The finding of a heterogeneous tumor of laminated or whirled appearance associated with ascites with characteristics compatible with hemoperitoneum in an appropriate context must lead to a suspicion of the existence of a ruptured GIST.
Laparoscopic surgery for abdominal wall hernias improves short-term results as compared with open hernia surgery. However, no evidence exists to recommend this approach for pseudohernias, which are abdominal wall defects postsurgery caused by denervation and muscular atrophy. The purpose of this study is to analyze whether the laparoscopic approach benefits patients with a pseudohernia. A prospective nonrandomized, single-center clinical study was conducted of 24 patients operated on for pseudohernia. This study was designed with the basic principle of one unit, one surgeon, one mesh, and two techniques (laparoscopic or open double prosthetic repair). The primary end point was assessment of the abdominal wall according to: 1) abdominal perimeter; 2) computed tomography scan; and 3) degree of satisfaction. The secondary end points were intraoperative parameters and comorbidity. Laparoscopy offered no benefits in patients with pseudohernias. Open surgery offered no significant differences in intra- and postoperative morbidity, but if the initial weakness improved with a decrease in abdominal perimeter and visceral content, then there was more than 90 per cent satisfaction ( P < 0.05). The laparoscopic approach does not improve the bulge caused by abdominal muscle atrophy. The option of a muscular and prosthetic reconstruction provides better clinical and cosmetic results.
A 70-year-old female attended to our hospital complaining of a pain in the upper abdomen for the last two months that had worsened in the last 72 hours. The pain was accompanied with bilious vomits, chills and fever (38.9°C).The laboratory tests performed were normal except for the presence of leukocytosis (16,000/mm 3 ).The abdominal ultrasound (US) showed a well-defined lobulated hyperechoic with hypoechoic foci submucosal mass in the posterior wall of the gastric antrum that measured 6.5cm x 2.5cm (fig1a), but to our surprise, on US we also found a large (7 cm) rounded, predominantly liquid with internal echogenic areas, mass in the left lobe of the liver (fig 1b). The liver lesion evidenced a "honeycomb pattern" on Contrast-Enhanced US (CEUS), with non-enhancing necrotic areas and enhancing internal septae (fig1c).On Multiphasic Multidetector computer tomography (CT) the submucosal mass in the gastric antrum had fat density and liquid collections inside (fig 1d,e). The hepatic mass was heterogeneous but predominantly hypodense and had a perilesional hypodense area which showed progressive enhancement in the following phases due to hyperemic inflammatory effects on the adjacent liver.Subsequently, the patient was referred to the Digestive Department, where an endoscopy revealed a submucosal mass in the posterolateral wall of the gastric antrum with an ulcerated area on it surface. Finally, the pathological study of the gastric mass, which was surgically resected, revealed an abscessed submucosal gastric lipoma, and the microbiological study of the hepatic abscess, which was radiologically drainaged, revealed Gemella morbillorum.Gastric lipomas comprise 2-3% of the gastric benign tumors and are composed of mature fat cells surrounded by a fibrous capsule [1,2]. They are usually located in the gastric antrum, and present as solitary intramural le Fig 1. a) and b) Ultrasound images show well-defined lobulated submucosal mass in the gastric antrum (white asterisk in a) and a rounded predominantly liquid with internal echogenic areas mass in the liver (black arrow in b); c) CEUS images of the liver lesion with a "honeycomb pattern"; axial (d) and coronal projection (e) of contrast-enhanced multiphasic multidetector computer tomography images evidence the submucosal mass in the gastric antrum with liquid collections inside (whitearrows) and the hepatic mass (m).
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