DOCSLIB.ORG

Diseases of the Peritoneum and Retroperitoneum

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diseases of the Peritoneum and Retroperitoneum gastrointestinal tract and abdomen 2 DISEASES OF THE PERITONEUM AND RETROPERITONEUM Amanda K. Arrington, MD, and Joseph Kim, MD Anatomy and Physiology: Peritoneum transverse mesocolon, on the other hand, is the mesentery of the transverse colon and suspends this structure from anatomy the posterior abdominal wall. The root of the transverse The word peritoneum is derived from the Greek terms peri mesocolon extends across the descending duodenum and (“around”) and tonos (“stretching”). The peritoneum, which the head of the pancreas and continues along the inferior lines the innermost surface of the abdominal wall and the border of the body and tail of the pancreas. The transverse majority of the abdominal organs, consists of a layer of mesocolon is continuous with the duodenocolic ligament on dense stroma covered on its inner surface by a single sheet the right and with the phrenicocolic and splenorenal liga- of mesothelial cells. In men, the peritoneum is completely ments on the left. Finally, the sigmoid mesocolon attaches enclosed, whereas in women, the peritoneum is open to the the sigmoid colon to the posterior pelvic wall. This mesen- exterior only at the ostia of the fallopian tubes. The perito- tery, which has an inverted V-shape confi guration, with its neum is divided into two components: the parietal and the apex lying anterior to the bifurcation of the left common ilia c visceral peritoneum [see Figure 1]. The parietal peritoneum artery, contains both sigmoid and hemorrhoidal vessels, covers the innermost surface of the abdominal walls, the lymph nodes, nerves, and abundant fat tissue.3 inferior surface of the diaphragm, and the pelvis. The vis- ceral peritoneum, on the other hand, covers the majority physiology of the intraperitoneal organs [see Table 1] and the anterior The blood supply and innervation of the peritoneum aspect (only) of the retroperitoneal organs [see Table 1]. As depend on whether it is visceral peritoneum or parietal peri- shown in Figure 1, the intraperitoneal organs are suspended toneum. The blood fl ow to the visceral peritoneum is sup- by ligaments of peritoneum within the abdomen that have plied by the splanchnic blood vessels, whereas the parietal previously been identifi ed by Meyers and colleagues [see peritoneum is supplied by intercostal, subcostal, lumbar, Figure 1 and Table 1].1 The spread of infection, as well as the and iliac vessels. Correspondingly, the innervation of the spread of a primary tumor or metastatic disease, can be pre- two components is divided: the visceral peritoneum is sup- dicted based on subdivisions of the abdominal compart- plied by nonsomatic nerves, whereas the parietal peritone- ments created by these peritoneal ligamentous structures of um is supplied by somatic nerves. This detail is important the abdomen. when evaluating for pain. Visceral pain is poorly localized The omentum (greater and lesser omentum) is a well- and vague and is generally caused by stretching, distention, vascularized double fold of peritoneum with fat that torsion, and twisting motion. On the other hand, parietal contributes to the control of intra-abdominal infection and pain is caused by direct stimulation of nerve fi bers and is infl ammation. The omentum aids in sealing off perforations described as sharp and well localized. (as in perforated ulcer or perforated appendicitis) and controls infl ammation (i.e., unruptured appendicitis). The peritoneum is a bidirectional, semipermanent bio- Additionally, the omentum delivers phagocytes that destroy membrane that controls the amount of fl uid in the perito- unopsonized bacteria. Thus, the omentum has multiple neal cavity. The peritoneal cavity typically contains less than functions in the body’s defense system against infection. 