A Tale of Scar. Again?!
My friend got this in his exam recently in London.
He was asked : what are the likely cause of this scar ?
Labels: Abdomen
posted by Wuchereria @ 9/26/2007 08:24:00 PM
Wednesday, September 26, 2007
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19 Comments:
liver transplantation as evidenced by presence of mercedes benz scar.
may be this is the scar of liver transplantation
Ok, but any other differential diagnosis ?
liver & renal transplant as evidenced by mercedes benz scar
Adrenalectomy scar?
could this scar be due to partial hepatectomy?
patient looks pigmented.may be hepatic transplantation was done for haemochromatosis.
bilateral adrenelectomy with Nelson's syndrome?
ok, any other causes ?
Primary Proliferative polycythemia with thromboembolic complication likes Budd chiari syndrome.....
Whipples procedure for Ca pancreas
Chevron (Roof Top) Modification of a standard Kochers incision :
The incision may be continued across the midline into a double Kocher incision or roof top
approach (Chevron Incision) which
provides excellent access to the upper abdomen; looks like a mercedes benz sign;particularly in those with a broad costal margin
This is useful in carrying out total gastrectomy, operations
for renovascular hypertension, total oesophagectomy, liver transplantation, extensive
hepatic resections, and bilateral adrenalectomy etc
This approach gives excellent access to the upper abdominal viscera and, in particular to all the diaphragmatic
hiatuses
liver transplant scar
so what's the answer?
Roof Top Scar of liver transplant
patient looks pigmented may be haemochromatosis I would look for arthropathy and artificial jts examine CVS and urine for sugar.The rooftop scar may be due to partial hepatectomy due to hepatocellular carcinoma or liver trnsplant
The Mercedes Benz Modification : Variant of this incision consists of bilateral low Kocher's incision with an upper midline limb up to and through the xiphisternum.
This gives excellent access to the upper abdominal viscera and, in particular to all the diaphragmatic hiatuses.
The rectus muscle can be divided transversely. Its anterior and posterior sheaths are closed without any serious weakening of the abdominal muscle
the incision passes between adjacent nerves without injuring them. The rectus muscle has a segmental nerve supply, so there is no risk of a transverse incision depriving the distal part of the rectus muscle of its innervation. Healing of the scar, in effect, simply results in the formation of a man made additional fibrous intersection in the muscle.
http://www.indmedica.com/journals.php?journalid=8&issueid=32&articleid=393&action=article
http://mrcppreview.blogspot.com/2008/06/scaragain.html
I had a patient with a mercedes-benz style scar in my PACES 2010/2,the patient was jaundiced, cachectic, tremulous, with spider naevi, tattoos & palmar erythema & he was itching like mad. However there was some tubing of some description in the patients LIF too which really threw me. Am now wondering if it was a PD catheter, although is it not a bit mad to put a PD catheter in a patient with the potential for decompensation, ascites formation & SBP. I wonder if I actually should have said what I thought?!
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