Quiste del canal de Nuck, a propósito de un caso / Canal of Nuck cyst; a case report

El descenso de estructuras inicialmente intraabdominales hacia la región inguinal arrastra consigo una evaginación de peritoneo parietal: el canal de Nuck. Su obliteración incompleta permitirá el paso de líquido o estructuras abdominales originando un hidrocele de dicho canal o hernias inguinales indirectas. El quiste del canal de Nuck se presenta como una masa fluctuante, elástica y no reductible, ecográficamente quística, bien delimitada, de pared ecogénica fina y contenido anecoico, sin señal Doppler color. El diagnóstico diferencial incluye hernias, adenomegalias, enfermedad vascular, tumoral, etc. Aunque el diagnóstico definitivo es histopatológico, la ecografía es una técnica accesible, eficiente y fiable, que permite el estudio dinámico y en tiempo real

The descent of initially intra-abdominal structures towards the inguinal region leads to an evagination of the parietal peritoneum, and is called the canal of Nuck. Its incomplete obliteration will allow the passage of liquid or abdominal structures, leading to a hydrocele of the said canal or indirect inguinal hernias. The canal of Nuck cyst appears as a fluctuating, elastic and non-reducible mass, cystic in the ultrasound, and well-defined with a thin echogenic wall and an anechoic content, with no colour Doppler signal. The differential diagnosis includes hernias, adenomegalies, vascular pathology, and tumours. Although the definitive diagnosis is histopathological, ultrasound is an accessible, efficient and reliable technique, which allows dynamic and real-time study

Internal supravesical hernia accompanied with anomalous fold formations: a cadaveric case report.

During the abdominal dissection of a 67-year-old male cadaver, an unusual peritoneal fold was encountered on the inner surface of the anterior abdominal wall. The peritoneal fold had two parts: the anterior part was located at the midsagittal plane including dispersed urachus remnants, the other part was located at the coronal plane with a triangular shape at the posterior edge of the sagittal part. Remnants of the umbilical arteries were ascending in the lateral margins of the coronal part. Accordingly, two peritoneal sacs were formed on both sides of this abnormal fold. Part of the small bowel herniated into the left peritoneal sac situated on the left side of the bladder. Although the aperture of the hernia sac was at the lateral side of the remnant of the umbilical artery which is concordant with the normal position of the medial inguinal fossa, the bottom of the sac was found to be located at the supravesical region. Therefore, this case was interpreted as an internal supravesical hernia with an unusual course. Although these rarely seen internal supravesical hernias in the literature were reported to be observed either preoperatively or postoperatively, to our knowledge our case is the first to be revealed in a cadaver which in detail enabled us to examine the features of this unique peritoneal variation and accompanying anatomic structures that caused hernia formation.

Multiple abdominal peritoneal and intestinal variations and their accompanying clinical implications.

Accessory peritoneal sac and cystoduodenal ligament as peritoneal variations were observed in a cadaver in our laboratory. Slender stomach, thin transverse colon, redundant sigmoid colon, absent ascending colon and doubly distended gall bladder were also reported in the same cadaver. Relevant anatomical and clinical implications are discussed.

Computed tomographic peritoneography in the investigation of patent processus vaginalis in CAPD patients.

Continuous ambulatory peritoneal dialysis (CAPD) is a useful and practical modality for the treatment of end-stage renal disease (ESRD). In the properly selected patient this method is well-tolerated with minimal complications. We report a case of intermittent massive genital edema secondary to patent processus vaginalis in a patient receiving CAPD. The diagnosis of patent processus vaginalis, which was strongly suggested by the intermittent nature of the symptoms, was confirmed by computerized tomography (CT) peritoneography.

Vertebral column kyphoscoliosis and unexpected death.

A case of spontaneous gastric perforation is reported in a 75-year-old woman due to massive hemorrhaging from a benign gastric ulcer. Blood was prevented from leaving the stomach due to posterior displacement and rotation of the stomach associated with marked underlying vertebral column kyphoscoliosis. Significant deformity of the spine had caused malpositioning of the stomach as a result of the abnormal shape of the peritoneal and chest cavities. This in turn had led to mechanical obstruction and prevented egress of blood arising from a bleeding arteriole in the base of a chronic gastric ulcer. Rapid distension had resulted from the inability to spontaneously decompress the stomach, which in turn had led to rupture.

A wandering spleen presenting as a pelvic mass: case report and review of the literature.

Wandering spleens are rare clinical entities found more commonly in females. We report a young female patient found to harbour a pelvic spleen. The literature regarding this rare ectopia is reviewed. The wandering spleen should be considered in the differential diagnosis of pelvic masses.

The persisting pneumatoenteric recess and the infracardiac bursa: possible role in the pathogenesis of right hydrothorax complicating peritoneal dialysis.

Hydrothorax, an uncommon complication of peritoneal dialysis (PD), results from the migration of dialysis fluid under pressure from the peritoneal cavity into the pleural space. The exact site of the transdiaphragmatic fluid leak remains obscure, but the right-sided predominance of the hydrothorax points to the presence of abnormalities in the right hemidiaphragm. Such abnormalities have occasionally been described. In a recent case of acute massive right hydrothorax at the start of PD, the autopsy revealed extensive changes of amyloidosis that were comparable in both hemidiaphragms, prompting us to revisit the accepted explanation for right hydrothorax. We propose that an embryonic remnant--namely, the persisting pneumatoenteric recess and the infracardiac bursa--provides a passage connecting the peritoneal cavity to the right pleural space. The potential presence of this mechanism is consistent with the recognized clinical features of right hydrothorax complicating PD. This proposed route for dialysis fluid to form a right hydrothorax during PD can be investigated by currently available high-definition imaging techniques. This novel mechanism may also be involved in the pathogenesis of right hydrothorax observed in other medical conditions with tense ascites (liver cirrhosis, Meigs syndrome).