100 mL of sterile peritoneal fl uid. This peritoneal fl uid may The small bowel mesentery and transverse mesocolon are act as both part of the local defense system and a lubricant also complex peritoneal folds that originated from the dorsal for intraperitoneal organs. In certain disease states, such as and ventral midline mesenteries early in development and nephrotic syndrome, congestive heart failure, cirrhosis, or are considered part of the peritoneum. The small bowel portal hypertension, the amount of peritoneal fl uid may mesentery suspends the jejunum and ileum from the poste- increase from the normal less than 100 cc protective amount rior abdominal wall. This mesentery contains the superior to several liters in volume [see Ascites, below]. mesenteric vessels, lymph nodes, nerves, and fat tissue. Its Circulation of peritoneal fl uid is driven in part by the root originates at the duodenojejunal junction and extends movement of the diaphragm. The peritoneal cavity can downward in an oblique direction across the aorta, inferior absorb peritoneal fl uid through two different systems. vena cava, right ureter, and psoas muscle to the right iliac Substances smaller than 2 kDa are absorbed through the fossa at the ileocecal junction. Across the mesenteric root, peritoneal mesothelial venous pores directly into the portal the small bowel mesentery is in anatomic continuity with circulation.4 Conversely, larger particles (> 2 kDa) are the extraperitoneal anterior pararenal space, thus providing absorbed through the peritoneal mesothelial lymphatics a channel for the spread of disease.2 As a result of its shorter and enter the lymphatic system via the thoracic duct. This length (15 cm) in comparison with the much longer length particular route of absorption plays an important role in of the small bowel itself (6 to 8 m), the small bowel mesen- controlling abdominal infections and has been shown to tery has a pleated appearance along its intestinal border. The propagate the metastatic spread of certain cancers. ACS Surgery © 2014 Decker Intellectual Properties Inc DOI 10.2310/7800.2257 07/14 SSurg_Gastro_tid2257.inddurg_Gastro_tid2257.indd 1 44/3/2014/3/2014 112:21:302:21:30 PPMM gastro diseases of the peritoneum and retroperitoneum — 2 Liver Visceral Peritoneum Parietal Peritoneum Pancreas Stomach Mesocolon Duodenum Colon Small Bowel Mesentery Greater Omentum Small Intestine Douglas Pouch Bladder Rectum Figure 1 Peritoneal components. The peritoneum consists of parietal peritoneum and visceral peritoneum. Visceral peritoneal covers the surface of intraperitoneal organs. The omentum and mesentery are also peritoneal structures. Anatomy and Physiology: Retroperitoneum iliac crest inferiorly. Organs are classifi ed as retroperitoneal The retroperitoneum is defi ned as the space between the in location if they have no peritoneal lining whatsoever or posterior parietal peritoneum and the posterior body wall. have peritoneum on their anterior surface only [see Table 1]. Although it has no specifi c delineating anatomic structures, Furthermore, structures that are not suspended by mesen- the retroperitoneal space is bound anteriorly by the poste- tery in the abdominal cavity and that lie between the pari- rior refl ection of the peritoneum, superiorly by the dia- etal peritoneum and the abdominal wall are also classifi ed phragm, and inferiorly by the levator ani muscles. This as retroperitoneal in location; this includes the duodenum, space also includes the lumbar fossa, extending from the ascending colon, and descending colon [see Figure 2]. 12th thoracic spine superiorly to the base of the sacrum and Because of the compliance of the anterior border of the ACS Surgery 07/14 SSurg_Gastro_tid2257.inddurg_Gastro_tid2257.indd 2 44/3/2014/3/2014 112:21:302:21:30 PPMM gastro diseases of the peritoneum and retroperitoneum — 3 Table 1 Abdominal Components Retroperitoneal operative approaches may be benefi cial for a number of reasons. First, it avoids entrance in to the Intraperitoneal organs peritoneum and, thus, decreases manipulation and the risk Gastrointestinal Stomach of injury to intra-abdominal organs. Minimal manipulation Small intestine of the small intestine, for instance, signifi cantly decreases Transverse colon complications such as postoperative ileus. Given successful Liver avoidance of entering the peritoneum, intra-abdominal Endocrine 7 Spleen adhesions are also minimized. Retroperitoneal structures Gastrointestinal Diseases of the Peritoneum Duodenum Ascending colon ascites Descending colon Pancreas Pathophysiology and Etiology Vascular Inferior vena cava Ascites is the pathologic accumulation of fl uid within the Aorta peritoneal cavity. The primary cause of nonmalignant asci- Lymphatics tes accumulation is liver disease (cirrhosis