1/5. An unusual peritoneal fossa: anatomic report and clinical implications.The peritoneal fossae are usually related to rotation and adhesion of the abdominal viscera to the posterior abdominal wall during fetal development, and/or the presence of retroperitoneal vessels running just under the peritoneum and raising serosal folds. These fossae, therefore, are regarded as congenital and have been considered clinically and surgically as sites of internal abdominal hernias. The authors describe a peritoneal fossa interposed between the fourth portion of the duodenum and the abdominal aorta. Due to a scoliosis of the lumbar column, the abdominal aorta had shifted to the left of the duodenum, stretching two semilunar avascular peritoneal folds connecting the vessel with the ascending duodenum. These two folds bounded above and below an entrance into a fossa lined by the posterior parietal peritoneum and bordered by the fourth portion of the duodenum on the right and the aorta on the left. This recess extended as far as the anterior surface of the second and third lumbar vertebrae. On the basis of the anatomic findings, the authors suggest that acquired fossae, because of their size and topography, may play a part in the etiopathogenesis of internal abdominal hernias.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. Epigastric hernia and its etiology.BACKGROUND: Controversies still prevail as to how exactly epigastric hernia occurs. Both the vascular lacunae hypothesis and the tendinous fibre decussation hypothesis have proved to be widely accepted as possible explanations for the etiology. PATIENT: We present a patient who suffered from early-onset epigastric hernia. CONCLUSIONS: We believe the identification of the ligamentum teres and its accompanying vessel at its fascial defect supports the vascular lacunae hypothesis. However, to further our understanding, biopsy of the linea alba in patients with epigastric hernias is indicated.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/5. Dynamic reconstruction of large abdominal defects using a free rectus femoris musculocutaneous flap with normal motor function.Reconstruction of large abdominal wall defects with conventional reconstruction including the component separation technique is difficult because of strong transverse tension and loss or weakness of the rectus abdominis muscle. To overcome this problem, dynamic reconstruction of the abdominal wall using a free innervated rectus femoris musculocutaneous flap was performed for large defects with separation of the bilateral rectus abdominis muscles. The intact motor nerve of the rectus femoris muscle was transferred without transection, and only the pedicle vessels were anastomosed to the omental vessels. Four and one-half years after surgery, the rectus femoris muscle had voluntary strong muscle contraction and there was no abdominal protrusion, herniation, or donor morbidity. This new method with dynamic function can replace conventional techniques for large abdominal defects without rectus muscle function.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/5. Acute acalculous cholecystitis due to an incarcerated epigastric hernia.A case of a 96 year old woman with an incarcerated gallbladder in an epigastric hernia causing acute acalculous cholecystitis is described. At operation the gallbladder was replaced in its anatomical site and the hernia was repaired. This unique case of acute acalculous cholecystitis demonstrates cystic duct obstruction and cystic vessel compression as possible aetiologies for this pathology.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/5. Paraduodenal hernia.An internal hernia is the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. Internal hernias account for 0.2 to 0.9 per cent of all cases of intestinal obstruction. Paraduodenal hernias are relatively rare congenital malformations and account for 30 to 53 per cent of all internal hernias. They result from incomplete rotation of the midgut, with part of the small intestine trapped posterior to the mesocolon. Right and left paraduodenal hernias are distinct and separate entities, varying not only in anatomic structure but also in embryological origin. Symptoms are often vague, and a high index of suspicion is required to make the diagnosis. This entity should be considered whenever atypical abdominal symptoms are present. A CT scan or barium upper gastrointestinal radiography provides the best preoperative evidence of this condition, although ultrasonography and plain films are also useful. Elective repair of such a hernia should always be performed to avoid bowel incarceration or strangulation. An understanding of the anatomy of these hernias facilitates the surgery and is necessary in decreasing the likelihood of complications. Careful reduction of the hernia and surgical repair will avoid injury to the major mesenteric vessels juxtaposed to the hernial orifice. The surgical management of three patients, who were diagnosed preoperatively with this condition, is described with a review of its pathogenesis and present surgical treatment.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |