Objective: To investigate the clinical characteristics, diagnosis, treatment, outcomes and prognostic factors of abdominal wall endometriosis (AWE). Methods: A total of 265 AWE patients who underwent surgical treatment in The First Affiliated Hospital of Anhui Medical University from January 2010 to April 2023 were retrospectively selected, and 244 patients had complete follow-up data. According to different depth of lesions, the enrolled patients were divided into three types: type Ⅰ (subcutaneous fat layer, n=30), type Ⅱ (anterior sheath muscle layer, n=174) and type Ⅲ (peritoneum layer, n=40). The general clinical features, perioperative conditions, recurrent outcome and prognostic factors were analyzed in three types. Results: (1) Compared with type Ⅲ patients, the age of onset, parity and incidence of pelvic endometriosis were significantly decreased in type Ⅱ patients [(32.0±4.0) vs (30.0±4.6) years, 1.6±0.6 vs 1.4±0.5, 10.0% (4/40) vs 1.7% (3/174), respectively; all P<0.05], while the proportion of patients with transverse incision was significantly increased [37.5% (15/40) vs 67.3% (115/171); P<0.01]. The first symptoms of type Ⅰ and type Ⅱ were mainly palpable mass in the abdominal wall [73.3% (22/30), 63.2% (110/174), respectively], but the first symptom of type Ⅲ was pain in the abdominal wall [55.0% (22/40); all P<0.05]. (2) No matter the results of preoperative B-ultrasound or intraoperative exploration, the lesion diameters of type Ⅰ, type Ⅱ and type Ⅲ showed significant upward trends (all P<0.05). The proportions of lesion diameter≥3 cm in type Ⅱ and type Ⅲ [67.8% (118/174), 80.0% (32/40)] were significantly higher than that in type Ⅰ (all P<0.05). The median operation time and blood loss of type Ⅰ and Ⅱ were significantly lower than those of type Ⅲ (type Ⅰ vs type Ⅲ: 37.5 vs 50.0 minutes, 10 vs 20 ml, all P<0.05; type Ⅱ vs type Ⅲ: 35.0 vs 50.0 minutes, 10 vs 20 ml, all P<0.05). (3) The median follow-up time was 49 months, the overall symptom remission rate was 98.4% (240/244), and the recurrence rate was 7.0% (17/244). There were no significant differences in recurrence rate and recurrence free time among three types (all P>0.05). Multivariate regression analysis showed that the depth, number, diameter of lesions and postoperative adjuvant medication were not significant factors for postoperative recurrence (all P>0.05). Conclusions: The clinical manifestations of type Ⅲ are the most serious, including obvious abdominal pain symptoms, larger lesion diameter, prolonged operation time, increased intraoperative blood loss and increased incidence of pelvic endometriosis. Complete resection of lesions is an effective treatment for AWE, with high symptom remission rate and low recurrence rate. The depth, number, diameter of lesions and postoperative adjuvant medication are not risk factors for recurrence.
Pregnancy ; Female ; Humans ; Adult ; Endometriosis/surgery* ; Retrospective Studies ; Abdominal Wall/pathology* ; Risk Factors ; Abdominal Pain

OBJECTIVETo investigate the clinical manifestations and endoscopic features of abdominal type Henoch purpura in children and improve the diagnostic level.

METHODSRetrospective review was made on the clinical, endoscopic and histopathological features of 57 cases of children with Henoch purpura abdominal type who had been hospitalized from Jan. 2002 to May 2007. Upper gastrointestinal endoscopy was performed in all cases. All the cases had various digestive system symptoms without cutaneous purpura before endoscopy. Mucosal specimens were taken from sinus ventriculi and duodenum for histopathological analysis. Helicobacter pylori (H.pylori) infection was identified by rapid urease test and histology, and diagnosis of H.pylori infection was made when both were positive.

RESULTSThe common gastrointestinal symptoms of Henoch purpura were abdominal pain (46 cases), vomiting (32 cases), hematochezia (11 cases), diarrhea (4 cases) and abdominal distention (1 case). Three cases had arthralgia and joint swelling. The main laboratory findings were increased peripheral white blood cells (33 cases, 57.9%), 1/5 of cases had elevated C reactive protein (CRP), low serum albumin and seroperitoneum. Endoscopy demonstrated the damages to the mucosa, which varied from congestion, edema, petechia and ecchymosis (37 cases, 64.9%) to erosive and multiple ulcers (14 cases, 24.6%), granulation of mucosa in descendent duodenum (4 cases, 7.0%), and diffuse hemorrhage of mucosa (2 cases, 3.5%). The upper gastrointestinal endoscopy showed that the commonest and most serious position involved was the descendent duodenum (55 cases, 96.5%), followed by duodenal bulb (32 cases, 56.1%) and stomach (18 cases, 36.1%), esophagus was less involved (1 case, 1.8%). Histological manifestations showed swollen vascular endothelial cells of capillary vessels and small blood vessels, fibrotic necrosis of small vessels and bleeding, diffuse perivascular lymphocytic and neutrophilic infiltration and nuclear debris in mucosa and submucosa. Three cases (5.3%) were found infected with H. pylori. In 49 cases (86.0%) cutaneous purpura appeared 1 - 7 days after endoscopy. Eight cases had no cutaneous purpura until they left hospital. Two cases were lost to follow up and 6 cases (10.5%) remained free from cutaneous purpura were followed up until now (1 - 5 years).

