A gross abdominal wall hematoma secondary to transversus abdominis plane block

We aimed to share our experience with an abdominal wall hematoma that developed after an ultrasonography-guided TAP block performed for the palliation of chronic abdominal wall pain. Bleeding was successfully stopped with coil embolization.

Linea alba 3D morphometric variability by CT scan exploration

PURPOSE

The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature. We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics.

METHODS

Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients' CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured.

RESULTS

The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p < 0.001), and was shorter in women (p < 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p < 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p < 0.001-p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007).

CONCLUSION

This study provides an exhaustive 3D description of Linea alba's anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.

Treatment of adenomyosis, abdominal wall endometriosis and uterine leiomyoma with interventional radiology: A review of current evidences

Interventional radiology shows promises in the field of women's health, particularly in pelvic interventions. This review article discusses the latest advancements in interventional radiology techniques for pelvic conditions affecting women including adenomyosis, abdominal wall endometriosis and uterine leiomyoma. Extraperitoneal endometriosis involving the abdominal wall may be treated by percutaneous thermal ablation, such as cryoablation, whereas uterine leiomyoma and adenomyosis can be managed either using percutaneous thermal ablation or using uterine artery embolization. Continued research and development in interventional radiology will further enhance the minimally-invasive interventions available for women's health, improving outcomes and quality of life for this large patient population of women.

Anthropometric parameters as a predictor for abdominal wall thickness in a patient with gastrostomy

BACKGROUND

Enteral feeding tubes play essential roles in clinical management and nutritional support. Knowledge of the abdominal wall is beneficial in surgical practice and safe for gastrostomy. Anthropometric parameters are currently used for clinical assessment in many clinical applications. That might be beneficial if we applied anthropometric measurement for thickness prediction of the abdominal wall to the schedule of patients' gastrostomy care. This study aimed to evaluate the anthropometric parameters of abdominal wall thickness (AWT).

METHODS

We conducted a cross-sectional study with anthropometric parameters and CT-measured anterior AWT were assessed and analyzed.

RESULTS

The data are collected from January 2020 to March 2021. Arm circumference and body mass index were strongly correlated with AWT at left upper quadrant area and anterior AWT at middle area. The data was created in an TAWT (Thammasat AWT) chart to represent body parameters to AWT.

CONCLUSIONS

Arm circumference is related to AWT. A TAWT chart is designed to help medical personnel evaluate the thickness of the abdominal wall and could guide estimating the gastrostomy tube length.

Volumetry after botulinum toxin A: the impact on abdominal wall compliance and endotracheal pressure

PURPOSE

Botulinum toxin type A (BTA) is an adjuvant tool used in the preoperative optimization of complex hernias before abdominal wall reconstruction (AWR). This study aims to investigate changes in the abdominal cavity and hernia sac dimensions after BTA application.

METHOD

A prospective study with 27 patients with a hernia defect of ≥ 10 cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated.

RESULTS

Imaging post-BTA revealed hernia width reduction of 1.9 cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1 cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH2O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%.

CONCLUSION

BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair.

Preoperative CT imaging as a tool to predict incisional hernia outcomes following abdominal wall reconstruction: A retrospective cohort analysis

INTRODUCTION

Ventral wall hernia often causes significant morbidity and requires complex abdominal wall reconstruction (AWR). This study aims to determine whether subcutaneous abdominal fat thickness (AFT) measured with preoperative CT scans could predict postoperative outcomes in patients undergoing AWR.

METHODS

A retrospective cohort study was conducted on all patients who underwent AWR at our institution between 2009 and 2021, with a minimum follow-up of 12 months. Using preoperative CT scans, AFT was measured at the xiphoid process, umbilicus, and pubic tubercle, as well as the hernia dimensions. Demographic, operative, and surgical outcome data were also collected and analyzed using statistical tests.

RESULTS

The results showed that 9 of 101 patients (8.9%) experienced hernia recurrence. Smoking was associated with an increased risk of hernia recurrence (p < 0.001) with a predictive odds ratio (OR) of 18.27 (p = 0.041). Increased AFT at the xiphoid (p = 0.005), umbilicus (p < 0.001), and pubic tubercle (p < 0.001) were also associated with hernia recurrence and risk of infection. Only AFT at the pubic tubercle reached significance in the regression model predicting recurrence (OR=1.10; p = 0.030) and infection (OR=1.04; p = 0.021). A cut-off value of 67 mm was associated with a positive predictive value of 42.14% (sensitivity of 67% and specificity of 91%). Hernia defect area was not associated with risk of recurrence or infection.

CONCLUSIONS

Smoking and increased AFT at the pubic tubercle are significant predictive factors for recurrence and infection in patients undergoing AWR, and preoperative optimization should focus on reducing these factors.

The effect of breathing on the in vivo mechanical characterization of linea alba by ultrasound shearwave elastography

The most common surgical repair of abdominal wall hernia consists in implanting a mesh to reinforce hernia defects during the healing phase. Ultrasound shearwave elastography (SWE) is a promising non-invasive method to estimate soft tissue mechanical properties at bedside through shear wave speed (SWS) measurement. Combined with conventional ultrasonography, it could help the clinician plan surgery. In this work, a novel protocol is proposed to reliably assess the stiffness of the linea alba, and to evaluate the effect of breathing and of inflating the abdomen on SWS. Fifteen healthy adults were included. SWS was measured in the linea alba, in the longitudinal and transverse direction, during several breathing cycle and during active abdominal inflation. SWS during normal breathing was 2.3 [2.0; 2.5] m/s in longitudinal direction and 2.2 [1.9; 2.7] m/s in the transversal. Inflating the abdomen increased SWS both in longitudinal and transversal direction (3.5 [2.8; 5.8] m/s and 5.2 [3.0; 6.0] m/s, respectively). The novel protocol significantly improved the reproducibility relative to the literature (8% in the longitudinal direction and 14% in the transverse one). Breathing had a mild effect on SWS, and accounting for it only marginally improved the reproducibility. This study proved the feasibility of the method, and its potential clinical interest. Further studies on larger cohort should focus on improving our understanding of the relationship between abdominal wall properties and clinical outcomes, but also provide a cartography of the abdominal wall, beyond the linea alba.

Abdominal Wall Endometriosis at the Cesarean Section Scar

Abdominal wall endometriosis is atypical localization of the extra-pelvic endometriosis with non-specific symptoms and is difficult for diagnosis. Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis, which usually develops after obstetric operations. We report a case of a 33-year-old woman who had two previous cesarean sections presented with a mass in the subcutaneous tissue of the abdominal wall, approximately 4 cm superior to the Pfannenstiel incision, 5 years after her second lower segment caesarean section. The classic clinical presentation, imaging findings on ultrasonography and computed tomography are analyzed. Treatment with local surgical excision of the mass is discussed. The diagnosis was confirmed with histopathological analysis of the surgical sample. When it comes to the limited painful lesion in the subcutaneous tissue at the cesarean scar, with a pain intensifying during menstruation, the physician should consider cesarean scar endometriosis in women of reproductive age with a history of cesarean section.