and portal hyper- Iliac arteries Renal tension), which accounts for 85% of cases of ascites in the Kidneys United States. Other causes of ascites are listed in Table 2 Ureters [see Table 2]. In cirrhotic patients, the onset of ascites is an Bladder overall poor prognostic factor as patients are more likely Endocrine Adrenals to develop spontaneous bacterial peritonitis (SBP), renal Sexual (hepatorenal) failure, decreased quality of life, and decreased Seminal vesicles overall survival.8 Vas deferens Ovaries Accumulation of ascites in patients with cirrhosis is Vagina secondary to the combination of renal sodium and water Other retention with portal hypertension [see Figure 3]. Driven Nerves by activation of the renin-angiotensin-aldosterone system, Peritoneal ligaments and mesenteries renal sodium retention is the result of proximal and distal Ligaments renal tubule sodium reabsorption. The renin system is acti- Splenorenal vated in response to decreased circulating blood volume Gastrohepatic
Load more

Recommended publications
  • Reference Sheet 1
    MALE SEXUAL SYSTEM 8 7 8 OJ 7 .£l"00\.....• ;:; ::>0\~ <Il '"~IQ)I"->. ~cru::>s ~ 6 5 bladder penis prostate gland 4 scrotum seminal vesicle testicle urethra vas deferens FEMALE SEXUAL SYSTEM 2 1 8 " \ 5 ... - ... j 4 labia \ ""\ bladderFallopian"k. "'"f"";".'''¥'&.tube\'WIT / I cervixt r r' \ \ clitorisurethrauterus 7 \ ~~ ;~f4f~ ~:iJ 3 ovaryvagina / ~ 2 / \ \\"- 9 6 adapted from F.L.A.S.H. Reproductive System Reference Sheet 3: GLOSSARY Anus – The opening in the buttocks from which bowel movements come when a person goes to the bathroom. It is part of the digestive system; it gets rid of body wastes. Buttocks – The medical word for a person’s “bottom” or “rear end.” Cervix – The opening of the uterus into the vagina. Circumcision – An operation to remove the foreskin from the penis. Cowper’s Glands – Glands on either side of the urethra that make a discharge which lines the urethra when a man gets an erection, making it less acid-like to protect the sperm. Clitoris – The part of the female genitals that’s full of nerves and becomes erect. It has a glans and a shaft like the penis, but only its glans is on the out side of the body, and it’s much smaller. Discharge – Liquid. Urine and semen are kinds of discharge, but the word is usually used to describe either the normal wetness of the vagina or the abnormal wetness that may come from an infection in the penis or vagina. Duct – Tube, the fallopian tubes may be called oviducts, because they are the path for an ovum.
    [Show full text]
  • Te2, Part Iii
    TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS
    [Show full text]
  • The Subperitoneal Space and Peritoneal Cavity: Basic Concepts Harpreet K
    ª The Author(s) 2015. This article is published with Abdom Imaging (2015) 40:2710–2722 Abdominal open access at Springerlink.com DOI: 10.1007/s00261-015-0429-5 Published online: 26 May 2015 Imaging The subperitoneal space and peritoneal cavity: basic concepts Harpreet K. Pannu,1 Michael Oliphant2 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA 2Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA Abstract The peritoneum is analogous to the pleura which has a visceral layer covering lung and a parietal layer lining the The subperitoneal space and peritoneal cavity are two thoracic cavity. Similar to the pleural cavity, the peri- mutually exclusive spaces that are separated by the toneal cavity is visualized on imaging if it is abnormally peritoneum. Each is a single continuous space with in- distended by fluid, gas, or masses. terconnected regions. Disease can spread either within the subperitoneal space or within the peritoneal cavity to Location of the abdominal and pelvic organs distant sites in the abdomen and pelvis via these inter- connecting pathways. Disease can also cross the peri- There are two spaces in the abdomen and pelvis, the toneum to spread from the subperitoneal space to the peritoneal cavity (a potential space) and the subperi- peritoneal cavity or vice versa. toneal space, and these are separated by the peritoneum (Fig. 1). Regardless of the complexity of development in Key words: Subperitoneal space—Peritoneal the embryo, the subperitoneal space and the peritoneal cavity—Anatomy cavity remain separated from each other, and each re- mains a single continuous space (Figs.
