Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.020
Filtrar
1.
J Med Case Rep ; 16(1): 444, 2022 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-36435796

RESUMO

BACKGROUND: Umbilical discharge in an adult is rare and generates broad diagnostic considerations. Umbilical anatomy is variable owing to congenital abnormalities and acquired pathology such as umbilical hernias. The umbilicus can be a site of primary or metastatic malignancy or endometriosis. CASE PRESENTATION: A 40-year-old white American woman came to the clinic with a 2-day history of spontaneous umbilical bleeding. She reported periumbilical pain associated with nausea and emesis. There were no visible skin abnormalities, but deep palpation of the abdomen produced a thin, watery, serosanguineous fluid from the umbilicus. She experienced a similar episode of umbilical bleeding 5 years prior without clear cause. Laboratory workup was notable for mildly elevated C-reactive protein . Computed tomography imaging revealed a fat-containing umbilical hernia with fat necrosis, necessitating complete surgical resection of the umbilicus. CONCLUSIONS: Umbilical hernia with fat necrosis is a rare condition that should be considered in adults with umbilical discharge. Additional diagnostic considerations in adults with spontaneous umbilical bleeding/discharge include embryonal remnants, omphalitis, and metastasis. If the cause is not readily apparent on physical exam, imaging with computed tomography should be considered to assess for hernia and embryonal anomalies.


Assuntos
Endometriose , Necrose Gordurosa , Hérnia Umbilical , Neoplasias , Dermatopatias , Adulto , Feminino , Humanos , Umbigo/patologia , Umbigo/cirurgia , Hérnia Umbilical/complicações , Hérnia Umbilical/diagnóstico por imagem , Hérnia Umbilical/cirurgia , Necrose Gordurosa/complicações , Necrose Gordurosa/patologia , Hemorragia Gastrointestinal/patologia , Endometriose/patologia , Dermatopatias/patologia
2.
Tidsskr Nor Laegeforen ; 142(13)2022 09 27.
Artigo em Norueguês | MEDLINE | ID: mdl-36164798

RESUMO

BACKGROUND: Endometriosis usually presents in the pelvic region, but extragenital endometriosis may occur in almost every other organ. Umbilical endometriosis represents 0.5-1.2 % of all cases of endometriosis, and can further be divided into primary and secondary presentation, occurring in women without and with umbilical scars, respectively. Common clinical presentation is periodic pain, swelling and bleeding. CASE PRESENTATION: A woman in her thirties without abdominal scars presented with a painful umbilical nodule with spontaneous periodic bleeding and swelling. MRI and fine needle aspiration cytology suggested umbilical endometriosis, and this diagnosis was confirmed histologically after surgical excision. INTERPRETATION: Umbilical endometriosis should be considered in cases of umbilical nodules with cyclic variation of symptoms. It is treated with simple surgical excision, and histopathology confirms the diagnosis. Approximately 20 % of patients also present with pelvic endometriosis, but diagnostic laparoscopy is only recommended if symptoms of pelvic endometriosis are also present.


Assuntos
Endometriose , Laparoscopia , Cicatriz , Endometriose/diagnóstico por imagem , Endometriose/cirurgia , Feminino , Hemorragia/cirurgia , Humanos , Umbigo/patologia , Umbigo/cirurgia
3.
J Nepal Health Res Counc ; 20(1): 173-179, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945872

RESUMO

BACKGROUND: Primary port placement is a critical step in any laparoscopic procedure. Although the safety and efficacy of open versus closed technique has been much debated, no particular technique is considered as the best. Therefore, over the period of time different methods have been developed and applied in order to perform laparoscopy procedures, Midat hospital has been using a version of modified trans-umbilical open technique for primary port entry from 2 decades and this study is being carried out to evaluate the technique. METHODS: Retrospective review was conducted. The patients who underwent laparoscopy surgery by modified trans-umbilical port placement at Midat hospital from June 2019- April 2020 were included in this study. RESULTS: A total of 100 cases were studied. Cholelithiasis was the main indication of surgery. The mean time recorded to establish pneumoperitoneum was 3.4±1.3 minutes. The rate of umbilical swab culture growth was 1%, pre-peritoneal port placements was 2%. Post-operative primary port site infection rate was 4%. No intra-abdominal injury was noted during the entry of primary port and there was no port site hematoma or recorded hernia over the period of one year. CONCLUSION: This technique of modified trans-umbilical primary port placement is one of the safest, fastest and easiest techniques to enter the peritoneal cavity.