Percutaneous Imaging-guided Cryoablation of Endometriosis Scars of the Anterior Abdominal Wall

STUDY OBJECTIVE

To evaluate the safety and clinical efficacy of percutaneous imaging-guided cryoablation for the management of anterior abdominal wall endometriosis.

DESIGN

Patients with abdominal wall endometriosis underwent percutaneous imaging-guided cryoablation and had a 6-month follow-up.

SETTING

Data dealing with patients' and anterior abdominal wall endometriosis (AAWE) characteristics, cryoablation, and clinical and radiologic outcomes were retrospectively collected and analyzed.

PATIENTS

Twenty-nine consecutive patients underwent cryoablation from June 2020 to September 2022.

INTERVENTIONS

Interventions were performed under US/computed tomography (CT) guidance or magnetic resonance imaging (MRI) guidance. Cryoprobes were directly inserted into the AAWE, and cryoablation was performed with a single 5 to 10 minute freezing cycle, which was stopped when the iceball expanded 3 to 5 mm beyond AAWE borders as assessed on intra-procedural cross-sectional imaging.

MEASUREMENTS AND MAIN RESULTS

Fifteen patients (15/29; 51.7%) had prior endometriosis, 28 (28/29; 95.5%) had previous cesarian section, and 22 (22/29; 75.9%) referred association between symptoms and menses. Cryoablation was performed under local (16/29; 55.2%) or general anesthesia (13/29; 44.8%) and mainly in an out-patient basis (18/20; 62%). There was only one (1/29; 3.5%) minor procedure-related complication. Complete symptom relief was recorded in 62.1% (18/29) and 72.4% (21/29) patients at 1 and 6 months, respectively. In the whole population, pain significantly dropped at 6 months compared to the baseline (1.1 ± 2.3; range 0-8 vs 7.1 ± 1.9; range 3-10; p <.05). Eight (8/29; 27.6%) patients presented residual symptoms at 6 months, and 4 (4/29; 13.8%) had an MRI-confirmed residual/recurring disease. Contrast-enhanced MRI obtained for the first 14 (14/29; 48.3%) patients of the series, all without signs of residual/recurring disease, demonstrated a significantly smaller ablation area compared to the baseline volume of the AAWE (1.0 cm3 ± 1.4; range 0-4.7; vs 11.1 ± 9.9 cm3; range 0.6-36.4; p <.05).

CONCLUSION

Percutaneous imaging-guided cryoablation of AAWE is safe and clinically effective in achieving pain relief.

Robot-assisted Laparoscopic Excision of Abdominal Wall Endometrioma Utilizing Intraoperative Ultrasound and Transabdominal Needle Placement

OBJECTIVE

In patients with endometriosis, extra pelvic endometriosis is estimated to have an incidence of 11% and a rare subset of extra pelvic lesions include abdominal wall endometriosis with an incidence of 0.03% to 3.5% [1,2]. Evaluation for and surgical management of abdominal wall endometriosis are an essential skill set for the advanced gynecologic surgeon. In this video, we demonstrate a surgical technique for robot-assisted laparoscopic excision of abdominal wall endometriosis with intraoperative ultrasound-guided needle placement.

DESIGN

Description and demonstration of surgical technique.

SETTING

A patient with previous history of 2 cesarean sections and right lower quadrant cyclic abdominal wall pain; a tertiary care, academic center.

INTERVENTIONS

Intraoperative ultrasound-guided needle placement to map location and boundaries of the lesion followed by minimally invasive resection of the lesion with the intermittent advancement and withdrawal of needles to confirm clear margins.

CONCLUSION

Minimally invasive resection of abdominal wall endometriosis using intraoperative ultrasound-guided needle placement is an effective technique to guide surgical dissection and allow for clear surgical margins and successful treatment of this rare condition.

The prominent role of percutaneous transarterial embolization in the treatment of anterior abdominal wall hematomas: the results of three high volume tertiary referral centers

PURPOSE

Percutaneous transarterial embolization (PTE) represents a fast, safe and effective option for life-threatening anterior abdominal wall hematomas (AWHs) and those unresponsive to conservative treatment. Our study aims to assess cumulative results of safety, technical and clinical success of PTE performed in three high-volume tertiary referral centers and to evaluate the efficacy of the different embolic materials employed.

MATERIALS AND METHODS

A consecutive series of 124 patients (72.8 ± 14.4 years) with AWHs of different etiology submitted to PTE were retrospectively collected and analyzed. Clinical success, defined as absence of recurrent bleeding within 96 h from PTE, was considered as primary endpoint. The results of the comparison of three groups based on embolic agent employed were also analyzed.

RESULTS

Spontaneous AWHs accounted for 62.1%, iatrogenic for 21.8% and post-traumatic for 16.1% of cases. SARS-CoV-19 infection was present in 22.6% of patients. The most commonly embolized vessels were epigastric inferior artery (n = 127) and superior epigastric artery (n = 25). Technical and clinical success were 97.6 and 87.1%, respectively. Angiographic signs of active bleeding were detected in 85.5% of cases. Four (4%) major complications were reported. The comparison of the three groups of embolic agents (mechanical, particulate/fluid and combined) showed no statistically significant differences in terms of clinical success. SARS-CoV-2 infection was found to be an independent factor for recurrent bleeding and poor 30-day survival.

CONCLUSION

PTE performed with all the embolic agent employed in our centers is a safe and effective tool in the treatment of life-threatening anterior AWH of each origin.

Correlation between abdominal visceral volume measured by a simple procedure and bulging at the abdominal free flap donor site for breast reconstruction

BACKGROUND

Breast reconstructions using autologous abdominal tissue result in breasts with a natural shape and consistency. One of the major complications is abdominal bulging. Because of the increased abdominal wall tension, high visceral volume (not visceral fat alone) may increase the occurrence rate of abdominal bulging. A simple procedure involving CT imaging was used to assess this relationship in patients undergoing an abdominal free flap for unilateral breast reconstruction.

METHODS

A total of 278 patients were enrolled in this study. The patients' demographics, the thicknesses of visceral volume were compared (Bulging (+) vs. Bulging (-)). Visceral volume was investigated based on the horizontal thickness, which was measured at the thickest part at the level of the umbilical fossa between both sides under the transverse abdominis muscles.

