Management of a hepatic hydatid cyst ruptured into the retroperitoneum and the abdominal wall muscles: A case report

Introduction. Hydatid disease is a zoonosis caused by the tapeworm Echinococcus granulosus. The liver is the most commonly involved organ, followed by lungs. The most common complications of hepatic hydatid cyst are rupture into the biliary tract and secondary bacterial infection. However, rupture into the retroperitoneum and the abdominal wall muscles is exceptional. Case presentation. We describe an unusual case of a 27-year-old female who was referred to our department for right flank pain for four months. Abdominal ultrasound and CT scan revealed a huge hydatid cyst in liver segment VI fistulizing to the retroperitoneum and the lateral and posterior abdominal wall muscles, causing anterior displacement of the right kidney, with two other cysts in segment II and VIII. Surgery was performed associated with perioperative antiparasitic chemotherapy. The cysts were unroofed and a resection of the protruding domes was performed. The hydatid material in the retroperitoneum and the muscles were completely evacuated by aspiration. Follow-up showed no recurrence. Discussion. Hepatic hydatid cyst rupture usually occurs into biliary tract, pleural cavity, bronchial tree and intraperitoneal cavity. Rupture into the retroperitoneum and the lateral and posterior abdominal wall muscles is exceptional. To our knowledge, this complication has never been documented before. The hydatid disease may involve insidiously for a long time to lead to such a complication. Surgery was inevitable in our case. It allowed to treat both the hydatid cyst and its complication. Conclusions. A rupture into the retroperitoneum and the abdominal wall muscles as a complication of a liver hydatid cyst is exceptional. In this presentation, we noticed that hydatid cysts can reach an extremely large size while remaining for a long time asymptomatic. We aim to highlight the significance of preventive measures and public health education to fight against the hydatid disease in endemic areas.

Generalized form of thoracic vertebral bodies chronic hematogenous osteomyelitis

The article presents a clinical observation of thoracic vertebrae bodies chronic hematogenous osteomyelitis, which proceeded with the formation of right-sided pyothorax, an abscess of the retroperitoneal space, an external fistula through an anatomically weak place of the posterior abdominal wall, complicated by severe sepsis. Complex staged surgical debridement of purulent foci in combination with intensive drug therapy led to the patient's recovery.

Morphological Study of Psoas Minor Muscles with Embryological Basis and Clinical Insights

Introduction: The psoas group of muscles belongs to the posterior abdominal wall. The psoas minor is an inconstant, vestigial, fusiform, slender muscle. Researchers have frequently paid attention to the anatomy, morphology, frequency, of this muscle and its clinical, racial, ethnic correlation. Aim: To investigate and study the psoas minor muscle, with regard to its frequency, agenesis, origin, insertion, morphological variations, its embryological basis and clinical significance. Materials and Methods: The present observational study was conducted at Lady Hardinge Medical College, New Delhi, between December 2018 to May 2019 in the Department of Anatomy. Nine cadavers were studied during routine dissection of the posterior abdominal wall (three females and six males). The prevalence, morphology, morphometry, laterality, sexual dimorphism for psoas minor muscle was assessed. The mean, standard deviation and coefficient of variation of the morphometric parameters were also evaluated. Results: Psoas minor muscle was present in 55.55% (5/9) cadavers. The muscle was bilateral in 22.22% (2/9) cases and unilateral in 33.33% (3/9) cases. In all the cases, the muscle took origin from the T12-L1 vertebra and the intervertebral disc. However, the muscle showed a variation in its distal attachment in one of the cadavers. The muscle was unilateral in both the female cadavers and bilateral in two male cadavers. Conclusion: The prevalence was found to be 55.55%. Knowledge about the incidence of psoas minor muscle is of significant academic interest to anatomists as well as clinicians, for diagnostic purposes (particularly in abdominal pain) and during radiographic imaging.

Subcostal nerve injury after laparoscopic lipoma surgery: an unusual culprit for an unusual complication

Endoscopic surgery has revolutionized the field of minimally invasive surgery. Nerve injury after laparoscopic surgery is presumably rare, with only scarce reports in the literature; however, the use of these techniques for new purposes presents the opportunity for novel complications. The authors report a case of subcostal nerve injury after an anterior laparoscopic approach to a posterior abdominal wall lipoma.A 62-year-old woman presented with a left abdominal flank bulge (pseudohernia) that developed after laparoscopic posterior flank wall lipoma resection. Imaging demonstrated frank ballooning of the oblique muscles; denervation atrophy and thinning of the external oblique, internal oblique, and transverse abdominis muscles; and thinning of the rectus abdominis muscle. The patient underwent subcostal nerve repair and removal of a foreign plastic material from the laparoscopic procedure. At 8 months, she has regained substantial improvement in abdominal wall strength.Although endoscopic procedures have resulted in significant reduction in morbidity, “minimally invasive” approaches should not be confused with “low risk” when approaching novel pathology. The subcostal nerve is at risk of injury in posterior abdominal wall surgery, whether laparoscopic or not. With the pseudohernia and abdominal bulge after this surgery, the cosmetic appeal of laparoscopic incisions was definitively undone. Selecting an approach based on the anatomy of adjacent structures may lead to a better functional result.

The Impacts of Elastic Band Training on the Posterior Abdominal Wall Muscles of Olympic-Style Weightlifters

Purpose: In this study, it was aimed to examine the impacts of elastics band trainings, which were applied for 12 weeks on the Olympic-style weightlifters, on their sportive performances and psoas, ilacus, and quadratus lumborum muscle volumes.Materials and Methods: This research study was conducted on 4 groups, comprising of 12 men (elastic band training group (n=6), control group (n=6)), and 12 women (elastic band training group (n=6), control group (n=6)) Olympic-style weightlifters. The athletes in the elastic band training groups were engaged in standing hip flexion exercises, clamshell exercises, lying hip flexion exercises, and side bend exercises. Before and after the elastic band training applied to the Olympic-style weightlifters for 12 weeks, (1.5 Tesla) MRI device was used for the axial images of the regions starting from the 12th thoracic vertebrae to the trochanter minor of femur. The volume calculations of the muscles were conducted via the Cavalieri method.Results: After the elastic band training, it was determined that the total volume of posterior abdominal wall muscles of the men and women weightlifters in the elastic band training groups and the total weights lifted by them were higher compared to those of the control group individuals (p<0,001).Conclusion: As the result, it can be stated that including the posterior abdominal wall muscle developing trainings into the general programs of the weightlifters in the Olympic weightlifting sport can both enable an increase in the volumes of the muscles in this region and positively influence the performance of the athletes.