CONCLUSIONDescending duodenum is the commonest and most serious position of upper gastrointestinal tract involved in Henoch purpura. Upper gastrointestinal endoscopy with the mucosal biopsy are useful for the early diagnosis of Henoch purpura.

Abdominal Pain ; pathology ; physiopathology ; Child ; Duodenum ; pathology ; physiopathology ; Endoscopy ; instrumentation ; Humans ; Purpura, Schoenlein-Henoch ; pathology ; physiopathology

The adverse effects of pain in post-surgery or trauma patients are well documented. A reliable, safe approach to achieving unilateral analgesia in multiple contiguous thoracic dermatomes would be of great benefit to anesthesiologists in acute pain setting following thoracic or upper abdominal surgery. The aim of this study of post-cholecystectomy pain was to compare two methods of postoperative analgesia with interpleural block and paravertebral block with bupivacaine. Thirty otherwise healthy patients who had undergone elective cholecystectomy through a subcostal incision were randomly allocated to two groups of fifteen patients each and given either interpleural block(group 1) or paravertebral block(group 2) with 20 ml 0.5% bupivacaine mixed with 1:200,000 epinephrine through a single catheter. The degree of analgesia was assessed by a verbal rating scale, Prince Henry pain score and a visual analogue scale(VAS 1-10 cm ; O=no pain, 10=worst pain). These pain scores and vital signs were assessed just before and 10, 20, 30, 60 and 120 minutes after injection of bupivacaine. The onset time of analgesia was similar in both groups(6.6+/-3.74 minutes in group 1 and 5.5+/-2.88 minutes in group 2), but the duration of analgesia was significantly longer in group 1(6.5+/-1.92 hours) than group 2(4.5+/-2.17 hours)(p<0.05). In both groups Prince Henry pain scores significantly decreased 10 minutes after injection of bupivacaine and VAS also significantly decreased 10 and 20 minutes after injection(p<0.05), but there was no significant difference between two groups. The systolic blood pressure decreased 10 minutes after the injection of bupivacaine in both groups(Group 1-3.7%, Group 2-6.5%) and the diastolic blood pressure decreased 10 minutes after the injection of bupivacaine only in group 1(2.5%), (p<0.05), however, these changes in arterial blood pressure were of minimal clinical significance. There is no complication in group 1, but 2 out of 15 patients in group 2 showed bilateral blockade without any serious hemodynamic derangement clinically. In conclusion, both techniques showed similarity in the onset and the degree of analgesia except the duration of analgesia, and presented only a few minor complications. Therefore, we feel that paravertebral block can be used in case that coexisting pulmonary or pleural pathology limits the use of interpleural block for post-cholecystectomy pain management. Furthermore, either of the two techniques may be used alternatively in management of thoracic or upper abdominal pain according to technical skill and preference of anesthesiologists.
Abdominal Pain ; Acute Pain ; Analgesia ; Arterial Pressure ; Blood Pressure ; Bupivacaine* ; Catheters ; Cholecystectomy* ; Epinephrine ; Hemodynamics ; Humans ; Pain Management ; Pathology ; Vital Signs

Abdominal Pain ; etiology ; Child ; Child, Preschool ; Female ; Humans ; Hyperplasia ; Lymph Nodes ; pathology ; Male ; Mesentery ; pathology ; Recurrence

PURPOSE: Nonparasitic hepatic cyst is being increasingly found due to the frequent application of diagnostic imaging. The treatment for nonparasitic hepatic cysts varies according to the nature of the lesion. Many authors have recently reported the benefit of performing laparoscopic unroofing for nonparasitic hepatic cyst. In this study, we reviewed the indications and the results of open surgery and laparoscopic unroofing for nonparasitic hepatic cyst. METHODS: From May 1992 until May 2005, 28 patients underwent an operation for nonparasitic hepatic cyst in our hospital. 12 patients had open surgery and 16 patients had laparoscopic unroofing. The indications and outcomes for open surgery and laparoscopic unroofing were compared. RESULTS: 25 patients were female and 3 patients were male, and the mean age was 59.7 (range: 35~80) years. Non- specific abdominal pain was the most common symptom in 74.4% (20/28) of the patients. The indications for open surgery included suspicious neoplastic cyst (3), hemorrhagic cyst (1), infected cysts (2), a huge cyst involving one lobe (1), cysts in segment 7 (2), and simple cysts that had been operated on before 1996 (2). Three suspicious neoplastic hepatic cysts turned out to be simple cysts on the pathology report. Laparoscopic unroofing was performed for 15 simple nonparasitic hepatic cysts and for one infected cyst. The mean hospital stay was 4.7 days (mean stay: 2~11) for the laparoscopic surgery patients compared to 16.2 days (mean tay: 7~38) for the open surgery patients (p< 0.0005). No morbidity or mortality was present in both groups. CONCLUSION: Laparoscopic unroofing for nonparasitic hepatic cyst is less invasive and it required a shorter hospital stay. Thus, laparoscopic unroofing is favored for the nonparasitic hepatic cyst unless it is complicated by neoplastic cysts.
Abdominal Pain ; Diagnostic Imaging ; Female ; Humans ; Laparoscopy ; Length of Stay ; Liver Diseases ; Male ; Mortality ; Pathology

