It can also be present as an indirect  hernia , typically on the right side, where it is known as a " Hernia of  Littré ". A case report of strangulated  umbilical hernia  with Meckel's diverticulum has also been published in the literature. [ 23 ]  Furthermore, it can be attached to the umbilical region by the vitelline ligament, with the possibility of vitelline cysts, or even a patent vitelline canal forming a vitelline  fistula  when the umbilical cord is cut. Torsions of intestine around the intestinal stalk may also occur, leading to obstruction,  ischemia , and  necrosis .


A  technetium-99m  ( 99mTc )  pertechnetate  scan, also called Meckel scan or nuclear scintigraphy scan, is the investigation of choice to diagnose Meckel's diverticula in children. This scan detects  gastric mucosa ; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them, [ 24 ]  this is displayed as a spot on the scan distant from the stomach itself. In children, this scan is highly accurate and  noninvasive , with 95% specificity and 85% sensitivity; [ 17 ]  however, in adults the test is only 9% specific and 62% sensitive. [ 25 ]  This scan is more accurate in children because gastric mucosa is found in 90% of bleeding diverticula; which is the most common symptom in children, not adults.  [ 26 ]


Patients with these misplaced gastric cells may experience  peptic ulcers  as a consequence. Therefore, other tests such as  colonoscopy  and screenings for  bleeding disorders  should be performed, and  angiography  can assist in determining the location and severity of bleeding. Colonoscopy might be helpful to rule out other sources of bleeding but it is not used as an identification tool. [ citation needed ]


Angiography  might identify brisk bleeding in patients with Meckel's diverticulum. [ 17 ]


Ultrasonography  could demonstrate omphaloenteric duct remnants or cysts. [ 27 ]   Computed tomography  (CT scan) might be a useful tool to demonstrate a blind ended and inflamed structure in the mid-abdominal cavity, which is not an appendix. [ 17 ]


In asymptomatic patients, Meckel's diverticulum is often diagnosed as an incidental finding during  laparoscopy  or  laparotomy . [ citation needed ]


Treatment is surgical, potentially with a laparoscopic  resection . [ 17 ]  In patients with bleeding, strangulation of bowel, bowel perforation or  bowel obstruction , treatment involves surgical resection of both the Meckel's diverticulum itself along with the adjacent bowel segment, and this procedure is called a "small bowel resection". [ 17 ]  In patients without any of the aforementioned complications, treatment involves surgical resection of the Meckel's diverticulum only, and this procedure is called a simple  diverticulectomy . [ 17 ]


With regards to asymptomatic Meckel's diverticulum, some recommend that a search for Meckel's diverticulum should be conducted in every case of  appendectomy /laparotomy done for  acute abdomen , and if found, Meckel's diverticulectomy or resection should be performed to avoid secondary complications arising from it. [ 28 ]


Meckel's diverticulum occurs in about 2% of the population. [ 21 ]  Prevalence in males is 3–5 times higher than in females. [ 20 ]  Only 2% of cases are symptomatic, which usually presents among children at the age of 2. [ 8 ]


Most cases of Meckel's diverticulum are diagnosed when complications manifest or incidentally in unrelated conditions such as laparotomy, laparoscopy or contrast study of the small intestine. Classic presentation in adults includes intestinal obstruction and inflammation of the diverticulum (diverticulitis). Painless rectal bleeding most commonly occurs in toddlers. [ 5 ]


Inflammation in the ileal diverticulum has symptoms that mimic appendicitis, therefore its diagnosis is of clinical importance. Detailed knowledge of the pathophysiological properties is essential in dealing with the life-threatening complications of Meckel's diverticulum. [ 17 ]


In  human anatomy , the  omental foramen  ( epiploic foramen ,  foramen of Winslow  after the anatomist  Jacob B. Winslow , or uncommonly  aditus ;  Latin :  Foramen epiploicum ) is the passage of communication, or foramen, between the  greater sac , and the  lesser sac  of the  peritoneal cavity .


It has the following borders:


As the portal vein is the most posterior structure in the hepatoduodenal ligament, and the inferior vena cava lies under the posterior wall, the epiploic foramen can be remembered as lying between the two great veins of the abdomen.


This article incorporates text in the  public domain  from  page 1156  of the 20th edition of   Gray's Anatomy   (1918)


A  Paget's abscess , named by eminent British surgeon and pathologist Sir  James Paget , is an  abscess  that recurs at the site of a former abscess which had resolved. [ 1 ] [ 2 ]


This article about a  disease , disorder, or medical condition is a  stub . You can help Wikipedia by  expanding it .