    [Show full text]
  • Sacrospinous Ligament Suspension and Uterosacral Ligament Suspension in the Treatment of Apical Prolapse
    6 Review Article Page 1 of 6 Sacrospinous ligament suspension and uterosacral ligament suspension in the treatment of apical prolapse Toy G. Lee, Bekir Serdar Unlu Division of Urogynecology, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Toy G. Lee, MD. Division of Urogynecology, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, 301 University Blvd, Galveston, Texas 77555, USA. Email: [email protected]. Abstract: In pelvic organ prolapse, anatomical defects may occur in either the anterior, posterior, or apical vaginal compartment. The apex must be evaluated correctly. Often, defects will occur in more the one compartment with apical defects contributing primarily to the descent of the anterior or posterior vaginal wall. If the vaginal apex, defined as either the cervix or vaginal cuff after total hysterectomy, is displaced downward, it is referred to as apical prolapse and must be addressed. Apical prolapse procedures may be performed via native tissue repair or with the use of mesh augmentation. Sacrospinous ligament suspension and uterosacral ligament suspension are common native tissue repairs, traditionally performed vaginally to re-support the apex. The uterosacral ligament suspension may also be performed laparoscopically. We review the pathophysiology, clinical presentation, evaluation, pre-operative considerations, surgical techniques, complications, and outcomes of these procedures.
    [Show full text]
  • General Signs and Symptoms of Abdominal Diseases
    General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid.
    [Show full text]
  • Pelvic Anatomyanatomy
    PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx)
    [Show full text]
  • Primary Desmoid Tumor of the Small Bowel: a Case Report and Literature Review
    Open Access Case Report DOI: 10.7759/cureus.4915 Primary Desmoid Tumor of the Small Bowel: A Case Report and Literature Review Peter A. Ebeling 1 , Tristan Fun 1 , Katherine Beale 1 , Robert Cromer 2 , Jason W. Kempenich 1 1. Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA 2. Surgery, Keesler U.S. Air Force Medical Center, Biloxi, USA Corresponding author: Peter A. Ebeling, [email protected] Abstract Desmoid tumors, also known as aggressive fibromatosis, are fibromuscular neoplasms that arise from mesenchymal cell lines. They may occur in almost all soft tissue compartments. Primary desmoids of the small bowel are rare but potentially serious tumors presenting unique challenges to the general surgeon. We present one case of a 59-year-old man presenting with three months of abdominal distension secondary to a small bowel desmoid. Computed tomography of the abdomen showed an 18-cm mass in the mid-abdomen without obvious vital structure encasement. Percutaneous biopsy of the mass indicated a desmoid tumor. The patient underwent a successful elective exploratory laparotomy with resection and primary enteric anastomosis. Final pathology revealed the mass to be a primary desmoid of the small bowel. His post- operative course was uneventful. At two years after surgery, he is symptom free, and there is no evidence of disease recurrence. Due to the rare nature of primary small bowel desmoids, there are few specific care pathways outlined. This is a challenging pathology to treat that often requires a multidisciplinary team of surgical and medical oncologists. Categories: General Surgery, Oncology Keywords: desmoid, small bowel, resection, aggressive fibromatosis Introduction Desmoid tumors, also known as aggressive fibromatosis, are fibromuscular neoplasms that arise from mesenchymal cell lines.
    [Show full text]
  • Abdominal Cavity.Pptx
    UNIVERSITY OF BABYLON HAMMURABI MEDICAL COLLEGE GASTROINTESTINAL TRACT S4-PHASE 1 2018-2019 Lect.2/session 3 Dr. Suhad KahduM Al-Sadoon F. I . B. M . S (S ur g. ) , M.B.Ch.B. [email protected] The Peritoneal Cavity & Disposition of the Viscera objectives u describe and recognise the general appearance and disposition of the major abdominal viscera • explain the peritoneal cavity and structure of the peritoneum • describe the surface anatomy of the abdominal wall and the markers of the abdominal viscera u describe the surface regions of the abdominal wall and the planes which define them § describe the structure and relations of : o supracolic and infracolic compartments o the greater and lesser omentum, transverse mesocolon o lesser and greater sac, the location of the subphrenic spaces (especially the right posterior subphrenic recess) The abdominal cavity The abdomen is the part of the trunk between the thorax and the pelvis. The abdominal wall encloses the abdominal cavity, containing the peritoneal cavity and housing Most of the organs (viscera) of the alimentary system and part of the urogenital system. The Abdomen --General Description u Abdominal viscera are either suspended in the peritoneal cavity by mesenteries or are positioned between the cavity and the musculoskeletal wall Peritoneal Cavity – Basic AnatoMical Concepts The abdominal viscera are contained either within a serous membrane– lined cavity called the Abdominopelvic cavity. The walls of the abdominopelvic cavity are lined by parietal peritoneum AbdoMinal viscera include : major components of the Gastrointestinal system(abdominal part of the oesophagus, stomach, small & large intestines, liver, pancreas and gall bladder), the spleen, components of the urinary system (kidneys & ureters),the suprarenal glands & major neurovascular structures.
    [Show full text]
  • Clinical Anatomy of the Anterior Abdominal Wall in Its Relation To
    ClinicalClinical AnatomyAnatomy ofof thethe AnteriorAnterior AbdominalAbdominal WallWall inin itsits RelationRelation toto HerniaHernia Handout download: http://www.oucom.ohiou.edu/dbms-witmer/gs-rpac.htm 24 April 2007 LawrenceLawrence M.M. Witmer,Witmer, PhDPhD Professor of Anatomy Department of Biomedical Sciences College of Osteopathic Medicine Ohio University Athens, Ohio 45701 [email protected] AnatomicalAnatomical OverviewOverview External Internal Transversus Rectus oblique oblique abdominis abdominis fleshyfleshy rectusrectus portionportion sheathsheath aponeuroticaponeurotic inguinalinguinal tendinoustendinous portionportion ligamentligament intersectionsintersections • Three flat abdominals: attach to trunk skeleton, inguinal lig., linea alba, etc.; fleshy laterally and aponeurotic medially, forming rectus sheath medially • Two vertical abdominals: rectus abdominis and pyramidalis (not shown) Moore & Dalley 2006 AnatomicalAnatomical OverviewOverview intramuscular exchange of intermuscular exchange of contralateral external oblique fibers contralateral external & internal oblique right external oblique left internal oblique • continuity of external oblique • continuity of fibers across midline fibers across midline • “digastric” muscle with central • blending of superficial & deep tendon fibers on opposite side • torsion of trunk Moore & Dalley 2006 AnatomicalAnatomical OverviewOverview transv. abd. linea alba rectus sheath rectus abdominis int. obl. ext. obl. semilunar line peritoneum transversalis fascia aponeuroses of abdominal
    [Show full text]
  • Lumps and Bumps of the Abdominal Wall and Lumbar Region—Part 2: Beyond Hernias
    Published online: 2019-06-18 THIEME Review Article 19 Lumps and Bumps of the Abdominal Wall and Lumbar Region—Part 2: Beyond Hernias Sangoh Lee1 Catalin V. Ivan1 Sarah R. Hudson1 Tahir Hussain1 Suchi Gaba2 Ratan Verma1 1 1 Arumugam Rajesh James A. Stephenson 1Department of Radiology, University Hospitals of Leicester, Address for correspondence James A. Stephenson, MD, FRCR, Leicester General Hospital, Leicester, United Kingdom Department of Radiology, University Hospitals of Leicester, 2Department of Radiology, University Hospitals of North Midlands, ­­Leicester General Hospital, Leicester, LE5 4PW, United Kingdom Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (e-mail: [email protected]). J Gastrointestinal Abdominal Radiol ISGAR 2018;1:19–32 Abstract Abdominal masses can often clinically mimic hernias, especially when they are locat- ed close to hernial orifices. Imaging findings can be challenging and nonspecific Keywords with numerous differential diagnoses. We present a variety of pathology involving ► abdominal wall the abdominal wall and lumbar region, which were referred as possible hernias. This ► hernia demonstrates the wide-ranging pathology that can present as abdominal wall lesions ► mimics or mimics of hernias that the radiologist should be alert to. Introduction well-differentiated liposarcomas are histologically identical. The term “atypical lipoma” was coined by Evans et al in 1979 to An abdominal hernia occurs when an organ of a body ca vity describe well-differentiated liposarcoma of subcutaneous and 1 protrudes through a defect in the wall of that cavity. It is a 6 intramuscular layers. The World Health Organization (WHO) common condition with lifetime risk of developing a groin has further refined the definition by using atypical lipoma to hernia being estimated at 27% for men and 3% for women; it has describe subcutaneous lesions only and well- differentiated 2 thus been covered extensively in the literature.
    [Show full text]
  • Carcinomatous Cirrhosis of the Liver with Sarcomatosis of the Peritoneum 1
    CARCINOMATOUS CIRRHOSIS OF THE LIVER WITH SARCOMATOSIS OF THE PERITONEUM 1 S. SANES, M.D., AND K. TERPLAN, M.D. (From tile Pathological Laboratory of the Buffalo General Hospital and School of Medicine, University of Buffalo) The following case is reported because of the occurrence of two different types of malignant neoplasm with typical portal cirrhosis of the liver. That a pathogenetic relationship exists between Laennec's cirrhosis and primary carcinoma of the liver is generally recognized. Whether the association of a peritoneal sarcoma with the cirrhosis in this case was more than a coincidence seemed an interesting point for discussion. REPORT OF CASE E. G., 11 white Italian male fifty-seven years old, was admitted to the Buffalo General Hospital on the service of Drs. N. G. Russell and A. H. Aaron, Nov. 25, 1934. He died Nov. 29, 1934. All his adult life he had partaken of large amounts of wine and whiskey daily. At the age of seventeen years he had suffered an attack of jaundice of several weeks' duration. The patient first began to lose weight and strength in 1932 and noticed that his skin was becoming dark. In March 1934 he complained of cramp-like abdominal pain, diarrhea, and bloating. The stools were watery. There was no nausea or vomiting. Upon hos­ pitalization, April 9, 1934, physical examination revealed that the pupils reacted to light and accommodation. The chest was emphysematous; breath sounds were diminished in both bases. The heart was regular; a systolic murmur was heard. The blood pressure was 118/70. The liver and spleen were palpable three finger breadths below the costal margin.
    [Show full text]
  • Medical Terminology Abbreviations Medical Terminology Abbreviations
    34 MEDICAL TERMINOLOGY ABBREVIATIONS MEDICAL TERMINOLOGY ABBREVIATIONS The following list contains some of the most common abbreviations found in medical records. Please note that in medical terminology, the capitalization of letters bears significance as to the meaning of certain terms, and is often used to distinguish terms with similar acronyms. @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial blood gas a.c.—before meals ac & cl—acetest and clinitest ACLS—advanced cardiac life support AD—right ear ADL—activities of daily living ad lib—as desired adm—admission afeb—afebrile, no fever AFB—acid-fast bacillus AKA—above the knee alb—albumin alt dieb—alternate days (every other day) am—morning AMA—against medical advice amal—amalgam amb—ambulate, walk AMI—acute myocardial infarction amt—amount ANS—automatic nervous system ant—anterior AOx3—alert and oriented to person, time, and place Ap—apical AP—apical pulse approx—approximately aq—aqueous ARDS—acute respiratory distress syndrome AS—left ear ASA—aspirin asap (ASAP)—as soon as possible as tol—as tolerated ATD—admission, transfer, discharge AU—both ears Ax—axillary BE—barium enema bid—twice a day bil, bilateral—both sides BK—below knee BKA—below the knee amputation bl—blood bl wk—blood work BLS—basic life support BM—bowel movement BOW—bag of waters B/P—blood pressure bpm—beats per minute BR—bed rest MEDICAL TERMINOLOGY ABBREVIATIONS 35 BRP—bathroom privileges BS—breath sounds BSI—body substance isolation BSO—bilateral salpingo-oophorectomy BUN—blood, urea, nitrogen
    [Show full text]