SU28.{1-4,18} | Abdominal Wall and Peritoneal Conditions — Glossary

The accumulation of free fluid in the peritoneal cavity, detected by shifting dullness and fluid thrill.

Aspiration of ascitic fluid for analysis; a polymorphonuclear count of 250 cells/mm3 or more diagnoses spontaneous bacterial peritonitis.

Listening with a stethoscope for bowel sounds (normal, tinkling in obstruction, absent in ileus) and vascular bruits.

A bimanual technique in which a deeply placed organ such as the kidney is bounced between the examining hands.

The commonest type of mesenteric cyst, a thin-walled cyst of lymphatic origin containing clear or chylous fluid.

An opening in the transversalis fascia about 1.25 cm above the midpoint of the inguinal ligament where an indirect hernia enters the canal.

A bedside test occluding the deep inguinal ring after reduction; it controls an indirect hernia but not a direct one.

An acquired hernia bulging through Hesselbach's triangle medial to the inferior epigastric vessels, rarely entering the scrotum.

Surgical shelling out of a cyst or encapsulated lesion, used to remove a mesenteric cyst.

Visible and palpable expansion of a hernia on coughing, confirming its communication with the abdominal cavity.

A hernia through the femoral canal below and lateral to the pubic tubercle, commoner in women, with the highest risk of strangulation.

A sign of large, tense ascites: a flick on one flank transmits a palpable wave to the other, damped at the midline by an assistant's hand.

Diffuse inflammation of the whole peritoneal cavity, producing a board-like rigid abdomen.

Involuntary tensing of the abdominal wall muscles overlying inflamed peritoneum, a sign of peritonism.

The abnormal protrusion of a viscus, or part of a viscus, through a defect in the wall of the cavity that normally contains it.

The pouch of peritoneum that forms the hernia, comprising a mouth, neck, body and fundus.

The triangle bounded laterally by the inferior epigastric vessels, medially by rectus abdominis and inferiorly by the inguinal ligament — the site of a direct hernia.

Placement of a catheter into a collection under ultrasound or CT guidance; first-line treatment for most accessible intra-abdominal abscesses.

A hernia passing through the deep inguinal ring lateral to the inferior epigastric vessels, usually congenital, that can descend into the scrotum.

Vessels running medial to the deep inguinal ring; the landmark that separates an indirect (lateral) from a direct (medial) inguinal hernia.

The first step of abdominal examination: looking for contour, respiratory movement, scars, veins, peristalsis, swellings and hernias.

A localised, walled-off collection of pus within the peritoneal cavity, a complication of peritonitis presenting with a swinging fever.

A hernia whose contents cannot be returned to the abdomen but remain viable.

A soft-tissue sarcoma of smooth-muscle origin, the second commonest primary retroperitoneal malignancy.

The standard open tension-free repair of an inguinal hernia using a prosthetic mesh to buttress the posterior wall of the canal.

The commonest primary malignant retroperitoneal tumour, a soft-tissue sarcoma of fatty tissue origin.

A benign cystic lesion within the mesentery, most commonly chylolymphatic, treated by excision.

The double fold of peritoneum suspending the small bowel and carrying its vessels, lymphatics and nodes.

The division of the abdomen by two vertical mid-clavicular planes and two horizontal planes used to localise findings.

A hernia in which bowel within the sac is obstructed, causing intestinal obstruction.

Enlargement of an abdominal organ such as the liver, spleen or kidney, detected by palpation and percussion.

Feeling the abdomen, light then deep, to detect tenderness, guarding, rigidity, rebound, masses and organomegaly.

Reflex cessation of bowel motility with absent bowel sounds, accompanying peritonitis.

A collection of pus in the pelvis (pouch of Douglas), causing lower abdominal pain and a boggy mass on rectal examination.

Digital examination of the rectum that completes the abdominal examination, assessing for masses, tenderness, blood and pelvic collections.

Tapping the abdomen to map organ borders and distinguish resonant gas from dull solid organ, mass or fluid.

Thorough washing out of the peritoneal cavity at operation to remove contamination during source-control surgery.

The serous membrane lining the abdominal wall (parietal) and covering the viscera (visceral), enclosing the peritoneal cavity.

The combination of tenderness, guarding, rigidity and rebound indicating irritation of the parietal peritoneum.

Inflammation of the peritoneum lining the abdominal cavity, usually due to infection or chemical irritation from a leaking viscus.

Free gas within the peritoneal cavity, seen as air under the diaphragm on an erect chest X-ray, indicating a perforated hollow viscus.

Spontaneous bacterial peritonitis with no surgical source, usually monomicrobial, classically in cirrhotic ascites; treated with antibiotics alone.

The bony landmark separating an inguinal hernia (above and medial) from a femoral hernia (below and lateral).

Complete surgical removal of a tumour with microscopically clear margins; the main determinant of outcome in retroperitoneal sarcoma.

Pain on sudden release of palpating pressure, indicating parietal peritoneal irritation.

A hernia whose contents can be returned to the abdominal cavity.

The space behind the peritoneum containing the kidneys, ureters, adrenals, pancreas, duodenum, great vessels and lymphatics.

A tumour arising in the retroperitoneal space, mostly malignant (usually a soft-tissue sarcoma), presenting late as a fixed deep mass.

Sustained, board-like contraction of the abdominal muscles, characteristic of generalised peritonitis.

Tensing the abdominal muscles by head- or leg-raising: a parietal (wall) mass becomes more prominent, an intra-abdominal mass less palpable.

Peritonitis from perforation, ischaemia or leakage of a hollow viscus; usually polymicrobial and requiring surgical source control.

Circulatory failure from overwhelming infection, with hypotension and tissue hypoperfusion, a complication of severe peritonitis.

A sign of ascites: percussion dullness in the flank shifts when the patient is rolled, demonstrable with roughly 500 mL or more of fluid.

The surgical step of identifying and dealing with the cause of peritonitis plus peritoneal lavage; decisive in secondary peritonitis.

A palpable notch on the medial border of an enlarged spleen that helps distinguish it from a renal or other mass.

A hernia in which the blood supply to the contents is cut off, causing ischaemia and necrosis — a surgical emergency.

A collection of pus beneath the diaphragm, a classic site of intra-abdominal abscess, sometimes causing shoulder-tip pain and a pleural effusion.

A fever that spikes and falls, characteristic of a walled-off collection of pus such as an intra-abdominal abscess.

Totally extraperitoneal and transabdominal preperitoneal laparoscopic hernia repairs that place mesh behind the defect, favoured for bilateral or recurrent hernias.

Persistent or recurrent intra-abdominal infection after apparently adequate treatment, occurring in critically ill or immunocompromised patients.

The classic sign of a mesenteric cyst: the mass moves freely in the direction perpendicular to the line of the mesentery but not along it.

Non-operative observation, appropriate only for a minimally symptomatic, easily reducible inguinal hernia in a selected adult.

Removal of a tumour together with a margin of normal tissue and any involved adjacent organs, the principle of surgery for a retroperitoneal sarcoma.