RESULTS

Bulging (+) consisted of 39 patients (14.0%), whereas Bulging (-) included 239 patients. Patients with Bulging (+) were significantly older, had higher gestational history rate, and had thin rectus abdominis muscle. In terms of visceral volume, the Bulging (+) group had significantly higher horizontal thicknesses (median 233 mm vs. 219 mm, P < 0.001). No significant differences were observed with respect to other factors (age, BMI, history of laparotomy, and operative details). The multivariate logistic regression analysis revealed that the thickness of the rectus abdominis muscle, horizontal visceral volume, and gestational history were independently significant predictors.

CONCLUSIONS

Not only the patients with thin rectus abdominis muscle but also patients with a thick horizontal visceral volume may have a higher risk of abdominal bulging.

Three-Dimensional Ultrasound Evaluation of Lung Volume in Fetuses with Abdominal Wall Defect

INTRODUCTION

Abdominal wall defects (AWDs) interfere with postnatal respiratory parameters. We aimed to evaluate lung volume (LV) in fetuses with AWD using three-dimensional (3D) ultrasound (US) and to correlate AWD with the type (omphalocele and gastroschisis) and size of the defect and neonatal morbidity and mortality.

METHODS

This prospective observational study included 72 pregnant women with fetuses with AWD and a gestational age <25 weeks. The data on abdominal volume, 3D US LV, and herniated volume were acquired every 4 weeks up to 33 weeks. LV was compared with normal reference curves and correlated with abdominal and herniated volumes.

RESULTS

Omphalocele (p < 0.001) and gastroschisis (p < 0.001) fetuses had smaller LV than normal fetuses. LV was positively correlated with abdominal volume (omphalocele, r = 0.86; gastroschisis, r = 0.88), whereas LV was negatively correlated with omphalocele-herniated volume/abdominal volume (p < 0.001, r = -0.51). LV was smaller in omphalocele fetuses that died (p = 0.002), were intubated (p = 0.02), or had secondary closure (p < 0.001). In gastroschisis, a smaller LV was observed in fetuses discharged using oxygen (p = 0.002).

CONCLUSION

Fetuses with AWD had smaller 3D LV than normal fetuses. Fetal abdominal volume was inversely correlated with LV. In omphalocele fetuses, a smaller LV was associated with neonatal mortality and morbidity.

Correlative Ultrasound Evaluation of Anterior Abdominal Wall Subcutaneous Tissue Thickness in Type 2 Diabetic and Non-Diabetic Adults

BACKGROUND

Subcutaneous fat accumulation complicating diabetes mellitus (DM) has long been recognised, even as its clinical significance remains controversial. Ultrasound is safe and accurate in assessing soft tissue dimensions. Reports on ultrasound evaluation of anterior abdominal wall subcutaneous fat in diabetic and apparently healthy normoglycaemic subjects are scanty in the Nigerian environment.

AIMS AND OBJECTIVES

To sonographically assess and compare the mean anterior abdominal wall subcutaneous tissue thickness (AAST) in adult diabetic subjects and apparently healthy, normoglycaemic subjects and correlate the values with age, gender, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and glycated hemoglobin (Hb1c).

MATERIALS AND METHODS

The AAST in 150 adult diabetic subjects and equal numbers of age, and sex matched apparently healthy individuals was assessed with a SONOACE X4 ultrasound scanner. (Medison Inc, SOUTH KOREA), using a l inear array transducer of frequency 7. 5MHz10MHz.Measurements were taken in the midline at two points; 2cm above and below the umbilicus. Anthropometric parameters such as BMI, WC, WHR, were recorded.

RESULTS

Adult diabetic subjects had significantly higher AAST values, compared to age and BMI matched male and female apparently healthy controls respectively. (2.7±0.9cm vs 2.2 ± 0.9cm (below the umbilicus; p=0.001), and 2.1 ± 0.8cm vs 1.6 ± 0.8cm (above the umbilicus; p = 0.001). Below the umbilicus, AAST correlated positively with WHR, BM1 and disease duration among diabetic patients.

CONCLUSION

AAST is significantly increased in diabetic subjects compared to controls, and can be a useful guide in the management of obesity in these patients. There is correlation of AAST below the umbilicus with BMI and waist circumference.

DECOMP Report: Answers surgeons expect from an abdominal wall imaging exam

Abdominal wall (AW) hernias are a common problem faced by general surgeons. With an essentially clinical diagnosis, abdominal hernias have been considered a simple problem to be repaired. However, long-term follow-up of patients has shown disappointing results, both in terms of complications and recurrence. In this context, preoperative planning with control of comorbidities and full knowledge of the hernia and its anatomical relationships with the AW has gained increasing attention. Computed tomography (CT) appears to be the best option to determine the precise size and location of abdominal hernias, presence of rectus diastase and/or associated muscle atrophy, as well as the proportion of the hernia in relation to the AW itself. This information might help the surgeon to choose the best surgical technique (open vs MIS), positioning and fixation of the meshes, and eventual need for application of botulinum toxin, preoperative pneumoperitoneum or component separation techniques. Despite the relevance of the findings, they are rarely described in CT scans as radiologists are not used to report findings of the AW as well as to know what information is really needed. For these reasons, we gathered a group of surgeons and radiologists to establish which information about the AW is important in a CT. Finally, a structured report is proposed to facilitate the description of the findings and their interpretation.

Dynamic-MRI quantification of abdominal wall motion and deformation during breathing and muscular contraction

BACKGROUND AND OBJECTIVE

Biomechanical assessment of the abdominal wall represents a major prerequisite for a better understanding of physiological and pathological situations such as hernia, post-delivery recovery, muscle dystrophy or sarcopenia. Such an assessment is challenging and requires muscular deformations quantification which have been very scarcely reported in vivo. In the present study, we intended to characterize abdominal wall deformations in passive and active conditions using dynamic MRI combined to a semiautomatic segmentation procedure.

METHODS

Dynamic deformations resulting from three complementary exercises i.e. forced breathing, coughing and Valsalva maneuver were mapped in a transversal abdominal plane and so for twenty healthy volunteers. Real-time dynamic MRI series were acquired at a rate of 182 ms per image, then segmented semi-automatically to follow muscles deformation through each exercise. Circumferential and radial strains of each abdominal muscle were computed from the geometrical characteristics' quantification, namely the medial axis length and the thickness. Muscular radial displacement maps were computed using image registration.

RESULTS

Large variations in circumferential and radial strains were observed for the lateral muscles (LM) but remained low for the rectus abdominis muscles (RA). Contraction phases of each exercise led to LM muscle shortening down to -9.6 ± 5.9% during Valsalva maneuver with a 16.2 ± 9.6% thickness increase. Contraction also led to inward radial displacement of the LM up to 9.9 ± 4.1 mm during coughing. During maximal inhalation, a significant 10.0 ± 6.6% lengthening was quantified for LM while a significant thickness decrease was computed for the whole set of muscles (-14.7 ± 6.6% for LM and -7.3 ± 6.5% for RA). The largest displacement was observed for the medial part of RA (17.9 ± 8.0 mm) whereas the posterior part of LM underwent limited motion (2.8 ± 2.3 mm). Displacement rate and correlation between muscle thickness and medial axis length during each exercise provided insights regarding subject-specific muscle function.

