right nephrectomy.An 84-year-old man underwent right radical nephrectomy for clear cell renal cell carcinoma(ccRCC)13 years ago.Solitary contralateral abdominal wall metastasis was found for left abdominal mass 9 years after nephrectomy.The man experienced melena underwent resection of sigmoid colon tumor in February,2016.The postoperative pathological examinations revealed that the tumors were metastases of ccRCC.Recurrence more than 5 years after nephrectomy has been accepted as late recurrence by the majority of urologists now.Late recurrence is one of the specific biological behaviors of RCC.Asynchronous late recurrence of abdominal wall and sigmoid metastases in ccRCC has not been reported before.When patients have sigmoid mass after nephrectomy for RCC,doctors may consider the possibility of late recurrence.

Left abdominal wall proliferative myositis resection and patch repair:A case report

BACKGROUND Proliferative myositis is a rare benign tumor that is typically self-limiting and does not become malignant.It can be cured by simple resection without reported recurrence.Due to its rapid growth,hard structure and ill-defined borders,it can however be mistaken for malignant tumors such as sarcomas.CASE SUMMARY We investigate the case of a 64-year-old male with proliferative myositis of the abdominal wall,who was preoperatively administered a needle aspiration biopsy and given a simple excision and patch repair.We then compared it with other similar cases to determine the effectiveness of this treatment method.CONCLUSION Resection with follow-up observation has shown to be an effective treatment method for proliferative myositis.To avoid unnecessarily extended or destructive resection,a thorough and conclusive diagnosis is crucial,which requires adequate imaging and pathological knowledge.

Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension

BACKGROUND: Noninvasive monitoring of intra-abdominal pressure(IAP) by measuring abdominal wall tension(AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit(ICU).METHODS: In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure(UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index(BMI) on baseline AWT(IAP<12 mm Hg) were assessed using one-way analysis of variance.RESULTS: A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP(R=0.986, P<0.01); the regression equation was Y=–1.369+9.57X(P<0.01). There were signif icant differences among the different respiratory phases and body positions(P<0.01). However, gender and BMI had no signif icant effects on baseline AWT(P=0.457 and 0.313, respectively).CONCLUSIONS: There was a signif icant linear correlation between AWT and UBP and respiratory phase, whereas body position had signif icant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

Tension-reduced closure of large abdominal wall defect caused by shotgun wound:A case report

BACKGROUND Large abdominal wall defect(LAWD)caused by shotgun wound is rarely reported.CASE SUMMARY Herein,we describe a case of LAWD caused by a gunshot wound in which the abdominal wall was reconstructed in stages,including debridement,tensionreduced closure(TRC),and reconstruction with mesh and a free musculocutaneous flap.During a 3-year follow-up,the patient recovered well without hernia or other problems.CONCLUSION TRC is a practical approach for the temporary closure of LAWD,particularly in cases when one-stage abdominal wall restoration is unfeasible due to significant comorbidities.

Multiple recurrent neurofibromas in the abdominal wall:A case report

BACKGROUND Neurofibroma can be a clinical manifestation of neurofibromatosis,which is a benign neurogenic tumor that occurs sporadically.Neurofibromas in the abdomen usually appear in the retroperitoneal space.Reports on neurofibromas in the abdominal wall are rare,and multiple recurrent neurofibromas in this area have not yet been reported.CASE SUMMARY This is a case of a 73-year-old man who suffered from multiple recurrent neurofibromas in the abdominal wall for 16 years and received 13 surgical treatments.CONCLUSION We need to pay due attention to its treatment,and primary surgery should be designed thoroughly.

Aseptic abscess in the abdominal wall accompanied by monoclonal gammopathy simulating the local recurrence of rectal cancer:A case report

BACKGROUND Infectious abscesses in the abdominal wall can be secondary to retained foreign bodies(e.g.,stones,use of artificial mesh,use of silk yarn in surgical suture),inflammatory diseases(e.g.,acute appendicitis),and perforated malignancies of the digestive tract(particularly the colon).Aseptic abscesses(AAs)are relatively rare.To the best of our knowledge,this is the first report of an AA in the abdominal wall accompanied by monoclonal gammopathy of undetermined significance(MGUS)at 5 years after laparoscopic proctectomy.CASE SUMMARY A 72-year-old female patient presented with an enlarged painless mass in the lower abdomen for 1 year.She had a history of obesity,diabetes,and MGUS.Her surgical history was laparoscopic resection for rectal cancer 6 years prior,followed by chemotherapy.She was afebrile.Abdominal examination revealed a smooth abdomen with a clinically palpable solid mass under a laparotomy scar in the left lower quadrant.No obvious tenderness or skin redness was spotted.Laboratory data were not remarkable.Computed tomography scan revealed a low-density mass of 4.8 cm in diameter in the lower abdominal wall,which showed high uptake on positron emission tomography.The preoperative diagnosis was an abscess or tumor,and surgical resection was recommended.The mass was confirmed to be an AA by microbiological and pathological examinations.The patient recovered well after surgery.There was no evidence of recurrence 2 years later.CONCLUSION It is important to consider underlying conditions(diabetes,chemotherapy,MGUS)which may contribute to AA formation in the surgical wound.

Ultrasound-guided percutaneous drainage of a traumatic abdominal wall hematoma in the emergency department

BACKGROUND:Abdominal wall hematoma is due to trauma,coagulation disorders or anticoagulation therapy complications.METHODS:in this report we present a case of a 44-year-old female who suffered from blunt abdominal trauma and presented to the emergency department with sharp abdominal pain and ecchymosis.FAST and abdominal computerized tomography(CT) revealed an abdominal wall hematoma.Treatment with an ultrasound-guided percutaneous drainage was performed successfully.RESULTS:The patient remained under observation for six hours with serial ultrasound scans,and no signs of hematoma recurrence were present.She was discharged the same day with clinical improvement.CONCLUSION:Complete history investigation and clinical examination help to make a correct diagnosis of abdominal wall hematoma,select a prompt treatment,and reduce complications.