Assuntos
Laparoscopia , Umbigo , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Nepal , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Umbigo/cirurgia
4.
Adv Skin Wound Care ; 35(8): 1-4, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35856614

RESUMO

OBJECTIVE: Pilonidal sinus disease (PSD) is a chronic inflammatory condition of skin that is thought to be related to implanted loose hair. Although PSD is most frequently seen in the sacrococcygeal region, it can also occur at the axilla, perineum, suprapubic regions, hands, and umbilicus. The aim of this project was to find factors influencing the development and treatment of umbilical PSD. METHODS: In this retrospective study, the authors evaluated 82 patients (19 women, 63 men) with a history of umbilical PSD between 2012 and 2020 to determine predisposing factors and treatment modalities. RESULTS: There was a 20% concordance with intergluteal PSD. Smoking was the only modifying factor for recurrence. The three different treatment methods studied (conservative treatment, surgical treatment, silver nitrate) did not differ in recurrence rate (P = .57). CONCLUSIONS: Because of its rare nature, umbilical PSD can be misdiagnosed or underdiagnosed. Key aspects of treatment include smoking cessation and a conservative approach.


Assuntos
Seio Pilonidal , Dermatopatias , Feminino , Humanos , Masculino , Seio Pilonidal/diagnóstico , Seio Pilonidal/cirurgia , Estudos Retrospectivos , Umbigo/cirurgia , Cicatrização
5.
Plast Reconstr Surg ; 150(3): 546e-556e, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35759631

RESUMO

BACKGROUND: A growing body of literature describes abdominal aesthetic goals to tailor surgical and nonsurgical treatment options to meet patient goals. The authors aimed to integrate layperson perceptions into the design of a novel professional aesthetic scale for the abdomen. METHODS: An iterative process of expert consensus was used to choose five domains: abdominal muscle lines, abdominal shape, scar, skin, and umbilicus. A survey was developed to measure global and domain-specific aesthetic preferences on five abdomens. This was distributed through Amazon Mechanical Turk to 340 respondents. Principal component analysis was used to integrate survey data into weights for each of the scale's subquestions. Attending plastic surgeons then rated abdomens using the final scale, and reliability and validity were calculated. RESULTS: The final scale included 11 subquestions-hourglass shape, bulges, hernia, infraumbilical skin, supraumbilical skin, umbilicus shape, umbilicus medialization position, umbilicus height position, semilunar lines, central midline depression, and scar-within the five domains. Central midline depression held the highest weight (16.1 percent) when correlated with global aesthetic rating, followed by semilunar lines (15.8 percent) and infraumbilical skin (11.8 percent). The final scale demonstrated strong validity (Pearson r = 0.99) and was rated as easy to use by seven attending plastic surgeons. CONCLUSIONS: The final scale is the first published professional aesthetic scale for the abdomen that aims to integrate layperson opinion. This analysis and survey data provide insights into the importance of 11 components in overall aesthetic appeal of the abdomen.


Assuntos
Parede Abdominal , Cicatriz , Abdome/cirurgia , Estética , Feminino , Humanos , Reprodutibilidade dos Testes , Umbigo/cirurgia
6.
BMC Gastroenterol ; 22(1): 216, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505286

RESUMO

BACKGROUND AND AIMS: Cholecystectomy is performed for most gallbladder polyps (GPs). However, cholecystectomy results concerning complications in some patients. For benign GPs, adoption of gallbladder-preserving surgery is worth to recommend. We describe our experiences performing gallbladder-preserving polypectomy for GPs by embryonic-natural orifice transumbilical endoscopic surgery (E-NOTES) with a gastric endoscopy. METHODS: This is a retrospective study of patients with GPs who underwent gallbladder-preserving polypectomy by E-NOTES with a gastric endoscopy from April 2018 to September 2019 in our hospital. The operative time, intraoperative hemorrhage, intraoperative and postoperative complications, gallbladder emptying function were obtained and analyzed. RESULTS: The procedure was performed successfully in all 12 patients with 5 cases of single polyp and 7 cases of multiple polyps. The range of GPs size was 2 mm to 15 mm. The mean operation time was (95.33 ± 23.08) minutes (55-135 min). There were no adverse events including heavy bleeding, mortality and conversion to open surgery during operation. All patients were discharged in 4-5 days after surgery without postoperative complications such as delayed bleeding, fever, peritonitis, intra-abdominal abscess and abdominal wall incisional hernia. All patients were followed up at 1, 3, 6, and 12 months postoperation who had almost no visible incision on the umbilical region, no recurrent GPs. The gallbladder emptying function decreased one month after surgery, and gradually improved 3, 6 and 12 months after surgery. CONCLUSION: E-NOTES gallbladder-preserving polypectomy is a safe and effective option for patients with GPs and is close to scar-free surgery which can be performed in routine clinical practice.


Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar , Pólipos , Colecistectomia Laparoscópica/métodos , Endoscopia Gastrointestinal , Doenças da Vesícula Biliar/cirurgia , Humanos , Pólipos/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Umbigo/cirurgia
7.
Medicine (Baltimore) ; 101(19): e29115, 2022 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-35583525

RESUMO

INTRODUCTION: Massive weight loss patients have a midline excess of abdominal adipose and skin tissue that contributes to an increased abdominal girth. This excess of tissue in these patients is not resolved with traditional techniques of abdominoplasty and usually the fleur-de-lis abdominoplasty technique is employed. PATIENT CONCERNS: A 22-year-old male patient came to our clinic after a massive weight loss of 170 kg, requesting an abdominoplasty for the excess adipose and skin tissue. DIAGNOSIS: Massive weight loss patient, with excess of adipose and skin tissue in the midline abdominal area. INTERVENTIONS: Fleur-de-lis abdominoplasty technique was employed for treatment of massive weight loss. OUTCOMES: During the surgery, it was decided that the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament needed to be ligated, to remove more tissue for better aesthetic result. The umbilicus survived on the collateral blood supply from ligamentum teres and superior epigastric collaterals. CONCLUSION/LESSONS: In this case report we review our experience treating a massive weight loss patient using a fleur-de-lis abdominoplasty technique without preserving the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament. We eventually relied on the collateral blood supply from ligamentum teres and superior epigastric collaterals, something that proved advantageous both in the survival of the umbilicus on the long run despite cutting off the main blood supply, and, the removal of further excess adipocutaneous tissue for a better aesthetic outcome.


Assuntos
Abdominoplastia , Umbigo , Abdominoplastia/métodos , Humanos , Masculino , Complicações Pós-Operatórias/cirurgia , Retalhos Cirúrgicos/cirurgia , Umbigo/cirurgia , Redução de Peso , Adulto Jovem
8.
Asian J Endosc Surg ; 15(3): 569-576, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35307970

RESUMO

INTRODUCTION: No standard procedure has been established for laparoendoscopic single-site surgery for urachal remnants (LESS-U). This study aimed to report the novel surgical techniques and initial outcomes of laparoendoscopic single-site surgery with an extraperitoneal approach through a suprapubic port for urachal remnants (spLESS). METHODS: Fifty-five patients (median age, 27 years; range, 15-69 years) who underwent LESS-U were analyzed. To overcome the limitations inherent in the conventional procedure (LESS-U through an umbilical port: uLESS), we modified the port placement and approached via the extraperitoneal space. spLESS is a novel procedure which reduces intestinal damage caused by the extraperitoneal approach and overcomes incomplete resection of the urachal remnant, especially in the bladder dome. Three trocars are inserted into the extraperitoneal space through a suprapubic port in spLESS, and complete resection of the urachal remnant from the umbilicus to the bladder is performed with an appropriate incision line. Patient characteristics and perioperative results were retrospectively collected. Cosmetic outcomes were prospectively evaluated using self-administered questionnaires (body image and photo-series questionnaire). RESULTS: spLESS and uLESS were performed in 43 and 12 patients, respectively. No differences were observed between the perioperative results. The cosmetic outcomes were compared between the groups using body image and photo-series questionnaires. No patient developed major complications; there was no recurrence in either group. CONCLUSIONS: spLESS is a novel procedure which can completely resect the urachal remnant and reduce the risk of intestinal damage. spLESS is a safe, effective, and feasible procedure with high postoperative cosmesis.