CONCLUSIONS

Dynamic MRI is a promising tool for the assessment of the abdominal wall motion and deformations. The corresponding metrics which have been continuously recorded during the exercises provided global and regional quantitative information. These metrics offer perspectives for a genuine clinical evaluation tool dedicated to the assessment of abdominal muscles function in both healthy subjects and patients.

Visceral Fat Volume is a Better Predictor of Insulin Resistance than Abdominal Wall Fat Index in Patients with Prediabetes and Type 2 Diabetes Mellitus

Diabetes mellitus is a global pandemic. India, China and USA will be the countries with major diabetic population in the year 2040. Age of onset is a decade earlier in India compared to other European countries. Relative increase in visceral fat vs. subcutaneous fat in Asians and Asian Indians may explain the greater prevalence of metabolic syndrome in those population than in African American men, in whom Subcutaneous fat predominates. It is possible that visceral fat is a marker for excess postprandial free fatty acids in obesity, which is an early major contributor to the development of insulin resistance. Present study attempts to compare and co-relate the association of visceral fat and abdominal wall fat index to Insulin resistance in patients suffering from T2DM and prediabetes. Material and Objectives: To study the relationship between insulin resistance (HOMA-IR) and abdominal wall fat index (AFI) in Prediabetes and type II Diabetes Mellitus patients. To compare the visceral fat volume (VFV) with abdominal wall fat index in relation to insulin resistance in same subset of patients.

METHOD

Cross sectional, observational study in 75 subjects (25 T2DM, 25 Prediabetes, 25 Controls). Detailed history including physical examination was performed. Patients were subjected to these investigations; FBS, HbA1C, S. Fasting Insulin levels, Lipid Profile, USG Abdomen to assess Visceral Fat Volume and Abdominal Wall Fat Index. Data were collected and analysed.

OBSERVATION

Mean age of T2DM &amp; prediabetes subjects was a decade higher than controls (T2DM 53 ±11.62 years, Prediabetes 55.76±11.97 years, Controls 45.72±10.42 years). Mean Systolic BP in T2DM subjects was 138.56±14.69, subjects with Prediabetes were 139.2±19.63 which is higher (p 0.02) compared to Controls(128±8.26). Average fasting serum insulin levels (mu/ml) of three groups; for T2DM: 25.41±13.7, for Prediabetes: 8.76 ±2.55, Controls: 6.07±2.55. The highest levels were in patients with T2DM, when compared to Prediabetes and controls. There was significant difference in the value of HOMA-IR, AFI, and the parameters of VFV (length between interior of abdominal muscle and splenic vein, length between interior of abdominal muscle and posterior wall of Aorta, Fat thickness of posterior renal wall) p&lt;0.05. A significant correlation between HOMA-IR levels and VFV was found with a p value of &lt;0.05.

CONCLUSION

VFV acted as an independent marker in predicting Insulin resistance in subjects with prediabetes and T2DM. Fasting Insulin levels were highest in T2DM group amongst all three groups reflecting inadequate response of the body to appropriate levels of Insulin.

Ultrasound-guided abdominal wall infiltration versus freehand technique in anterior cutaneous nerve entrapment syndrome (ACNES): randomized clinical trial

Background

The optimal technique of abdominal wall infiltration for chronic abdominal wall pain due to anterior cutaneous nerve entrapment syndrome (ACNES) is unknown. The aim of this study was to compare pain reduction after an abdominal wall anaesthetic injection by use of an ultrasound-guided technique (US) or given freehand (FH).

Methods

In this multicentre non-blinded randomized trial, adult patients with ACNES were randomized (1:1) to an US or a FH injection technique. Primary outcome was the proportion of injections achieving a minimum of 50 per cent pain reduction on the Numeric Rating Scale (range 0–10) 15–20 min after abdominal wall infiltration (‘successful response’). Secondary outcomes were treatment efficacy after 6 weeks and 3 months, and the influence of the subcutaneous tissue thickness on treatment outcome.

Results

Between January 2018 and April 2020, 391 injections (US = 192, FH = 199) were administered in 117 randomized patients (US = 55, FH = 62; 76.0 per cent female, mean age 45 years). The proportion of successful responses did not significantly differ immediately after the injection regimen (US 27.1 per cent versus FH 33.2 per cent; P = 0.19) or after 3 months (US 29.4 per cent versus FH 30.5 per cent; P = 0.90). Success was not determined by subcutaneous tissue thickness.

Conclusion

Pain relief following abdominal wall infiltration by a US or FH technique in ACNES is similar and not influenced by subcutaneous tissue thickness.

Registration number

Dutch Clinical Trial Register NL8465.

Abdominal Wall Thickness Predicts Surgical Site Infection in Emergency Colon Operations

BACKGROUND

Body mass index (BMI) does not reliably predict Surgical site infections (SSI). We hypothesize that abdominal wall thickness (AWT) would serve as a better predictor of SSI for patients undergoing emergency colon operations.

METHODS

We retrospectively evaluated our Emergency Surgery Database (2007-2018). Emergency colon operations for any indication were included. AWT was measured by pre-operative CT scans at 5 locations. Only superficial and deep SSIs were considered as SSI in the analysis. Univariate then multivariable analyses were used to determine predictors of SSI.

RESULTS

236 patients met inclusion criteria. The incidence of post-operative SSI was 25.8% and the median BMI was 25.8kg/m2 [22.5-30.1]. The median AWT between patients with and without SSI was significantly different (2.1cm [1.4, 2.8] and 1.8cm [1.2, 2.5], respectively). A higher BMI trended toward increased rates of SSI, but this was not statistically significant. In overweight (BMI 25-29.9kg/m2) and obese (BMI ≥30kg/m2) patients, SSI versus no SSI rates were (50.0% versus 41.9% and 47.4% versus 36.4%, P = 0.365 and 0.230) respectively. The incidence of SSI in patients with an average AWT < 1.8cm was 20% and 30% for patients with average AWT ≥1.8cm. On multivariable analysis, AWT ≥1.8cm at 2cm inferior to umbilicus was an independent predictor of SSI (OR 2.98, 95%CI 1.34-6.63, P = 0.007).

CONCLUSIONS

AWT is a better predictor of SSI than BMI. Preoperative imaging of AWT may direct intraoperative decisions regarding wound management. Future clinical outcomes research in emergency surgery should include abdominal wall thickness as an important patient variable.