Pelvic abscess  is a  collection of pus  in the  pelvis , typically occurring following lower abdominal  surgical procedures , or as a complication of  pelvic inflammatory disease  (PID),  appendicitis , or lower genital tract infections. [ 1 ]  Signs and symptoms include a high  fever , pelvic mass, vaginal bleeding or discharge, and lower  abdominal pain . [ 1 ]  It can lead to sepsis and death. [ 1 ]


Blood tests typically show a  raised white cell count . [ 1 ]  Other tests generally include  urine pregnancy test ,  blood  and  exudate culture , and  vaginal wet mount . [ 1 ]   Ultrasound ,  CT-scan  or  MRI  may be used to locate the abscess and assess its dimensions. [ 1 ]  Treatment is with  antibiotics  and drainage of the abscess; typically guided by  ultrasound  or  CT . [ 3 ]  Endoscopic ultrasound (EUS) is a minimally invasive alternative method. [ 3 ]


Signs and symptoms include a high  fever , pelvic mass, vaginal bleeding or discharge, and lower  abdominal pain . [ 1 ]  There may be urinary frequency,  diarrhoea , or persistent  feeling of needing to pass stool . [ 4 ]  Other symptoms may include fatigue, nausea, and vomiting. [ 2 ]  Clinical features might not be apparent until the pelvic abscess has grown in size. [ 2 ]  The lower abdomen is generally tender; one or both sides. [ 2 ]  A bulging of the front wall of the rectum might be felt on digital examination via the rectum or vagina. [ 2 ]


Complications include sepsis and  peritonitis . [ 1 ]  In the longterm, a  fistula  may develop. [ 2 ]


Pelvic abscess typically occurs following  gynecological surgery  and  abdominal surgery ; hysterectomy, laparotomy, caesarian section, and induced abortion. [ 1 ]   It may occur as a complication of  pelvic inflammatory disease  (PID),  appendicitis ,  diverticulitis ,  inflammatory bowel disease  (IBD), trauma, pelvic organ cancer, or lower genital tract infections. [ 1 ] [ 3 ]  The abscess may be in the  pouch of Douglas ,  fallopian tube ,  ovary , or  parametrium . [ 1 ]  It begins as inflammation or a  collection of blood  in the pelvis. [ 1 ]  Other risk factors include immunodeficiency, pregnancy,  hydrosalpinx ,  endometrioma , poorly controlled  diabetes ,  kidney disease ,  obesity , and genital tract abnormalities. [ 1 ] [ 2 ]  Opening the rectum to resect a  rectal cancer  may lead to developing a pelvic abscess. [ 3 ]


PID in females may lead to a  tubo-ovarian abscess , where the abscess may be in the  fallopian tube  or  ovary . [ 1 ] [ 2 ]


In children, it is more frequently associated with IBD and appendicitis. [ 5 ]


Blood tests typically show a  raised white cell count , often with a high  ESR  and  C-reactive protein . [ 1 ]  Other tests generally include  urine pregnancy test ,  blood  and  exudate culture , and  vaginal wet mount . [ 1 ]   Medical imaging  to assess the dimensions and locate the abscess may include  ultrasound ,  CT-scan  or  MRI . [ 1 ]


Other conditions that appear similar include  ectopic pregnancy , PID, appendicitis,  kidney stone ,  bowel obstruction , and sepsis following  miscarriage  or  termination of pregnancy . [ 1 ]


Treatment is with  antibiotics  and drainage of the abscess; typically guided by  ultrasound  or  CT ,  through the skin ,  via the rectum , or  transvaginal  routes. [ 3 ]  Occasionally antibiotics may be used without surgery; if the abscess is at a very stage and small. [ 2 ]  Until sensitivities are received, a broad spectrum antibiotic is generally required. [ 2 ]  Sometimes, a laparotomy of laparoscopy is required. [ 2 ]


Endoscopic ultrasound (EUS) is a minimally invasive alternative method. [ 3 ]  Treatment also includes  adequate hydration . [ 1 ]


Further surgery such as is sometimes required to treat the underlying cause; such as salpingo-oophorectomy for tubo-ovarian abscess. [ 2 ]


Pelvic abscess responds well to antibiotics and hydration. [ 1 ]  The outcome is less successful in the presence of fistula. [ 2 ]


It is uncommon. [ 2 ]  The incidence of pelvic abscess is less than 1% in an individual undergoing obstetric and gynecological operative procedure. [ 3 ]


A  retrograde appendicectomy  is a form of  surgery  to remove an  appendix  that is retrocaecal and adherent [ 1 ]  or otherwise inaccessible, so that the  appendicectomy  is performed in a retrograde fashion. [ 2 ]  In cases of acute appendicitis, antegrade appendicectomy is the preferred option, but in cases where the base of the appendix is accessible but is difficult to identify or deliver its more distal portion, a retrograde appendicectomy becomes necessary. [ 3 ]


