Umbilicus

OBJECTIVE: To provide a video tutorial describing intraperitoneal (IP) and intracoelomic (IC) therapeutics (IP/IC fluids, euthanasia, direct peritoneal resuscitation). ANIMALS: Dogs, cats, and exotic pets. METHODS: Peritoneal and coelomic centesis allows for delivery of fluids or to perform euthanasia. The peritoneal and coelomic membranes contain a vast network of capillaries and lymphatics that allow absorption of fluids and blood products...

We present a patient who developed an incisional hernia, from epigastrium to umbilicus, after omphalocele repair. The hernia gradually enlarged to a 10 cm × 10 cm defect with significant rectus abdominis muscle diastasis at the costal arch attachment point. At 6 years of age, the abdominal wall defect in the umbilical region was closed using the components separation technique. For the muscle defect of the epigastric region, composite flaps were made by suturing together the flap of the upper rectus abdominis muscle, after peeling it away from the costal arch attachment point, and the vertically inverted flap of the lower rectus abdominis fascia, created with a U-shaped incision...

PURPOSE: Understanding the vascular morphology is fundamental for resuscitative endovascular balloon occlusion of the aorta. This study aimed to evaluate the effect of aging on length and diameter of aorta and iliac arteries in trauma patients, and to investigate the predictiveness of anatomical landmarks for aortic zones. METHODS: A total of 235 patients in a regional trauma center registry from September 1, 2018, to January 3, 2024, participated in the study. Reconstruction of computed tomography was applied to the torso area...

INTRODUCTION: Combined ventral hernia repair and abdominoplasty treat risk factors such as high body mass index and weak abdominal musculature, providing excellent intraoperative exposure and improved patient outcomes. Unfortunately, a combination of traditional procedures is unfeasible as the umbilical blood supply would be compromised, leading to increased umbilical necrosis risk. This narrative review aimed to identify new techniques and solidify evidence in preserving umbilical blood supply and associated level of evidence...

INTRODUCTION: Spinal anesthesia is a widely used regional anesthesia technique for surgeries below the umbilicus, but postoperative analgesia is of major concern due to the relatively short duration of the local anesthetic. Various drugs were used as an additive to local anesthetic to prolong the duration of postoperative analgesia. This study aims to compare the efficacy of nalbuphine and fentanyl as an intrathecal additive along with local anesthetic. METHODOLOGY: A total of 166 patients aged between 18 and 65 years belonging to the American Society of Anesthesiologists (ASA) I and II undergoing elective infraumbilical surgeries were included in the prospective double-blind randomized controlled trial...

We report a case of term neonate presenting with purulent and foul-smelling discharge from the umbilicus, later investigated to have multiple non-drainable, sterile liver micro-abscesses. Conservative management was continued with intravenous antibiotics, after completion of a total of six weeks of antibiotics, all liver abscesses resolved and the baby was discharged.

This study aimed to assess the status of abdominal wall adhesions resulting from prior surgeries and their impact on the outcomes of robotic surgery. We retrospectively reviewed clinical information, surgical outcomes, and the status of abdominal wall adhesions in patients who underwent gynecologic robotic surgery at Yamanashi Central Hospital, between April 2018 and March 2023. Abdominal wall adhesions were classified into seven locations and their presence was assessed at each site. Among the 768 cases examined, 196 showed the presence of abdominal wall adhesions...

Clomiphene citrate is a common treatment for ovulation induction in subfertile women, but its use is associated with elevated risk of adverse perinatal outcomes and birth defects. To investigate the biological plausibility of a causal relationship, this study investigated in mice the consequences for fetal development and pregnancy outcome of peri-conception clomiphene citrate administration at doses approximating human exposures. A dose-dependent adverse effect of clomiphene citrate given twice in the 36 h after mating was seen, with a moderate dose of 0...

Endometriosis is a disease characterized by the implantation of endometrial-like tissue outside the uterine cavity. Common symptoms include cyclical pain, dysmenorrhea, dyspareunia, and infertility. Although endometriosis can spread to various extrauterine locations including the ovaries, fallopian tubes, and peritoneal surfaces, umbilical endometriosis is a rare manifestation of the disease. We report an intriguing clinical case of primary umbilical endometriosis in a 36-year-old female patient admitted to our department due to the notable manifestation of a painful swelling at the umbilicus, accompanied by cyclic episodes of bleeding...

BACKGROUND Endometriosis is a common cause of chronic pelvic pain among women globally. Pharmacological therapy for endometriosis includes non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives, while surgical therapy often involves either laparoscopic excision and ablation of endometriosis implants or open surgery. Surgical therapy is one of the mainstays of treatment especially for extrapelvic endometriomas. However, little guidance exists for the treatment of non-palpable or intermittently palpable lesions of this nature...