Ultrasound-Guided Lateral Abdominal Wall Botulinum Toxin Injection Before Ventral Hernia Repair: A Review for Radiologists

Preoperative ultrasound-guided lateral abdominal wall botulinum toxin injection is a promising method for improving patient outcomes and reducing recurrence rates after ventral hernia repair. A review of the literature demonstrates variability in the procedural technique, without current standardization of protocols. As radiologists may be increasingly asked to perform ultrasound-guided botulinum toxin injections of the lateral abdominal wall, familiarity with the procedure and current literature is necessary.

Using Radiographic Domain for Evaluating Indications in Abdominal Wall Transplantation

BACKGROUND

There is currently no description of abdominal domain changes in small bowel transplantation population or consensus of criteria regarding which patients are at high risk for immediate postoperative abdominal wall complications or would benefit from abdominal wall vascularized composite allotransplantation.

METHODS

A retrospective chart review was performed on 14 adult patients receiving intestinal or multivisceral transplantation. Preoperative and postoperative computed tomography scans were reviewed, and multiple variables were collected regarding abdominal domain and volume and analyzed comparing postoperative changes and abdominal wall complications.

RESULTS

Patients after intestinal or multivisceral transplantation had a mean reduction in overall intraperitoneal volume in the immediate postoperative period from 9031 cm3 to 7846 cm3 (P = 0.314). This intraperitoneal volume was further reduced to an average of 6261 cm3 upon radiographic evaluation greater than 1 year postoperatively (P = 0.024). Patients with preexisting abdominal wound (P = 0.002), radiation, or presence of ostomy (P = 0.047) were significantly associated with postoperative abdominal wall complications. No preoperative radiographic findings had a significant association with postoperative abdominal wall complications.

CONCLUSIONS

Computed tomography imaging demonstrates that intestinal and multivisceral transplant patients have significant reduction in intraperitoneal volume and domain after transplantation in the acute and delayed postoperative setting. Preoperative radiographic abdominal domain was not able to predict patients with postoperative abdominal wall complications. Patients with abdominal wounds, ostomies, and preoperative radiation therapy were associated with acute postoperative abdominal complications and may be considered for need of reconstructive techniques including abdominal wall transplantation.

Malignant transformation of abdominal wall endometriosis: A systematic review of the epidemiology, diagnosis, treatment, and outcomes

Malignant transformation of abdominal wall endometriosis (AWE) is rare. The clinical characteristics and treatment of malignant transformation of AWE are not well known. Therefore, in this review, we performed a thorough search for malignant transformation of AWE on MEDLINE and Web of Science from their inception to May 2021. In total, the data of 46 patients with malignant transformation of AWE were retrieved, and all the data on these patients were collected. After reviewing and analyzing the clinical parameters, we found that cesarean scar was the most common site of malignant transformation of AWE, and the most common pathological type of malignant transformation of AWE was clear cell cancer, followed by endometrioid adenocarcinoma. The main symptoms of malignant transformation of AWE included an abdominal nodule or mass, and ultrasonography was the first choice for diagnosis. The most widely accepted treatment was surgical resection of local lesions with adjunctive chemotherapy and/or radiotherapy, and the overall survival of patients with malignant transformation of AWE was poor. In conclusion, malignant transformation of AWE is rare, and the prognosis is poor. Thus, improving abdominal surgical technology and avoiding iatrogenic ectopia and implantation of the endometrium are necessary to prevent malignant transformation of AWE.

Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management

PURPOSE OF REVIEW

Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of AWE.

RECENT FINDINGS

Recent studies further characterize presenting symptoms and locations of AWE. Prior abdominal surgery remains the greatest risk factor for the development of AWE. Newer evidence suggests that increasing BMI may also be a risk factor. Ultrasound is first-line imaging for diagnosis. Magnetic resonance image is preferred for surgical planning for deep or extensive lesions. Laparotomy with wide local excision is considered standard treatment for AWE with great success. Novel techniques in minimally invasive surgery have been described as effective for the treatment of AWE. A multidisciplinary surgical approach is often warranted for successful excision and reapproximation of skin and/or fascial defects. Noninvasive therapies including ultrasonic ablation or cryotherapy are also emerging as promising treatment strategies in select patients.

SUMMARY

Recent studies provide further evidence to guide diagnosis through physical exam and imaging as well as pretreatment planning. Treatment options for AWE are rapidly expanding with novel approaches in minimally invasive and noninvasive therapies now available.

Lymphocutaneous sporotrichosis of the abdominal wall: A lesson in lymphatic drainage

Cutaneous sporotrichosis (CS) presents as asymptomatic lesions of varied morphology. The most common variant is the lymphocutaneous type which typically progresses from a papule to an ulcer and then forms nodules along the superficial lymphatic channels. Diagnosis CS may be challenging when the lesion presents at an uncommon site where the superficial lymphatic drainage is unfamiliar. We present here a case of sporotrichosis of the abdominal wall which was initially misdiagnosed as an abscess but later confirmed by culture and managed successfully.

Anterior Abdominal Wall Synovial Sarcoma: A Rare Presentation

Abdominal wall sarcoma belongs to a heterogeneous group of uncommon malignant neoplastic conditions with differentiated morphological patterns and originating from mesenchymal tissues. Soft tissue sarcomas predominantly involve the lower and upper limbs and retroperitoneum. We present a case of a 30-year-old patient, complaining of swelling in the left flank whose magnetic resonance imaging (MRI) revealed a solid tumour on the abdominal wall of the flank and biopsy turned out to be synovial sarcoma.

Linear versus volumetric CT analysis in predicting tension-free fascial closure in abdominal wall reconstruction

BACKGROUND

Improved outcomes of abdominal wall reconstruction (AWR) have been shown when tension-free fascial closure (TFFC) is achieved. Our objective was to determine the clinical and radiologic predictors of TFFC in patients undergoing AWR.

STUDY DESIGN

We conducted a single institution retrospective cohort study of adults who underwent AWR between 2007 and 2018. Demographics, hernia characteristics and operative data were collected. Linear and volumetric variables were obtained from preoperative abdominal CT scans, the latter following 3D reconstruction. Logistic regression was used to evaluate predictors of TFFC. Area under the curve (AUC) ≥ 0.70 was considered to have acceptable discrimination.

RESULTS

A total of 108 patients were eligible for analysis. The mean age was 57 ± 11 years and 53 (49%) were female. 42 (39%) hernias were recurrent, 10 (9%) patients had a stoma and 9 (8%) had a history of open abdomen. The mean defect width was 11 ± 4 cm and mean defect surface area was 150 ± 95 cm². The most common AWR technique was endoscopic component separation 75 (69%). TFFC was achieved in 90 (83%) patients. No demographics or 3D volumetric measures were predictive of TFFC (all AUC < 0.7). European hernia society (EHS) class M1 was predictive of failure of TFFC [AUC = 0.70; odds ratio 7.0 (referent M3); 95% confidence interval, 2.1-23.8]. Linear variables of rectus muscle separation were the most predictive of TFFC (AUC 0.73-0.77).

