A cutaneous malignancy of the anterior abdominal wall 2 inches above the umbilicus will drain to which lymphatic basin?
The lymphatic drainage of the anterior abdominal wall is principally to the axillary nodal basin and the inguinal nodal basin. The area of demarcation is roughly the arcuate line (semilunar line of Douglas) at the level of the anterior iliac spine.
The appropriate treatment of rectus abdominis diastasis is:
Rectus abdominis diastasis (or diastasis recti) is a separation of the two rectus abdominis muscular pillars. This results in a bulge of the abdominal wall that is sometimes mistaken for a ventral hernia despite the fact that the midline aponeurosis is intact and no hernia defect is present. Computed tomography ( CT) scanning can provide an accurate measure of the distance between the rectus pillars and will differentiate rectus diastasis from a true ventral hernia. Surgical correction has been described for cosmetic reasons but is unnecessary and risks the formation of a true postoperative hernia.
Persistence of the vitelline duct can lead to which of the following?
During the third trimester of pregnancy, the vitelline duct regresses. Persistence of the vitelline duct remnant on the ileal border results in a Meckel diverticulum. Complete failure of the vitelline duct to regress results in a vitelline duct fistula which is associated with drainage of small intestinal contents from the umbilicus. If both the intestinal and umbilical ends of the vitelline duct regress into fibrous cords, a central vitelline duct (omphalomesenteric duct) cyst may occur.
The usual presentation of a rectus sheath hematoma is:
Hemorrhage from the network of collateralizing vessels within the rectus sheath and muscles can result in a rectus sheath hematoma. Although a history of trauma may be present, a rectus sheath hematoma can follow vigorous coughing, sneezing, or extreme exertion. It typically occurs in elderly patients or those on anticoagulant therapy. Patients usually report the sudden onset of unilateral abdominal pain and have localized tenderness which is not accompanied by peritoneal signs.
A 40-year-old woman who underwent total abdominal colectomy for familial adenomatous polyposis (FAP) 5 years ago presents with a gradually expanding painless 4 cm mass of the anterior abdominal wall. A biopsy is returned as "desmoid tumor with no sign of malignancY:' The correct management is:
Desmoid tumors of the abdominal wall are fibrous neoplasms that occur sporadically or in the setting of familial adenomatous polyposis (FAP). The condition can result in mortality due to aggressive local growth, so radical excision with confirmation of tumor-free margins of resection is required. Medical treatment with an antineoplastic agent such as doxorubicin, dacarbazine, or carboplatin can produce remission but the prognosis of advanced desmoids is poor.
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