BACKGROUND: Robotic-assisted surgery is steadily becoming more prominent. The majority of reports regarding port site hernias (PSHs) have involved laparoscopic procedures. Currently, it is common to suture the fascia at port sites that are 10 mm or larger; however, the closure of 5-mm port sites is not considered mandatory. The da Vinci® surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) utilizes a distinctive 8-mm port. We report a case of an early-onset PSH at an 8-mm port site after robotic-assisted ileocecal resection...

Anisakiosis, also known as Anisakis larvae infestation, is an increasing parasitic infestation due to the worldwide spread of raw fish and shellfish consumption habits. We present a rare presentation of intestinal intussusception as a preoperative diagnosis and noticed it postoperatively due to Anisakis larvae. A 43-year-old man presented to the emergency department with abdominal pain around the umbilicus and vomiting for several hours. On physical examination at presentation, he had tenderness in the lower abdomen...

Background: Reduced-port robotic myomectomy (RPRM) using Da Vinci® Xi™ is a good fertility-saving surgical option, but the surgical and fertility outcomes are unknown. Methods: This was a retrospective cohort study evaluating the feasibility of RPRM in an academic tertiary hospital setting. A total of 401 patients who underwent RPRM by a single operator between October 2017 and October 2021 were included. For RPRM, three ports are required: a 1.5 cm umbilical incision and two 0.8 cm incisions 8 cm lateral to the umbilicus...

Background : The umbilicus is a fibrous remnant located in the centre of the abdomen. Various entities may be encountered in this special anatomical location; however, little is known about their dermoscopic presentation. The aim of this study was to provide a comprehensive summary of existing evidence on dermoscopic features of umbilical lesions. Methods : Studies assessing dermoscopic images of umbilical lesions were included in this study. No age, ethnicity or skin phototype restrictions were applied. Papers assessing lesions outside of the umbilical area, lacking dermoscopic images and/or dermoscopic description and not related to the topic were excluded...

BACKGROUND AND OBJECTIVES: Intrathecal baclofen (ITB) for severe spasticity can encounter complications such as wound dehiscence and ulcers because of elevated intracompartmental pressure within the abdominal subcutaneous and subfascial pocket housing the pump. We propose an innovative technique to manage ITB wound ulcers. METHODS: Resecting the umbilicus create a more spacious and less tension-prone pocket for the ITB pump. RESULTS: Between 2015 and 2023, we implanted ITB pumps in 65 patients...

STUDY OBJECTIVE: Investigating the effect of lumbar lordosis on the relationship between abdominal trocar entry points and major vascular structures. DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Distances between the skin and the aorta and inferior vena cava at the trocar entry points, both at the umbilicus and 3 cm and 5 cm superior to the umbilicus, were measured at entry angles of 90 and 45 degrees in 101 abdominal computer tomography images...

Primary umbilical neoplasms are exceptionally rare. Neurofibromas histologic findings vary from collagenous to myxoid matrix according to the neoplastic elements differentiation. We present a case of neurofibroma in the supraumbilical region undergoing cystic myxomatous degeneration. A 75-year-old female presented to the department with a complaint of swelling above the umbilicus for the last three years. The swelling was excised and grossly was a single, irregular, reddish-yellow cystic mass measuring 4.5 × 4 x 3 cm...

INTRODUCTION: Surgical intervention is the treatment of choice in patients with urachal carcinoma. Due to complications and to reduce hospital stay from open surgery, minimally invasive approaches are desirable. Nowadays, robotic-assisted surgery has become increasingly popular, and robot-assisted cystectomy can be performed in patients with urachal carcinoma with low complication rates. METHODS: We performed a systematic review to search for studies that evaluated patients who underwent robotic-assisted surgery for urachal carcinoma...

QUESTION: What is the effect of a 12-week abdominal and pelvic floor muscle exercise program during pregnancy on the inter-recti distance (IRD) in women with diastasis recti abdominis immediately after the 12-week intervention period and at follow-up 6 weeks postpartum? DESIGN: An exploratory, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Ninety-six pregnant women aged ≥ 18 years, either primigravida or multigravida, in gestation week 24 with an IRD of ≥ 28 mm measured at rest and/or a protrusion on initial assessment...

INTRODUCTION: Bezoars are a known cause of complications in Meckel's diverticulum. We present a case in which a bezoar in a Meckel's diverticulum resulted in intestinal obstruction. In addition, we conducted a narrative review to explore the association between Meckel's diverticulum and bezoars. CASE PRESENTATION: We present the case of a 22-year-old patient admitted for bowel obstruction persisting for three days and periumbilical tenderness. Abdominal CT tomography revealed a hyper dense circular structure with a diameter of 2 cm, small bowel distension of 41 mm, and free fluid...