CONCLUSION

In contrast to clinical characteristics, radiologic characteristics of large incisional hernias requiring AWR are predictive of TFFC. In particular, EHS class M1 and linear variables of rectus muscle separation appear to be better predictors of TFFC than volumetric measurements.

[Abdominal pseudohernia: diagnosis and treatment]

OBJECTIVE

To present an effective treatment strategy for abdominal pseudohernia considering own clinical experience and literature data.

MATERIAL AND METHODS

The authors report surgical treatment of 2 patients and therapeutic management of 1 patient with abdominal pseudohernia. Moreover, current state of this problem is analyzed according to literature data in Pubmed, Google and e-library databases.

RESULTS. P

Seudohernia is followed by asymmetrical protrusion of abdominal wall, prolapsed site is not involved in breathing; patients cannot tense muscles in the affected area. T8-L2 skin sensitivity impairment or hyperesthesia may be observed. Denervation is confirmed by electroneuromyography. Ultrasound, CT and MRI reveal no defect in abdominal wall. However, its thinning within denervation area is visualized. Treatment is determined by the cause and reversibility of denervation. If mechanical damage (intersection) of T8-L2 nerves following trauma or any manipulation is absent, the main cause is herpes zoster neuropathy. Surgical treatment is not indicated. Antiherpetic therapy and physical therapy result functional restoration of abdominal wall muscles within 2-4 months. In case of mechanical cause of pseudohernia, it is advisable to wait at least a year after denervation for real assessment of situation. Partial or complete re-innervation is possible throughout this period. Surgical treatment is indicated if re-innervation is absent. An effective technique presented in this manuscript is reconstruction of the prolapsed area with several imbrication sutures in several planes up to symmetry with contralateral area with subsequent reinforcement with a mesh implant if necessary. There were no relapses in 2 our patients within 5 and 7 years, respectively.

CONCLUSION

In our opinion, this report is the first manuscript devoted to systematic analysis of diagnosis and treatment of abdominal pseudohernia in available literature. Surgical treatment is not indicated for postherpetic pseudohernia. It is carried out for pseudohernia persisting for more than 1 year if its cause is trauma or any manipulation.

The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes

OBJECTIVES

To evaluate the utility of fetal abdominal wall thickness (AWT) for predicting intrapartum complications amongst mothers with pregestational type 2 diabetes.

METHODS

This was a historical cohort study of pregnant mothers with pregestational type 2 diabetes delivering at a Canadian tertiary-care center between January 1, 2014, and December 31, 2018. Delivery records were reviewed to collect information about demographics and peripartum complications. Stored fetal ultrasound images from 36 weeks' gestation were reviewed to collect fetal biometry and postprocessing measurement of AWT performed in a standardized fashion by 2 blinded and independent observers. The relationship between fetal AWT was then correlated with risk of intrapartum complications including emergency Caesarean section (CS) and shoulder dystocia.

RESULTS

216 pregnant women with type 2 diabetes had planned vaginal deliveries and were eligible for inclusion. Mean maternal age was 31.3 years, and almost all were overweight or obese at the time of delivery (96.8%). Overall, the incidence of shoulder dystocia and emergency intrapartum CS was 7.4% and 17.6%, respectively. There was no difference in mean fetal AWT between those having a spontaneous vaginal delivery (8.2 mm (95% CI 7.9-8.5)) and those needing emergency intrapartum CS (8.1 mm (95% CI 7.4-8.8); p = 0.71) or shoulder dystocia (8.7 mm (95% CI 7.9-9.5); p = 0.23). There was strong interobserver correlation of AWT measurements (r = 0.838; p < 0.00001). The strongest association with intrapartum complications was birthweight (p = 0.003): with birthweight > 4000 grams, the relative risk of shoulder dystocia or CS is 2.75 (95% CI 1.74-4.36; p < 0.001).

CONCLUSIONS

There was no obvious benefit of AWT measurement at 36 weeks for predicting shoulder dystocia or intrapartum CS amongst women with type 2 diabetes in our population. The strongest predictor of intrapartum complications remained birthweight, and so studies for improving estimation of fetal weight and evaluating the role of intrapartum ultrasound for predicting risk of delivery complications are still needed.

Ultrasound-guided peripheral abdominal wall blocks

The practice of regional anesthesia is in a state of progressive evolution, mainly due to the advent of ultrasound as an anesthesiologist's instrument. Alternative techniques for postoperative analgesia of abdominal surgeries, such as transversus abdominis plane block, oblique subcostal transversus abdominis plane block, rectus abdominis muscle sheath block, ilioinguinal and iliohypogastric nerve block, and quadratus lumborum plane block, have proven useful, with good analgesic efficacy, especially when neuroaxial techniques (spinal anesthesia or epidural anesthesia) are not possible. This review discusses such blockades in detail, including the anatomical principles, indications, techniques, and potential complications.

Abdominal Cutaneous Thermography and Perfusion Mapping after Caesarean Section: A Scoping Review

Introduction: Caesarean section (CS) is the most prevalent surgical procedure in women. The incidence of surgical site infection (SSI) after CS remains high but recent observations of CS wounds using infrared thermography has shown promise for the technique in SSI prognosis. Although thermography is recognised as a 'surrogate' of skin perfusion, little is known of the relationship between skin temperature and skin perfusion in the context of wound healing. Aim: To assess the extent of literature regarding the application of infrared thermography and mapping of abdominal cutaneous perfusion after CS. Methods: Wide eligibility criteria were used to capture all relevant studies of any design, published in English, and addressing thermal imaging or skin perfusion mapping of the abdominal wall. The CINAHL and MEDLINE databases were searched, with two independent reviewers screening the title and abstracts of all identified citations, followed by full-text screening of relevant studies. Data extraction from included studies was undertaken using a pre-specified data extraction chart. Data were tabulated and synthesised in narrative format. Results: From 83 citations identified, 18 studies were considered relevant. With three additional studies identified from the reference lists, 21 studies were screened via full text. None of the studies reported thermal imaging and cutaneous perfusion patterns of the anterior abdominal wall. However, two observational studies partially met the inclusion criteria. The first explored analysis methodologies to 'interrogate' the abdominal thermal map. A specific thermal signature ('cold spots') was identified as an early 'flag' for SSI risk. A second study, by the same authors, focusing on obesity (a known risk factor for SSI after CS) showed that a 1 °C lower abdominal skin temperature led to a 3-fold odds of SSI. Conclusion: There is a significant gap in knowledge on how to forewarn of wound complications after CS. By utilising the known association between skin temperature and blood flow, thermographic assessment of the wound and adjacent thermal territories has potential as a non-invasive, independent, imaging option with which to identify tissue 'at risk'. By identifying skin 'hot' or 'cold' spots, commensurate with high or low blood flow regions, there is potential to shed light on the underlying mechanisms leading to infective and non-infective wound complications.