A rare multiple variation of the greater omentum.

In a dissection performed in our department, we observed multiple variations of the greater omentum. The unusual attachments of the greater omentum were identified. While the right upper part combined with ligamentum teres hepatis, the left upper part had connection with the anterolateral abdominal wall. In addition, the free lower margin of the greater omentum was bound to the front of the abdomen wall. These unusual attachments contained vessels and nerves. The greater omentum is used in reconstructive surgery of the chest wall. And its ligaments are important in abdominal surgery. Therefore, it is important to keep in mind the different attachments of the greater omentum, so that caution is required during intraabdominal surgery and also in appropriately interpreting the radiographs.

An unusual peritoneal fossa: anatomic report and clinical implications.

The peritoneal fossae are usually related to rotation and adhesion of the abdominal viscera to the posterior abdominal wall during fetal development, and/or the presence of retroperitoneal vessels running just under the peritoneum and raising serosal folds. These fossae, therefore, are regarded as congenital and have been considered clinically and surgically as sites of internal abdominal hernias. The authors describe a peritoneal fossa interposed between the fourth portion of the duodenum and the abdominal aorta. Due to a scoliosis of the lumbar column, the abdominal aorta had shifted to the left of the duodenum, stretching two semilunar avascular peritoneal folds connecting the vessel with the ascending duodenum. These two folds bounded above and below an entrance into a fossa lined by the posterior parietal peritoneum and bordered by the fourth portion of the duodenum on the right and the aorta on the left. This recess extended as far as the anterior surface of the second and third lumbar vertebrae. On the basis of the anatomic findings, the authors suggest that acquired fossae, because of their size and topography, may play a part in the etiopathogenesis of internal abdominal hernias.

[Anatomic and physiologic characteristics of the peritoneal cavity with reference to peritoneal dialysis]. / Anatomske i fizioloske osobine peritoneumske supljine od znacaja za peritoneumsku dijalizu.

Most common complications of peritoneal dialysis are those related to anatomic defect of the abdominal wall and peritoneum. The aim of this investigation was to examine the frequency of congenital and acquired wall defects in patients on CAPD treatment causing complications. Fifty patients, 32 women and 18 men, on CAPD treatment for more than two years, were investigated. Most common was a defect in the anterior-lateral abdominal wall predisposing to hernias in 14% of patients. Umbilical and pericatheteral hernias were more common than other, with a mean time of 21 months for the appearance. Persistence of vaginal process of peritoneum related to scrotal oedema was documented in 4% of patients. Communication of peritoneal cavity with the abdominal ostium of tuba uterina was found not to be an important factor for peritonitis.

Congenital testicular maldescent: significance of the complete hernial sac.

OBJECTIVE: To test the hypothesis that testicular maldescent is rarely congenital in the absence of a complete hernial sac. PATIENTS AND METHODS: The study comprised 110 boys undergoing orchidopexy. Operative findings (complete hernial sac versus no hernial sac) were compared with recorded testicular descent at birth. RESULTS: Among 70 testes recorded as maldescended neonatally there was no example without a complete hernial sac at orchidopexy. Among 60 recorded as descended neonatally, 43 had no sac at orchidopexy. CONCLUSIONS: The findings are consistent with the hypothesis, though not with the proposition, that the presence of a complete hernial sac at orchidopexy constitutes proof of congenital testicular maldescent.

[Increase in the number of operations for undescended testis]. / Wzrost liczby operacji niezstapionych jader.

In recent years the frequency of operations for cryptorchism has been increasing, as evidence by operation protocols of boys qualified for treatment and operated on by the same surgeon in certain years. The principles of qualification for surgical treatment was evaluated on the basis of testicle position during and after the operation, testicle size, presence of inguinal hernia sac or patent vaginal peritoneal processes. It was found that the increase in the number of these operations in the hospital was not due to changes of these principles. Possible causes of increased frequency of these operations are discussed.

Ileal band in northwest Indian subjects.

The incidence of the ileal band was recorded in 1,040 northwest Indian subjects varying in age from 1 day to 100 years on whom a medicolegal postmortem had been performed by the author. The band was present in 31.8% of male and 17.5% of female subjects (P less than .05) and was either quadrilateral (60%) or triangular in shape. In addition 25 foetuses, each above 250 mm in crown-rump length, 25 neonates, 25 monkeys (Macaca mulatta), and an equal number of dogs, rabbits, guinea pigs and rats were also dissected, but the band was found to be absent. In all the foetuses dissected and in 24 out of 25 newborns the caecum was found to be either in the subhepatic or right lumbar region. The earliest age at which the band was found was 7 months. As the band was absent in the animals and the newborns, it appears that it develops in man on account of attaining an erect posture.

The use of technetium-99m sulfur colloid in the detection of patent processus vaginalis in patients on continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) is commonly used in patients with renal failure as an alternative to hemodialysis. A not infrequent complication is scrotal swelling due to bowel or fluid passing through a patent processus vaginalis secondary to increased abdominal pressure. A radionuclide study using Tc-99m sulfur colloid is a safe and simple method to determine if this complication is present or may be used as a pre-CAPD screening procedure.