Scalloping of the Liver and Spleen on Preoperative CT-Scan of Pseudomyxoma Peritonei Patients: Impact on Prediction of Resectability, Grade, Morbidity and Survival.

Pseudomyxoma peritonei (PMP) is ideally treated by cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), leading to significant morbidity. Beyond the histologic grade, the prognosis lies in the completeness of cytoreduction (CC-score of 0/1 vs. 2/3) and the severe complication rate. The mucinous nature of the peritoneal implants sometimes induces liver and/or spleen scalloping on imaging. The predictive value of scalloping was assessed regarding resectability, grade, survival and severe morbidity. This monocentric, retrospective analysis compared CC-0/1 with CC-2/3 groups regarding liver and spleen scalloping parameters, assessed on pre-operative computed tomography (CT) scan, reviewed for the study. In addition, prognostic factors of severe complications and recurrence-free and overall survivals were explored in the CC-0/1 population. Overall, 129 patients were included (109 CC-0/1, 20 CC-2/3), with 58 (45%) exhibiting scalloping. All patients with splenic scalloping also had a liver one. Scalloping was more frequent (75% vs. 39%), with greater median maximal depth (21 vs. 11 mm) and higher PCI (32 vs. 14) in the CC-2/3 population, but was not predictive of either grade or survival. In CC-0/1 patients, survivals and postoperative complications were not affected by scalloping parameters. Scalloping appeared as a marker of advanced PMP, but was not predictive of grade, severe complications, or long-term outcomes.

Traumatic Abdominal Wall Hernia-A Series of 12 Patients and a Review of the Literature.

BACKGROUND: The traumatic abdominal wall hernia (TAWH) is strongly associated with blunt abdominal trauma. The importance of the CT scan cannot be underestimated-the diagnosis of TAWH is easy to miss clinically, but simple to spot radiologically. We report a case series of patients managed in a French-level one trauma centre, to contribute our experience in the detection and management of associated injuries, and of the hernia itself. METHODS: All patients (n = 4238) presenting to a single-level one trauma centre for trauma resuscitation (including systematic full-body computerised tomography) from November 2014 to February 2020 were screened for the presence of TAWH and prospectively added to our database. Particular attention was paid to the late detection of associated intra-abdominal injuries. Finally, the choice of management of the hernia itself was noted. A literature review of all case series and individual case reports until the time of writing was performed and summarised. RESULTS: We report 12 cases of TAWH amongst 4238 patients presenting to the trauma resuscitation bay between November 2014 and February 2020. All patients underwent a contrast-enhanced CT immediately after stabilisation. No patients had clinically detected TAWH prior to CT. Intra-abdominal injuries were found in 9 patients (75%), and urgent surgery was required in 7 patients (58.3%). Two (28.5%) of these seven patients had a missed diagnosis of intra-abdominal injury at the time of the index CT scan, although the TAWH had been detected. Based on our literature review, 271 patients across 12 case series were identified. In total, 183 (67;5%) of these patients were reported to have ≥ 1 associated intra-abdominal injuries. In total, 127 (46,8%) patients required an urgent laparotomy for management of these injuries. Five (3.9%) of the patients requiring urgent laparotomy had a missed CT diagnosis of intra-abdominal injury but not of TAWH at the time of the baseline CT. CONCLUSIONS: TAWH is a rare clinical entity that may alert to more significant, associated trauma lesions. The CT scan is the imaging modality of choice, to both diagnose and classify the hernia and to screen for other injuries. The presence of TAWH must lower the threshold to operatively explore or at least closely monitor these patients, in view of the high rate of false-negative findings at index imaging.