Colonoscopic evaluation has revolutionized the management of colorectal disorders, of which colorectal neoplasia is the most important. Experience with 2000 consecutive colonoscopies was reviewed to determine their clinical significance. The symptoms that patients complained about were anal bleeding, abdominal pain, diarrhea, and constipation. Colonic polyps, colon cancer, and ulcerative colitis were diagnosed by colonoscopy. Colonic polyps were the most common pathology for anal bleeding and constipation. Ulcerative colitis was the most common pathology for diarrhea. Intestinal tuberculosis was the most common pathology for abdominal pain. Colon cancer was the most common pathology for tenesmus. Lymphoid hyperplasia was the most common pathology in patients under 10. Ulcerative colitis was the most common pathology in patients in their 3rd or 4th decade. Colonic polyp was the most common pathology in patients in their 5th, 6th, or 7th decade. Colon cancer was the most common pathology in patients in their of 8th or 9th decade. A colonoscopic polypectomy was performed in 49.5% of the colonoscopies, and an open polypectomy was done in 2.7%. There were no surgical complications from the colonoscopies. As a result of this study, it is concluded that total colonoscopic examination should be performed in patients over 40 who complain about rectal bleeding and tenesmus. To avoid complications and give proper management, it is recommended that colonoscopy be performed by a surgeon.
Abdominal Pain ; Colitis, Ulcerative ; Colonic Neoplasms ; Colonic Polyps ; Colonoscopy ; Constipation ; Diarrhea ; Hemorrhage ; Humans ; Hyperplasia ; Pathology ; Tuberculosis

We experienced a case of chronic fibrosing pancreatitis in an 18/12-year-old girl, which was idiopathic because there were no familial back ground, no cystic fibrosis of pancrease, no ductal anomalies and obstruction. The patient presented intermittent colicky abdominal pain and progressive obstructive jaundice, but T-tube drainage and removal of the lymph nodes around the common bile duct relieved her symptoms and disease process. This seems to be the first case reported in a Korean child. Idiopathic fibrosing pancreatitis should be considered in the differential diagnosis of abdominal pain with obstructive jaundice in children.
Abdominal Pain/complications ; Female ; Fibrosis ; Humans ; Infant ; Jaundice, Chronic Idiopathic/complications ; Pancreatitis/complications/*pathology

Actinomycosis, rare in pelvic localization and a severe condition not well known to gynecologists, is an uncommon entity caused by anaerobic bacteria, Actinomycosis israelii. After trauma, surgery, or other infections that alter the host's mucosal barriers, these organisms advance to invade surrounding tissue and organs. The pelvic loculation of the disease generally presents as a pseudoneoplastic formation, so it is very difficult to make an accurate diagnosis initially. We experienced a pelvic and abdominal actinomycosis confirmed by pathology in a woman who had been wearing an IUD and complained fever, chill, headache for one month, and lower abdominal pain and palpable mass. This case illustrates the importance of considering the possibility of actinomycosis when we met a vague abdominal mass.
Abdominal Pain ; Actinomycosis* ; Bacteria, Anaerobic ; Diagnosis ; Female ; Fever ; Headache ; Humans ; Intrauterine Devices* ; Pathology

Mesenteric panniculitis is a rare inflammatory condition of mesenteric adipose tissue in which the mesentery is replaced with fibrosis. The frequent symptoms of mesenteric panniculitis are palpable mass, abdominal pain and gastrointestinal obstructive symptoms. In the majority of cases, its course is self-limiting and the prognosis is favorable. 3 cases of mesenteric panniculitis are described that presented with obstructive symptoms of gastrointestinal tract, which occurred in 2 weeks following colectomy of colonic tumors. And reviewed the symptomatology, pathology, treatment, and outcome of this disorder.
Abdominal Pain ; Adipose Tissue ; Colectomy ; Colon ; Fibrosis ; Gastrointestinal Tract ; Mesentery ; Panniculitis, Peritoneal* ; Pathology ; Prognosis

Abdominal Pain ; etiology ; Child ; Child, Preschool ; Endoscopy, Gastrointestinal ; Female ; Humans ; Male ; Purpura, Schoenlein-Henoch ; complications ; pathology