Firstly, the base is divided between artery forceps then the appendiceal vessels are then ligated, the stump ligated and invaginated, and gentle traction on the caecum will enable the surgeon to deliver the body of the appendix, which is then removed from base to tip. [ 4 ]


In  general surgery , a  Roux-en-Y anastomosis , or  Roux-en-Y , is an end-to-side  surgical anastomosis  of  bowel  used to reconstruct the  gastrointestinal tract .  Typically, it is between  stomach  and small bowel that is  distal  (or further down the  gastrointestinal tract ) from the cut end. [ 1 ]


The name is derived from the  surgeon  who first described it ( César Roux ) [ 1 ]  and the  stick-figure  representation.  Diagrammatically , the Roux-en-Y anastomosis looks a little like the  letter   Y . [ citation needed ]


Typically, the two upper limbs of the Y represent (1) the  proximal  segment of stomach and the distal small bowel it joins with and (2) the blind end that is surgically divided off, and the lower part of the Y is formed by the  distal  small bowel beyond the anastomosis. [ citation needed ]


Roux-en-Ys are used in several operations and collectively called  Roux operations . [ 1 ]


When describing the surgery, the  Roux limb  is the  efferent  or antegrade limb that serves as the primary recipient of food after the surgery, while the  hepatobiliary  or  afferent  limb that anastomoses with the biliary system serves as the recipient for biliary secretions, which then travel through the excluded small bowel to the distal anastomosis at the mid jejunum to aid digestion. The altered anatomy can contribute to indigestion following surgery. [ 2 ]  The procedure has also been associated with an increased incidence of  iron-deficiency anemia . Iron-deficiency anemia develops in up to 45% of people who have had a Roux-en-Y anastomosis. [ 3 ]


Subphrenic abscess  is a disease characterized by an accumulation of infected fluid between the  diaphragm ,  liver , and  spleen . [ 2 ]   This  abscess  develops after surgical operations like  splenectomy .
Presents with cough, increased respiratory rate with shallow respiration, diminished or absent breath sounds, hiccups, dullness in percussion, tenderness over the 8th–11th ribs, fever, chills, anorexia and shoulder tip pain on the affected side. Lack of treatment or misdiagnosis could quickly lead to sepsis, septic shock, and death.
Patients who develop peritonitis may get localized abscesses in the right or left subphrenic space. The right side is more common due to the high frequency of ruptured appendices and perforated duodenal ulcers.
Two common approaches to draining a subphrenic abscess are 1) incision inferior to or through the bed of the 12th rib (no need to create an opening in the pleura or peritoneum) 2) an anterior subphrenic abscess is often drained through a subcostal incision located inferior and parallel to the right costal margin.  [ 3 ]  It is also associated with  peritonitis . [ 4 ]


This article related to  pathology  is a  stub . You can help Wikipedia by  expanding it .


This article about a medical condition affecting the respiratory system is a  stub . You can help Wikipedia by  expanding it .


A  tracheo-esophageal puncture  (or  tracheoesophageal puncture ) is a surgically created hole between the  trachea  (windpipe) and the  esophagus  (food pipe) in a person who has had a total  laryngectomy , a surgery where the  larynx  (voice box) is removed. The purpose of the puncture is to restore a person’s ability to speak after the vocal cords have been removed. This involves creation of a  fistula  between the trachea and the esophagus, puncturing the short segment of tissue or “common wall” that typically separates these two structures.  A voice prosthesis is inserted into this puncture. The prosthesis keeps food out of the trachea but lets air into the esophagus for  esophageal speech .


A laryngectomized person is required to breathe through a permanent breathing hole in the neck, called a  tracheostoma . When a laryngectomized person occludes the tracheostoma, completely blocking exhaled air to leave the body through that pathway, exhaled air is directed through the voice prosthesis. This air enters the esophagus and escapes through the mouth. During this process, as the air passes through the upper tissues of the esophagus and lower throat, it allows for vibration of the tissues of the pharyngo-esophageal segment (also called PE-segment, neoglottis or pseudoglottis). This vibration creates a sound that serves to replace the sound the  vocal cords  previously produced. Other methods of  alaryngeal speech  (speech without vocal cords) are esophageal speech, and  electrolaryngeal speech . Studies show that tracheo-esophageal speech is found to be closer to normal speech than esophageal speech [ 1 ] [ 2 ] [ 3 ]  and is often reported to be better, both in terms of naturalness as well as how well it is understood, when compared to esophageal speech [ 4 ] [ 5 ]   and electrolarynx speech. [ 6 ]
The first report on a tracheo-esophageal puncture dates back to 1932 [ 7 ]  when a laryngectomized patient was said to use a hot ice pick to create a tracheo-esophageal puncture in himself. This enabled him to speak by forcing air through the puncture when closing off the tracheostoma with a finger.


