Congenital intestinal malrotation with gastric wall defects causing extensive gut necrosis and short gut syndrome:A case report

BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.

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.

Perioperative management of postoperative sigmoid colon cancer complicated by a large abdominal wall defect:A case report

BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.

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.

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

Surgical treatment of pulsatile tinnitus related to the sigmoid sinus

Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus(PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study.Methods: We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinusassociated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Postoperative tinnitus grading and surgical efficacy were determined.Results: After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient.During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage.Conclusion: Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.

Bowel adhesion and therapy with the stable gastric pentadecapeptide BPC 157,L-NAME and L-arginine in rats

BACKGROUND After parietal peritoneum excision with an underlying superficial layer of muscle tissue in rats,there is failed vasculature,and finally,increased adhesion formation.We hypothesized that unlike nitric oxide(NO)-agents,L-NAME and/or L-arginine,the application of the stable gastric pentadecapeptide BPC 157 with its most recent vascular effects(“vascular recruitment”)means attenuated bowel adhesion formation and NO-and malondialdehyde(MDA)-tissue values.AIM To focused on the bowel adhesion and the therapy with the BPC 157,its most and application of NO-agents.METHODS Along with defect creation,medication was(1)during surgery,once,at 1 min after defect creation as an abdominal bath(1 mL/rat),BPC 157(10μg/kg,10 ng/kg,1 mL/rat),an equivolume of saline,L-NAME(5 mg/kg),L-arginine(200 mg/kg)alone and/or combined.Alternatively,medication was(2)intraperitoneally once daily,first application at 30 min after surgery,last application 24 h before assessment at d 7 or d 14.As a postponed therapy to preexisting adhesion(3),BPC 157(10μg/kg,10 ng/kg intraperitoneally,1 mL/rat)was given once daily since d 7.RESULTSThe recovery effect of the BPC 157 regimens goes with the presence of abundant vascular vessels in and near the defect,which occurs rapidly.Lastly,also applied as post-treatment,BPC 157 creates attenuated adhesions,minimal or no adhesion.Contrarily,NO-agents have diverse initial and final effects:The initial weakening of blood vessel disappearance and finally,severe worsening of adhesions(LNAME)vs the initial weakening of blood vessel disappearance and finally,attenuation of adhesions formation(L-arginine),which counteract each other response given together.Importantly,BPC 157 maintains its beneficial effect also when given with NO-agents(L-NAME+BC 157;L-arginine+BPC 157;L-NAME+L-arginine+BPC 157).Finally,with respect to the increased NO-and MDAvalues-adhesion tissue formation relation,unlike diverse effect of the NO-agents,the BPC 157 application effect regularly combines decrease on the increased NOand MDA-values and the beneficial outcome(less adhesion formation).CONCLUSION BPC 157 therapy can be suited for the realization of the peritoneal defect healing with minimal or no adhesion formation.

A Rare Interstitial Type of Post Appendectomy Incisional Hernia

Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appendectomy is a very common surgical procedure, and post appendectomy incisional hernia is a very rare complication. Here we present a case of a 24-year-old male with swelling in the right hypochondrium and lumbar region with an open appendectomy scar. He was diagnosed to have an interparietal hernia in the anterior abdominal wall. After obtaining consent patient was taken up for surgery. At surgery, the patient was found to have a defect in the transverse abdominis muscle with a medial leaf far from the incision site. Open repair of the defect along with double breasting of external oblique done. Interparietal hernias are rare in post appendectomy scar and this case is of significance since it Highlights a rare interstitial type incisional hernia, as a complication of post appendectomy scar, and not many cases reports are mentioned in literature.

Inner wall running state monitoring for the main pipe of nuclear power

The heat conduction equation is solved in this paper under specific boundary conditions.The coefficients of the obtained distribution equation are simplified with the piecewise integral method.Then the associated model for the cylindrical thermal equipment is established.The relationship of the surface temperatures,the material properties and the inner wall state of the cylindrical thermal equipment is described in the associated model.This model is applied to the inner wall running state monitoring of the main pipe.A multi-channel distributed optical fiber temperature measurement system is designed to acquire the external surface temperatures of the main pipe.Then the associated model can be used to analyze the surface temperature data of the main pipe.The location and the physical dimension of the inner wall defect can be got.Therefore,the inner wall defect monitoring of the main pipe can be realized.The feasibility of this method is verified by experiment.This method also provides a theoretical basis for the real-time monitoring of the main pipe’s internal state.