Assuntos
Laparoscopia , Úraco , Adulto , Humanos , Laparoscopia/métodos , Estudos Retrospectivos , Umbigo/cirurgia , Úraco/cirurgia , Bexiga Urinária
9.
Aesthetic Plast Surg ; 46(5): 2333-2341, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35169914

RESUMO

BACKGROUND: The umbilicus is crucial to the aesthetic appearance of the abdomen. With abdominoplasty and umbilicoplasty, placement of the umbilicus is essential and often left at the surgeon's discretion. This study aims to investigate the ideal male umbilical shape and location by examining photographs of top male models in 2019. METHODS: In this observational study, we examined 81 photographs of top male models to assess different ratios based on anatomical landmarks and umbilical appearance. RESULTS: The ratio of the distance from the xiphoid to the center of umbilicus (XU) and corresponding distance from center of umbilicus to abdominal crease (UC) had the most reliability (ratio XU/UC, with average measurement: 1.68 ± 0.38), which placed the male navel at a similar position but marginally below the average female umbilicus. Our findings revealed that an oval horizontal is the ideal umbilical shape in males, which differs from what is most aesthetically pleasing in females (oval vertical). In addition, we introduced the SHAPE (Shape, Hood, Adiposity, Protrusion & Position, External piercing) classification for navel appearance to better define the umbilicus and its direct management. CONCLUSIONS: This study establishes that the ideal male umbilicus differs from that of females; it should be placed at the XU/UC ratio of 1.68 ± 0.38 and aim for a horizontal shape with hooding (SHAPE: H II). The SHAPE classification facilitates a logical stepwise approach for the surgeon to refashion the umbilicus. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Abdominoplastia , Umbigo , Masculino , Feminino , Humanos , Umbigo/cirurgia , Reprodutibilidade dos Testes
11.
J Plast Reconstr Aesthet Surg ; 75(6): 1826-1832, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35172949

RESUMO

BACKGROUND: Umbilical complications can be relatively common after breast reconstruction with deep inferior epigastric perforator (DIEP) flaps. The medial umbilical ligaments and the ligamentum teres hepatis can be the sole blood supply to the umbilicus after a DIEP flap harvest. Prior incisions along the epigastric midline may disrupt the ligamentum teres hepatis. In this retrospective study, we assess the influence of previous midline epigastric scars on umbilical complications after DIEP flap harvest. METHODS: All patients who underwent breast reconstruction with DIEP flaps were identified at an academic institution over six years. Relevant sociodemographic and clinicopathologic factors were reviewed in the electronic medical records. Univariate and multivariate analyses were performed to determine the role of clinical variables to predict the chance of umbilical complications. RESULTS: A total of 243 patients met inclusion criteria, with 39 patients (16%) having prior surgery utilizing midline epigastric incisions. Twenty-one patients had umbilical complications. No significant difference in patient characteristics was found between patients with and without prior midline epigastric scars. Patients with a history of previous midline epigastric scars had a higher rate of umbilical complications (20.5% vs. 6.4%, p < 0.01). Bilateral medial row perforator-based DIEP flap harvest was also related to a higher rate of umbilical complications (18.4% vs. 6.2% p < 0.01). CONCLUSION: Previous midline epigastric scars are associated with higher rates of umbilical complications after DIEP flap harvest. Bilateral medial row perforator-based DIEP flap harvest exacerbates the rate of umbilical complications and should be avoided in patients with prior midline epigastric incision whenever possible.


Assuntos
Mamoplastia , Retalho Perfurante , Cicatriz/etiologia , Cicatriz/cirurgia , Artérias Epigástricas/cirurgia , Humanos , Mamoplastia/efeitos adversos , Retalho Perfurante/irrigação sanguínea , Estudos Retrospectivos , Umbigo/cirurgia
12.
J Laparoendosc Adv Surg Tech A ; 32(4): 432-437, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35119309

RESUMO

Background: The umbilicus is commonly used as an access site to perform minimally invasive colorectal surgery. Umbilical stomas are becoming an attractive option as an alternative site for temporary stomas since they reduce the need for additional abdominal incisions. Methods: We retrospectively evaluated patients who underwent umbilical stoma creation after colorectal resection for diagnosis of rectal cancer, diverticulitis, or ulcerative colitis between January 2020 and July 2021. Surgical technique, clinical and perioperative outcomes, complications, and cosmetic end results were described. Results: A total of 11 patients underwent umbilical stoma creation. There were no major surgical complications. Peristomal skin irritation was secondary to difficulties with the management of the pouching system. One patient presented with ostomy prolapse. Three patients experienced incisional hernia after stoma reversal. There were no wound infections. Conclusion: Umbilical stomas appear to be a safe alternative to conventional stomas and provide superior cosmetic outcomes.