There are two tracheo-esophageal puncture procedure types: Primary and secondary puncture. Initially, the procedure was described as a secondary procedure [ 8 ]  and later also as a primary procedure. [ 9 ]


This procedure is performed during the total laryngectomy surgery. After removal of the larynx and creation of the tracheostoma, the puncture is made through the back wall of the trachea into the front wall of the esophagus. The main advantages of a primary puncture are: 1) that a second surgery to create the puncture is avoided (including the related costs and risks) and: 2) that the patient will be able to speak within a few weeks after total laryngectomy. [ 10 ] [ 11 ]


There are cases where a primary procedure cannot be performed. For example, this procedure cannot be used when there is complete separation of the tracheo-esophageal wall where the puncture would otherwise be placed (for example, in case a portion of the esophagus is removed requiring an anastomosis, or “reconnection” of structures in the region).  In that case, a sufficient period of recovery and wound healing would be required. A secondary puncture could then be placed. [ citation needed ]


This procedure refers to a puncture that is placed anytime after the total laryngectomy surgery. The decision to use a primary or secondary puncture can vary greatly. Secondary puncture can be performed when: 1) primary puncture was not possible, 2) for re-puncture after closure of a previous tracheo-esophageal puncture, 3) because of physician or patient preference, and 4) in case failure of esophageal or electrolarynx speech if this was chosen as the initial speech option. [ citation needed ]


There are two different methods that can be used to place the  voice prosthesis :
Primary placement: A voice prosthesis is placed into the puncture [ 12 ] [ 13 ]  immediately after it is created. During the immediate postoperative period, the patient is fed through a feeding tube, either inserted directly into the stomach or through a more temporary version than extends from the nose into the stomach. This tube is removed when the patient is able to eat enough by mouth to maintain nutritional needs; this can be as early as the second day following surgery. [ 11 ]  Speech production with the voice prosthesis is initiated when the surgical area has healed, after clearance by the surgeon. The advantages of this method are:
1) the voice prosthesis stabilizes the TE wall,
2) the flanges of the device protect the puncture against leakage of fluids, stomach acids and other stomach contents,
3) there is no irritation or pressure from a stenting catheter, used to maintain the puncture opening until a voice prosthesis can be placed,
4) patients become quickly familiar with their prosthesis care as they receive instructions while hospitalized,
5) the patient will not have to undergo an outpatient procedure during which the voice prosthesis needs to be fitted,
6) many patients can learn to speak before the start of any post-operative radiation therapy (if indicated)
7) the patient can focus on voice production immediately, as wound healing allows. [ 11 ]


Another advantage is that generally, the voice prosthesis placed at the time of surgery lasts relatively long and requires no early frequent replacements. [ 14 ] [ 15 ]  The only disadvantage is that the patient will need to use a feeding tube for a few days.


Delayed placement: Instead of the voice prosthesis, a catheter (red rubber, Silastic Foley catheter,  Ryle's tube ) is introduced through the puncture into esophagus. [ 10 ]  The tube is sometimes utilized for feeding the patient during the immediate post operative period, or the patient has a standard feeding tube for feeding. The voice prosthesis is placed after the patient is able to eat sufficiently by mouth and speech production is initiated when healing has completed, after clearance by the surgeon. The advantage of this method is that the patient may be fed through the catheter, not requiring standard tube feeding. The primary disadvantage is that the patient will have to undergo an outpatient procedure to have the voice prosthesis placed. Another disadvantage can be the need for more frequent replacements early after fitting of the voice prosthesis due to changes in the length of the puncture. [ 16 ]


Indications  include voice rehabilitation for patients who are undergoing a total laryngectomy (primary puncture) or patients who have had a total laryngectomy in the past (secondary puncture).
 Contra-indications  are mainly related to the use of the voice prosthesis and not the puncture procedure itself. It is important to have healthy tissue at the puncture site. This  will help ensure the voice prosthesis is properly supported. Poor tissue condition at the puncture site can be a contra-indication for TE puncture. It is also important that the patient candidacy be taken into account. Patients must be able to understand and manage proper prosthesis maintenance and monitor for complications or device problems. Bleeding disorders, anxiety disorders, dementia, poor vision and poor manual dexterity are all factors that may negatively interfere with successful voice restoration using tracheo-esophageal techniques and should be discussed further with an appropriate healthcare provider who is knowledgeable in this topic. [ citation needed ]