Three-dimensional visualization and measurement of myopectineal orifice in non-inguinal hernia patients

PURPOSE

The myopectineal orifice (MPO) is a weak area at lower part of the anterior abdominal wall that directly determines the mesh size required in inguinal hernia repair. However, MPO data have mainly been acquired from measurements of cadavers or anesthetized patients. Furthermore, there are very few reports on the measurement of the MPO in Chinese patients. The present study aimed to use three-dimensional visualization technology to measure the MPO in live non-anesthetized Chinese patients, and to use this information to indicate the appropriate mesh size required for inguinal hernia repair.

METHODS

In this study, we used the parameters of the MPO and the pelvis that were measured in 40 patients with peripheral arterial disease of the lower limb arteries (80 inguinal regions) using Medraw software (Image Medraw Technology Co., Ltd., China).

RESULTS

The result showed that the average width and height of the MPO were 5.71 ± 0.99 cm and 4.96 ± 0.69 cm, respectively (5.22 ± 0.77 cm and 5.13 ± 0.63 cm in males, and 6.20 ± 0.95 cm and 4.80 ± 0.71 cm in females). The average projected area of the MPO was 16.06 ± 4.37 cm² on the left, and 15.61 ± 4.10 cm² on the right (P > 0.05).

CONCLUSION

Three-dimensional visualization was used to measure the area, width, and height of the MPO in living non-anesthetized Chinese patients. MPO area was correlated with age, but not with pelvic parameters.

Use of Shear Wave Elastography to Quantify Abdominal Wall Muscular Properties in Patients With Incisional Hernia

Shear wave elastography (SWE) is a potential modality that quantitatively measures the elasticity (shear wave speed [SWS]) of musculoskeletal structure. This SWS was bilaterally measured in the rectus abdominis (RA), external oblique (EO) muscle, internal oblique (IO) muscle and transversus abdominis (TrA) using SWE in 28 patients with incisional hernia and 14 healthy controls. The differences in muscle thickness for IO and TrA were significant between the two groups (p < 0.05). The SWS of RA, EO, IO and TrA was significantly higher in the incisional hernia patient group than in the healthy controls (p < 0.05). Significant differences were also observed between the upper and lower points in both groups (p < 0.05). The measurements of SWS help in evaluating the elastic properties of abdominal wall muscles, which could further aid in preparing treatment plans to improve muscle strength.

Percutaneous cryoablation of abdominal wall endometriosis: the Mayo Clinic approach

Abdominal wall endometriosis (AWE) is a rare form of endometriosis that often results in substantial pain and debility. The current treatment algorithm for AWE is not well established. The purpose of this review is to describe the Mayo Clinic experience with thermal ablation of symptomatic AWE as well as to review current imaging and interventional literature regarding the diagnosis and treatment of AWE.

Abdominal wall sonography: a pictorial review

The anterior abdominal wall, which is composed of three layers (skin and adipose tissues; the myofascial layer; and the deep layer, consisting of the transversalis fascia, preperitoneal fat, and the parietal peritoneum), has many functions: containment, support and protection for the intraperitoneal contents, and involvement in movement and breathing. While hernias are often encountered and well reviewed in the literature, the other abdominal wall pathologies are less commonly described. In this pictorial review, we briefly discuss the normal anatomy of the anterior abdominal wall, describe the normal ultrasonographic anatomy, and present a wide range of pathologic abnormalities beyond hernias. Sonography emerges as the diagnostic imaging of first choice for assessing abdominal wall disorders, thus representing a valuable tool for ensuring appropriate management and limiting functional impairment.

Fetal umbilical cord cyst may evolve to omphalocele during pregnancy

Omphalocele is rarely complicated by umbilical cord cysts. In our case, an umbilical cord cyst and fetal ascites were detected at 26 weeks' gestation in a fetus with trisomy 13. This changed to omphalocele with subsequently absorbed fetal ascites at 35 weeks' gestation. We propose two hypotheses. The abdominal wall may have been physically pierced or an omphalocele might have preexisted, and the intestinal tract in the hernia sac was pushed by fetal ascites.

Dietary Protein Supplementation Helps in Muscle Thickness Regain after Abdominal Wall Reconstruction for Incisional Hernia

A modern approach to incisional hernia is oriented toward midline restoration to re-establish abdominal wall physiology and to restore muscular strength. A high-protein diet has been demonstrated to improve muscle function and mass. The aim of this prospective study was to evaluate the effect of a high-protein diet on abdominal muscle remodeling in patients submitted to abdominal wall reconstruction (AWR). Forty-five patients submitted to elective AWR were prospectively divided into two groups depending on pre- and postoperative daily protein assumption: Group A patients were submitted to a standard 2300 kcal diet with 103 g of protein intake (males) and 1800 kcal diet with 80 g of protein intake (females) starting one month before surgery and lasting for three months postoperatively; Group B patients were submitted to the same dietary regimen plus 34 g of purified proteins daily. Patients underwent ultrasound scan preoperatively and three and six months after surgery, to evaluate the widest thickness of the rectus abdominis muscle on the transverse umbilical line. Three patients reporting hernia recurrence were excluded. No significant difference among the two groups in muscle thickness growth after surgery was observed at three months after surgery, even if a favorable trend in Group B was noted (10% vs 19%, P = not significant). At six months after surgery, Group B patients showed a significant difference in muscle thickening (13% vs 32%, P < 0.05 ). The study demonstrates a positive effect of a protein diet on the rectus abdominis muscle thickening after AWR. Further studies are needed.

Assessment of the diagnostic efficacy of abdominal ultrasonography and cine magnetic resonance imaging in detecting abdominal adhesions: A double-blind research study

PURPOSE

This cohort aimed to determine the efficacy and safety of abdominal ulrasonography and cine-MRI by a double-blind study in the diagnosis of intraabdominal organs and abdominal wall adhesions in patients with previous abdominal operations.

METHODS

Between 2017 and 2019, 108 consecutive patients were prospectively included in the study. Visceral slide and induced visceral slide were measured during AU and cine-MRI. An abdominal map consisting of nine segments was created to document the location and extent of the adhesion. The degree and severity of the adhesions detected by the radiologist preoperatively and detected in surgery as the gold standard was recorded in the same abdominal zones. AU, c-MRI and intraoperative findings were correlated.

RESULTS

The mean age was 53.0 ± 10.3 years, body mass index was 30.4 ± 3.4, male (52.8 %) and female (47.2 %). According to the total nine zones, the sensitivity of AU was 91.4 %, specificity was 100 %, positive predictive value was 90.7 %, negative predictive value was 100 % and diagnostic accuracy was 87.9 %. Considering the total zones, the sensitivity of c-MRI was 90.8 %, specificity was 100 %, PPV was 90.7 %, NPV was 100 % and diagnostic accuracy was 91.7 %. A comparison of AU and c-MRI showed no significant difference in the detection of adhesions to the abdominal wall; however, c-MRI was superior in detecting intraabdominal organs adhesion.