Gastric cancer with soft tissue metastasis of the abdominal wall:a case report

Abdominal wall metastasis of gastric cancer(GC)is a very rare occurrence in the clinic setting.We recently diagnosed and treated a patient with abdominal wall metastasis of GC and we hope to provide some helpful guidance on the clinical diagnosis and treatment of this disease.A 49-year-old male patient with GC was admitted to our hospital(Dalian Municipal Central Hospital,Dalian,China)complaining of left upper abdominal wall mass.Physical examination and regular laboratory blood tests showed no obvious abnormalities.Ultrasound and CT of the abdomen showed a subcutaneous solid mass in the abdominal wall.Radical gastrectomy was performed on February 27,2019,six months after it was first noticed by the patient.Pathological examination and immunohistochemistry showed GC with abdominal metastasis.Postoperative radiotherapy or chemotherapy was not pursued after the second operation and no recurrence or metastasis has been noted so far.GC with abdominal metastasis is very rare and can be easily missed or misdiagnosed.For metastasis to a single site in the abdominal wall,surgical resection,which is recommended,may improve patient outcomes.

Treatment of large defect of abdominal wall after tumors resection by transposition of tissue flaps with pedicle

Objective To report evaluat of division region of abdominal wall large defect after tumors resection and repair methods by tissue flaps with pedicle. Methods Form October 1992 to September 2001, 8 cases large abdominal wall defect after malignant tumors resection(10 × 10 cm-32 cm×32 cm) were reviewed. The defectcontributed:Ⅰ region, 2 cases; twin-Ⅱ region, 2; Ⅲ region, 2; Ⅰ and Ⅱ region of one side, 1 and total abdominal wall,one case, The tissue flaps of transposition included: gracilis myocutaneous flaps, 4; retus abdominal myocutaneous flaps, 2; external abdominal obligue musculo-fascia flaps, 2; latissimus dorsi muscle, tensor fasciae latae muscle and retus femoris muscle flaps each, 1. One patient used MycroMesh also. Results In the course of peroperation, the incisions of 8 cases healed in first time; total tissue flaps survived and all pateints started exercise left the bed in 3 weeks. All 8 patients were followed up average of 2 years and 5 months: the success rate of reconstruction

Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments

Background：Magnetic anchored surgical instruments （MASI）,relying on magnetic force,can break through the limitations of the single port approach in dexterity.Individual characteristic abdominal wall thickness （ICAWT） deeply influences magnetic force that determines the safety of MASI.The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT,and then construct an artful method to predict ICAWT,resulting in better safety and feasibility for MASI.Methods：For MASI,ICAWT is referred to the thickness of thickest point in the applied environment.We determined ICAWT through finding the thickest point in computed tomography scans.We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT.Results：Abdominal wall at C point in the middle third lumbar vertebra plane （L3） is the thickest during chosen points.Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness.＂BMI-ICAWT＂ curve was obtained based on abdominal wall thickness of C point in L3 plane,and the expression was as follow：f（x） =P1 × x^2 ＋ P2 x x ＋ P3,where P1 =0.03916 （0.01776,0.06056）,P2 =1.098 （0.03197,2.164）,P3 =-18.52 （-31.64,-5.412）,R-square：0.99.Conclusions：Abdominal wall thickness of C point at L3 could be regarded as ICAWT.BMI could be a reliable predictor of ICAWT.In the light of ＂BMI-ICAWT＂ curve,we may conveniently predict ICAWT by BMI,resulting a better safety and feasibility for MASI.

Resection and repair of large abdominal wall lesions in gynecologic patients

Background The techniques of resection and repair of large lesions in the abdominal wall are very challenging in the area of gynecology. We explored the techniques of resection and plastic surgical repair of large abdominal wall lesions in gynecologic patients. Methods Twenty-six patients with large lesions in the abdominal wall underwent resection by the gynecologists and repair through abdominal plasty and V-Y plasty with or without fascia patch grafting by the gynecologists or plastic surgeons from March 2003 to October 2010. Results All patients had a history of cesarean section. One patient had an infected sinus tract after cesarean section, one patient had an inflammatory nodule, and the others had lesions of endometriosis, including one cancer. The average largest lesion diameter was （4.79 ± 4.18） cm according to the ultrasonography results. The lesions of all patients were completely resected with pretty abdominal contour. A polypropylene biological mesh was added to the fascia in 20 patients. One patient underwent groin flap repair, and one underwent V-Y advanced skin flap repair on the left of the incision to relieve the suture tension. Conclusions Multi-department cooperation involving the gynecology and plastic surgery departments, and even the general surgery department, is essential for patients with large lesions in the abdominal wall. This cooperative effort enabled surgeons to completely resect large lesions. Abdominal wall plastic surgical repair can ameliorate large wounds of the abdominal wall.

Staged management of giant traumatic abdominal wall defect: A rare case report

Blunt traumatic abdominal wall disruptions associated with evisceration (abdominal wall injury grade type Ⅵ) are very rare. We describe a case of large traumatic abdominal wall disruption with bowel evisceration and complete transection of jejunum and sigmoid colon that occurred after a 30-year-old male sustained run over injury to abdomen. Abdominal exploration and primary end to end jejuno-jejunal and colo-colic anastomosis were done. Staged management of giant abdominal wall defect was performed without any plastic reconstruction with good clinical outcome.