Assuntos
Cirurgia Colorretal , Umbigo , Colostomia/efeitos adversos , Humanos , Ileostomia/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Umbigo/cirurgia
14.
J Laparoendosc Adv Surg Tech A ; 32(4): 448-451, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34990296

RESUMO

Background: The advent of laparoscopy has revolutionized surgery. The surgeon strives to minimize incisions and their adverse consequences. Although laparoscopy has gained widespread popularity, several advantages in open surgery are thereby lost. Tactile sensation of the tissue, hand-sewn anastomosis, and nonthermic vascular control are most prominent. To combine both approaches, single incision laparoscopic-assisted surgery (SILS) was advanced, trying to combine the best in both worlds. This approach is widely used in appendectomies. After having gained experience in this approach, we expanded the indications and hereby present our experience with bowel resections utilizing SILS. Patients and Methods: Data were collected retrospectively from operations performed during the past 3 years. We found 11 cases of SILS bowel resections: 3 sigmoidectomies, 3 small bowel atresia repairs, 1 subtotal colectomy, 1 Meckel's diverticulectomy, and 3 resections of bowel duplications. The age of the patients ranged from 2 days to 17 years. In all cases, a working 10 mm scope was inserted through the umbilicus, the bowel was extracted outside the abdomen through the umbilicus, dissection and resection with anastomosis were performed outside the abdomen in the classic open approach, and the bowel was returned to the abdomen. Results and Conclusions: All patients recovered promptly with no need for further intervention. There were no cases of wound infection, leak, or intra-abdominal abscess formation. Cosmesis was excellent with a small umbilical scar. We conclude that this approach is feasible and safe in a select population.


Assuntos
Colectomia , Laparoscopia , Abdome/cirurgia , Pré-Escolar , Colectomia/métodos , Humanos , Laparoscopia/métodos , Estudos Retrospectivos , Umbigo/cirurgia
15.
Anticancer Res ; 42(2): 1115-1121, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35093914

RESUMO

AIM: To evaluate the complication rates and risk factors associated with transumbilical incision (TUI) and comprehensively examine differences according to the procedures using propensity score matching. PATIENTS AND METHODS: The study involved 737 patients who underwent laparoscopic procedures between 2009 and 2017 (Japanese University-Hospital-Medical-Information-Network Clinical Trials Resistry No. 000040653). The occurrences of superficial surgical site infection (SSI) and TUI hernia were analyzed. RESULTS: SSI occurred in 17 patients (2.31%) and hernia occurred in 29 (3.93%). Multivariate analysis revealed that female sex and diabetes mellitus were correlated with incisional hernia. Propensity score-matching analysis was performed to compare those who underwent colorectal resection with those who underwent other resections; the results showed that the former had a significantly higher rate of TUI hernia (p<0.001), as well as a significantly higher incidence of SSI (p=0.004). CONCLUSION: A significant higher incidence of SSI and TUI hernia in laparoscopic colorectal resection was found. The construction of the TUI was feasible with rationality.


Assuntos
Neoplasias Colorretais/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Umbigo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Colectomia/efeitos adversos , Colectomia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Incidência , Hérnia Incisional/epidemiologia , Hérnia Incisional/etiologia , Japão/epidemiologia , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
18.
Med J Malaysia ; 77(1): 132-134, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-35087015

RESUMO

Dysmenorrhea is a common presentation in women of reproductive age in primary care. It can negatively affect the quality of life of a woman and restrict her daily activities. Endometriosis is the most common diagnosis for secondary dysmenorrhea. However, cutaneous endometriosis is an uncommon presentation of endometriosis. It requires a thorough history, physical examination and histological findings for definitive diagnosis. This paper reports an interesting case of a 47- year-old woman with primary cutaneous umbilical endometriosis and its management. Her final diagnosis was primary umbilical endometriosis with Stage 3 endometriosis based on the patient's history, clinical and surgical findings. The patient was discharged well on day three of operation and has been well since then with no signs of recurrence.


Assuntos
Endometriose , Dermatopatias , Endometriose/complicações , Endometriose/diagnóstico , Feminino , Hemorragia Gastrointestinal , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Dermatopatias/diagnóstico , Umbigo/patologia , Umbigo/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...