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

Abdominal Wall/surgery* ; Adenocarcinoma, Clear Cell/surgery* ; Endometriosis/pathology* ; Humans

OBJECTIVETo evaluate the safety and feasibility of radical surgery for giant desmoid in abdominal wall accompanied with the repair of giant myofascial defect using synthetic prosthesis.

METHODSWe analyzed the clinical and follow-up data of 31 patients with giant desmoid in abdominal wall undergoing radical resection and immediate abdominal wall reconstruction with synthetic prosthesis from January 2007 to January 2017 retrospectively. Patients were recruited at the Diagnostic and Therapeutic Center of Hernia and Abdominal Wall Diseases, the First Affiliated Hospital of Chinese PLA General Hospital and the Department of General Surgery, Chinese PLA General Hospital. Operative conditions, morbidity of complication, short- and long-term outcomes were summarized. All the patients underwent radical resection and infiltrated organs or tissues were simultaneously treated. Synthetic prosthesis was used to perform primary-intention reconstruction of giant myofascial defect in anterior or lateral abdominal wall. Bridging repair procedure for incisional hernia was used to perform double border fixation between prosthesis border and myofascial defect border. Placement and fixation of prosthesis followed the idea of "conformal repair", then prosthesis was finally repaired as arch in accordance with original abdominal wall.

RESULTSOf 31 patients, 28 cases were female with mean age of 35.2 (16-58) years and 3 were male with mean age of 42.6 (20-79) years. Six initial cases (19.4%) were diagnosed by preoperative biopsy, and 25 recurrent cases (60.6%) were diagnosed by medical history. The mean minimal diameter of tumors was 18.2 (14-25) cm, and the mean maximal diameter was 45.3 (32-53) cm. All 31 patients underwent radical resection and immediate abdominal wall reconstruction using synthetic prosthesis in bridging fashion successfully, and rapid pathological examination showed that all resection margins were negative. The average operative time was 335 (245-610) min, and the average intra-operative blood loss was 1260 (500-3500) ml. The size of abdominal wall defect after removal of desmoid ranged from 21 cm × 23 cm to 35 cm × 60 cm. The defects in 29 patients were repaired with compound synthetic prosthesis and the defects in 2 patients were repaired with compound prosthesis and polypropylene mesh. Four patients(12.9%) developed postoperative infection, in whom 3 patients had prosthesis infection during 1 month postoperatively, then 1 case recovered with conservative therapy, the other 2 cases were healed after the removal of infected prosthesis at 2 weeks and 3 months postoperatively, respectively; 1 patient had infection of artificial vessel prosthesis and received a second operation to remove the infected artificial vessel. The other 27 patients recovered smoothly and got primary intention wound healing. These 31 patients were followed up for a median of 60.5 (10-121) months with complete data. No marginal recurrence, incisional hernia, and abdominal wall bulge happened. One patient undergoing removal of all anterior and lateral abdominal wall had difficult defecation and urination during the first month after operation, and recovered through practising chest breathing. Ten patients developed fresh desmoids in other body positions postoperatively within 1-3 years, in whom 3 patients died of intestinal obstruction due to rapid neoplasm development and 7 patients survived with tumor receiving conservative therapy. All the 28 survival patients could restore normal life and workand have appropriate sports.

CONCLUSIONRadical resection and immediate reconstruction of giant myofascial defect using synthetic prosthesis for patients with giant desmoid in abdominal wall is safe and effective.

Abdominal Wall ; pathology ; surgery ; Adolescent ; Adult ; Female ; Fibromatosis, Aggressive ; surgery ; Hernia ; Hernia, Ventral ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Surgical Mesh ; Treatment Outcome ; Young Adult

Actinomycosis is a chronic suppurative granulomatous infectious disease caused by actinomyces species that is characterized by formation of characteristic clumps called as sulfur granules. Abdominal actinomycosis is a rare disease and is often difficult to diagnose before operation. Abdominal actinomycosis infiltrating into the abdominal wall and adhering to the colon is even rarer. Most abdominal actinomycosis develops after operation, trauma or inflammatory bowel disease, and is also considered as an opportunistic infection in immunocompromised patient with underlying malignancy, diabetes mellitus, human immunodefidiency virus infection, etc. Actinomycosis is diagnosed based on histologic demonstration of sulfur granules in surgically resected specimen or pus, and treatment consists of long-term penicillin based antibiotics therapy with or without surgical resection. Herein, we report an unusual case of abdominal wall actinomycosis which developed in a patient after acupuncture and presented as abdominal wall mass that was first mistaken for abdominal wall invasion of diverticulum perforation.
Abdominal Wall/surgery ; Actinomycosis/*diagnosis/drug therapy/pathology ; Acupuncture ; Anti-Bacterial Agents/therapeutic use ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

Abdominal Wall ; Adult ; Female ; Follow-Up Studies ; Humans ; Melanoma ; pathology ; surgery ; Pregnancy ; Pregnancy Complications, Neoplastic ; pathology ; surgery ; Skin Neoplasms ; pathology ; surgery

OBJECTIVETo study the clinicopathologic features and differential diagnosis of myxoid dermafibrosarcoma protuberans (DFSP).

