Additional branches of celiac trunk and its clinical significance.
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The anatomical variations of the abdominal arteries are important due to its clinical significance. Various types of vascular anomalies are frequently found in human abdominal viscera, during cadaveric dissection and diagnostic radiological imaging. The present report describes a variation in the celiac trunk as found during routine dissection in a 59-year-old male cadaver. The celiac trunk (CT) was unusually lengthy and took origin from the left antero-lateral surface of the abdominal aorta. Altogether, there were five branches, including three classic branches of CT. The left phrenic artery (LPA) was the first branch of the CT. The remaining four branches were left gastric artery (LGA), splenic artery (SA), common hepatic artery (CHA) and gastroduodenal artery (GDA). There was an arterial loop between the posterior branches of the superior pancreatico-duodenal artery (SPDA), arising from the GDA, and the posterior branch of the inferior pancreatico-duodenal artery (IPDA), arising from the superior mesenteric artery (SMA). The arterial loop formed by the above arteries, supplied the head of the pancreas and duodeno-jejunal flexure. The embryological and clinical significance of above variations has been described. (+info)
Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage.
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AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP >or= 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE II scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 +/- 3.90 vs 15.70 +/- 4.25, P = 0.616; 3.70 +/- 0.93 vs 3.47 +/- 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period of the first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival. (+info)
Treatment of abdominal compartment syndrome in severe acute pancreatitis patients with traditional Chinese medicine.
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AIM: To investigate the therapeutic effect of traditional Chinese traditional medicines Da Cheng Qi Decoction (Timely-Purging and Yin-Preserving Decoction) and Glauber's salt combined with conservative measures on abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) patients. METHODS: Eighty consecutive SAP patients, admitted for routine non-operative conservative treatment, were randomly divided into study group and control group (40 patients in each group). Patients in the study group received Da Cheng Qi Decoction enema for 2 h and external use of Glauber's salt, once a day for 7 d. Patients in the control group received normal saline (NS) enema. Routine non-operative conservative treatments included non-per os nutrition (NPON), gastrointestinal decompression, life support, total parenteral nutrition (TPN), continuous peripancreatic vascular pharmaceutical infusion and drug therapy. Intra-cystic pressure (ICP) of the two groups was measured during treatment. The effectiveness and outcomes of treatment were observed and APACHE II scores were applied in analysis. RESULTS: On days 4 and 5 of treatment, the ICP was lower in the study group than in the control group (P < 0.05). On days 3-5 of treatment, acute physiology and chronic health evaluation II (APACHE II) scores for the study and control groups were significantly different (P < 0.05). Both the effectiveness and outcome of the treatment with Da Cheng Qi Decoction on abdominalgia, burbulence relief time, ascites quantity, cyst formation rate and hospitalization time were quite different between the two groups (P < 0.05). The mortality rate for the two groups had no significant difference. CONCLUSION: Da Cheng Qi Decoction enema and external use of Glauber's salt combined with routine non-operative conservative treatment can decrease the intra-abdominal pressure (IAP) of SAP patients and have preventive and therapeutic effects on abdominal compartment syndrome of SAP. (+info)
Intra-abdominal pectus bar migration--a rare clinical entity: case report.
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Acute intestinal distress syndrome: the importance of intra-abdominal pressure.
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This review article will focus primarily on the recent literature on abdominal compartment syndrome (ACS) as well as the definitions and recommendations published by the World Society for the Abdominal Compartment Syndrome (WSACS, www.wsacs.org). The risk factors for intra-abdominal hypertension (IAH) and the definitions regarding increased intra-abdominal pressure (IAP) will be listed, followed by a brief but comprehensive overview of the different mechanisms of end-organ dysfunction associated with IAH. Measurement techniques for IAP will be discussed, as well as recommendations for organ function support in patients with IAH. Finally, noninvasive medical management options for IAH, surgical treatment for ACS and management of the open abdomen will be briefly discussed. (+info)
Preoperative risk factors for intraabdominal adhesions should not contraindicate surgical laparoscopy for infertility.
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OBJECTIVE: Abdominal wall adhesions at laparoscopy may predispose infertile patients to access-related injuries and increase the complexity of the procedure. We have observed concern from referring physicians regarding the safety of surgical laparoscopy in infertile patients who previously underwent surgery because of the risk of abdominal adhesions. To assess the risk of intraabdominal adhesions at laparoscopy, a retrospective cohort study was performed. METHODS: All infertile patients who underwent a reproductive laparoscopic procedure in a 6-year period at our institution were included in this study. A chart review was performed to obtain demographic/surgical data and identify preoperative risk factors for intraabdominal adhesions. Operative videotapes were reviewed to determine the presence and location of adhesions. Standard statistical analyses were performed. RESULTS: During the study period, 254 infertile patients underwent reproductive surgical laparoscopy, and videotapes on 164 (65%) were available for review. A total of 88 patients (54%) were identified with preoperative risk factors for intraabdominal adhesions (group 1), while 76 (46%) had no risk factors (group 2). The relative risk of adhesions was 1.34 (95% CI, range 0.89 to 2.01, P=0.18) when risk factors were identified. There were no differences in the groups regarding patient age, operative time, access technique, conversion to open surgery, or complications. Estimated blood loss was significantly higher in group 2, likely due to the predominance of laparoscopic surgery for ovarian endometriomata and complexity of the cases rather than the presence or absence of intraabdominal adhesion risk factors. CONCLUSIONS: No difference existed in the risk of intraabdominal adhesions in infertile patients with and without identifiable preoperative risk factors. Preoperative risk factors for intraabdominal adhesions should not contraindicate the surgical laparoscopic approach for reproductive procedures. (+info)
Natural Orifice Surgery: Transdouglas surgery--a new concept.
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BACKGROUND: During the 20th century, laparoscopic procedures replaced most traditional abdominal operations and achieved high-quality standards. It seemed that the optimal surgical method had been achieved; however, a new concept, which might possibly become even safer and simpler is now being developed, the concept of Natural Orifice Surgery (NOS). The existing natural openings of the body started to be used for introduction of surgical instruments for diagnostic purposes and surgical procedures, avoiding penetrating the abdominal wall. Parallel to the American Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) group, is the New European Surgical Academy (NESA) established in Berlin on June 23, 2006. It is the first European-based NOS working group with participation of scientists and surgeons from different disciplines and countries. After the published experimental achievements had been presented and discussed, the working group decided to concentrate mainly on the transvaginal/transdouglas access in women. DATABASE: A new surgical instrument, the Transdouglas Endoscopic Device (TED) has been designed. This is a flexible multichannel instrument enabling single-entry surgical, urological, and gynecological operations. TED respects the anatomy of the pelvis. To get to the upper abdomen, an S-shaped device was designed, bending first to the front, and then backwards. For the lower abdomen, the U-shaped mode of the instrument was designed. The wide diameter of the device (35 mm) and its multichannel design enables simultaneous use of different instruments, therefore avoiding hybrid procedures. Various surgical and gynecological procedures have been successfully simulated, and the manufacturing of the device is in progress. Preclinical studies will start soon. CONCLUSIONS: Transvaginal/transdouglas surgery is expected to be a valid alternative to traditional endoscopic procedures in women. It seems that NOS will create a spectrum of innovative and high-quality procedures performed by an interdisciplinary team and will improve patient safety. (+info)
Transanal endoscopic drainage of abdominopelvic sepsis.
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Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an evolving experimental field exploring the technical feasibility and outcome of therapeutic interventions performed through the natural orifices of the body. The knowledge accumulating in NOTES is the result of animal experimentation and ongoing early clinical experience in humans. In this report we describe a patient treated with transanal endoscopic drainage of postoperative abdominopelvic sepsis. (+info)