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Chapter 35: Abdominal Wall, Omentum, Mesentery, and Retroperitoneum

A cutaneous malignancy of the anterior abdominal wall 2 inches above the umbilicus will drain to which lymphatic basin?

A. Umbilical

B. Axillary

C. Retroperitoneal

D. Inguinal

Answer: B

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. (See Schwartz 10th ed., p. 1450.)

The appropriate treatment of rectus abdominis diastasis is

A. Observation

B. Resection and primary repair

C. Mesh overlay

D. Lateral component separation

Answer: A

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. (See Schwartz 10th ed., p. 1453.)

Persistence of the vitelline duct can lead to which of the following?

A. Colonic diverticulum

B. Urachal cyst

C. Umbilical cord hernia

D. Omphalomesenteric duct cyst

Answer: D

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. (See Schwartz 10th ed., p. 1453.)

The usual presentation of a rectus sheath hematoma is

A. Unexplained anemia

B. Abdominal wall bulge


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