CONCLUSION

We have demonstrated that AU and c-MRI are accurate for diagnosing adhesions in patients undergoing repeated surgery and may have a place on planning elective laparoscopic or open surgery to avoid bowel injury.

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

BACKGROUND

Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence.

METHODS

An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce-induced distension as compared to basal conditions.

KEY RESULTS

Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents.

CONCLUSION AND INFERENCES

Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.

Ultrasonographic evaluation of abdominal wall fat index, carotid intima-media thickness and plaque score in obstructive sleep apnea syndrome

AIMS

Obstructive sleep apnea syndrome (OSAS) is strongly related with increased risk of cardiovascular diseases andvisceral obesity. Abdominal wall fat index (AFI) is an indicator of visceral fat accumulation determined by ultrasonography(US). Carotid intima-media thickness (C-IMT) and carotid plaque score (C-PS) are the indicators of cardiovascular risk. Theaim of this study was to investigate the relation between OSAS and AFI, C-IMT or C-PS.

MATERIALS AND METHODS

One-hundred and four subjects (31 females, 73 males) between 23-73year-old, candidate for polysomnography (PSG) with suspect of OSAS and without other atherosclerotic risk factor, were evaluated by US. AFI, C-IMTmean and C-PS values were determined and the subjects were grouped according to their apnea-hypopnea index (AHI) values as follows: no OSAS (<5), mild OSAS (5-15), moderate OSAS (15-30) and severe OSAS (>30).

RESULTS

There was a statistically significant correlation between AFI and AHI (p=0.019). The C-IMTmean values of subjects with OSAS (AHI >5) were significantly higher than those without OSAS (AHI <5) (p=0.035). C-PS was not correlated with AHI (p=0.345) and also there was not a statistically significant difference between OSAS groups in terms of C-PS (p=0.775).

CONCLUSIONS

This study revealed that AFI correlates with AHI and C-IMT increases in OSAS. The two parameters could be used as indicators of risk of metabolic disorders and atheroscleroticdiseases in subjects with sleep apnea in the future.

The role of non-invasive imaging techniques in detecting intra-abdominal adhesions: a systematic review

BACKGROUND

Intra-abdominal adhesions after surgery are highly prevalent. Adhesions implicate complications during subsequent surgery and can cause chronic abdominal pain. The objective of this review was to investigate the usefulness of non-invasive diagnostic methods for detection of adhesions.

METHODS

We searched the electronic databases: MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials for studies investigating the use of non-invasive diagnostic imaging techniques for detecting adhesions. Main outcome was the sensitivity and specificity of each technique. We used the Quality Assessment of Diagnostic Accuracy studies tool to assess bias.

RESULTS

In total, 25 studies were included: 18 using ultrasound (US), 5 using magnetic resonance imaging (MRI), 1 using computed tomography (CT), and 1 using both US and MRI. A total of 2195 patients were included. Overall accuracy ranged between 76 and 100% for US studies and between 79 and 90% for MRI and was 66% for CT. Sensitivity ranged between 21 and 100% for US and between 22 and 93% for MRI and was 61% for CT. Specificity was 32-100% for US, 25-93% for MRI, and 63% for CT. Bias analysis revealed that in most studies, investigators were blinded to the reference standard but not to the index test and 11 of 25 studies had a high risk of selection bias.

CONCLUSIONS

Currently, abdominal US can be used to determine the presence of adhesions between bowel and the abdominal wall. MRI is also an accurate diagnostic modality and can in addition visualize adhesions between viscera, however, with a tendency to over diagnose adhesions. There is insufficient evidence to support CT as a diagnostic modality for adhesions.

Ultrasound Probe Pressure on the Maternal Abdominal Wall and the Effect on Fetal Middle Cerebral Artery Doppler Indices

Background and objectives: Doppler ultrasound of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation, and other perinatal outcomes. The adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies. The aim of this study was to evaluate the effect of increased pressure exerted on the maternal abdominal wall during routine ultrasound on the middle cerebral artery (MCA), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). Materials and Methods: A prospective study was conducted, in which we included 40 pregnant women between 24 + 0 and 41 + 3 gestational weeks (GW), with singleton pregnancies, without any associated pathologies, undergoing routine US examination. We recorded the flow velocity waveforms in the MCA, and we measured the RI, PI, PSV, and the applied pressure on to the maternal abdominal wall-needed for a proper evaluation of MCA. We then repeated the same measurements at two different higher pressure levels, at the same time having a proper image of the targeted vessel. Results: We found significant differences for the PI and RI levels with an increase in abdominal pressure (median PI 1.46, 1.58, and 1.92, respectively; median RI 0.74, 0.78, and 0.85, respectively; p < 0.05), for both PI and RI. At the same time, we found no significant differences for PSV in the studied group in relationship with increase in abdominal pressure (median PSV 39.56, 40.10, and 39.70, respectively; p > 0.05). Conclusions: The applied abdominal pressure by the examiner's hand, during routine US scan in pregnancy, can modify the MCA parameters of blood flow resistance (PI and RI) when measured by Doppler US, thus influencing the diagnostic accuracy in a series of pregnancy associated pathologies, such as chronic fetal distress (CFD) or intrauterine growth restriction (IUGR).

3D surface imaging of abdominal wall muscular contraction

BACKGROUND AND OBJECTIVE

The biomechanical analysis of the abdominal wall should take into account muscle activation and related phenomena, such as intra-abdominal pressure variation and abdomen surface deformation. The geometry of abdominal surface and its deformation during contraction have not been extensively characterized, while represent a key issue to be investigated.

METHODS

In this work, the antero-lateral abdominal wall surface of ten healthy volunteers in supine position is acquired via laser scanning in relaxed conditions and during abdominal muscles contraction, repeating each acquisition six times. The average relaxed and contracted abdominal surfaces are compared for each subject and displacements measured.

RESULTS

Muscular activation induces raising in the region adjacent to linea alba along the posterior-anterior direction and a simultaneous lowering along lateral-medial direction of the abdominal wall sides. Displacements reach a maximum value of 12.5 mm for the involved subjects. The coefficient of variation associated to the abdomen surface measurements in the same configuration (relaxed or contracted) is below 0.75%. Non-parametric Mann-Whitney U test highlights that the differences between relaxed and contracted abdominal wall surfaces are significant (p < 0.01).

CONCLUSIONS

Laser scanning is an accurate and reliable method to evaluate surface changes on the abdominal wall during muscular contraction. The results of this experimental activity can be useful to validate numerical models aimed at describing abdominal wall biomechanics.