METHODSThe clinical and pathologic features of 16 cases of myxoid DFSP were reviewed.

RESULTSThere were altogether 15 males and 1 female. The age of the patients ranged from 11 to 73 years (mean = 47 years and median = 48 years). The commonest site of involvement was trunk (number = 11), followed by shoulder (number = 2), head and neck (number = 2), and extremity (number = 1). Similar to conventional DFSP, most patients presented with a slowly enlarging subcutaneous nodule which showed a rapid recent growth in some cases. Amongst the 16 cases studied, 12 occurred de novo and 4 represented local recurrence. The tumors ranged from 2 to 10 cm in greatest dimension (mean = 5 cm and median = 4 cm). Histologically, they were poorly circumscribed and located in the dermis, with focal infiltration into the underlying subcutaneous tissue. Seven cases were purely myxoid and composed of spindly and stellate cells with delicate arborizing vascular meshwork. The remaining 9 cases were predominantly myxoid (> 50%), with 5 cases containing cellular areas resembling conventional DFSP and 4 cases showing fibrosarcomatous transformation. In addition, foci of giant cell fibroblastoma-like areas were noted in 1 case. Immunohistochemical study showed that the tumors cells were positive for CD34. The staining was weak in the myxoid areas, as compared with conventional DFSP. Of the 4 recurrent cases, one patient developed lung metastases.

CONCLUSIONSMyxoid DFSP represents a rare variant of DFSP and may pose important diagnostic pitfalls. It is especially so if the tumor purely consists of myxoid element. Familiarity with the histologic features helps to avoid misdiagnosis.

Abdominal Wall ; Adolescent ; Adult ; Aged ; Antigens, CD34 ; metabolism ; Child ; Dermatofibrosarcoma ; diagnostic imaging ; immunology ; pathology ; surgery ; Diagnosis, Differential ; Female ; Head and Neck Neoplasms ; diagnostic imaging ; immunology ; pathology ; surgery ; Humans ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Radiography ; Shoulder ; Skin Neoplasms ; diagnostic imaging ; immunology ; pathology ; surgery ; Young Adult

Abdominal Wall ; pathology ; surgery ; Hernia, Abdominal ; etiology ; surgery ; Humans ; Models, Anatomic ; Postoperative Complications ; etiology ; surgery

Abdominal Neoplasms ; secondary ; surgery ; Abdominal Wall ; Antiporters ; metabolism ; Choriocarcinoma ; pathology ; Diagnosis, Differential ; Epithelioid Cells ; pathology ; Female ; Gestational Trophoblastic Disease ; metabolism ; pathology ; secondary ; surgery ; Humans ; Pregnancy ; Uterine Neoplasms ; metabolism ; pathology ; surgery ; Young Adult

We report a rare case of traumatic abdominal wall hernia (TAWH) caused by a traffic accident. A 47-year-old woman presented to the emergency room soon after a traffic accident. She complained of diffuse, dull abdominal pain and mild nausea. She had no history of prior abdominal surgery or hernia. We found a bulging mass on her right abdomen. Plain abdominal films demonstrated a protrusion of hollow viscus beyond the right paracolic fat plane. Computed tomography (CT) showed intestinal herniation through an abdominal wall defect into the subcutaneous space. She underwent an exploratory surgery, followed by a layer-by-layer interrupted closure of the wall defect using absorbable monofilament sutures without mesh and with no tension, despite the large size of the defect. Her postoperative course was uneventful.
Abdominal Injuries/complications ; Abdominal Wall/pathology/*surgery ; Female ; Hernia, Abdominal/etiology/radiography/*surgery ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

The increased use of interventional procedures and laparoscopic cholecystectomy in the management of hepatobiliary disorders is associated with an increased incidence of hemobilia and hepatic artery aneurysm. Here we report a case of hepatic artery pseudoaneurysm associated with a plastic biliary stent. Multiple factors were involved in the formation of the hepatic artery aneurysm (HAA) and it was successfully treated by embolization.
Aneurysm, False/etiology/*therapy ; Biliary Tract Surgical Procedures/adverse effects ; Embolization, Therapeutic/methods ; Female ; Hemobilia/etiology/therapy ; Hepatic Artery/*pathology/radiography ; Humans ; Middle Aged ; *Stents ; Abdominal Injuries/complications ; Abdominal Wall/pathology/*surgery ; Female ; Hernia, Abdominal/etiology/radiography/*surgery ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome