The liver is an essential organ that occupies the right upper quadrant of the abdomen. This structure is supported by the hepatic veins, which open into the inferior vena cava, as well as by intraabdominal pressure and peritoneal ligaments. The liver is covered by visceral peritoneum, which reflects onto adjacent viscerae and the abdominal wall as peritoneal ligaments. The falciform ligament is a bilayered, sickle-shaped fold of parietal peritoneum that extends from the anterior abdominal wall to the inferior border and anterior surface of the liver. This fibrous band serves as a crucial landmark during minimally invasive and laparoscopic abdominal procedures. This ligament may also be used as a patch or flap for reconstruction or repair of nearby structures. During surgery, the falciform may be seen drooping from the liver hilum. The structure attaches to the liver between the right and left lobes and to the inferior diaphragmatic surface. The ligament's free, inferior border contains the paraumbilical veins and the round ligament of the liver (ligamentum teres hepatis), which runs along a fissure between the inferior surfaces of the right and left lobes. To avoid confusion, the shorthand “round ligament” here refers specifically to the round ligament of the liver, not the round ligament of the uterus. The paraumbilical veins become more prominent and patent in portal hypertension, when the portal vein is engorged with blood that cannot fully enter the liver. If severe, these veins form a caput medusae—engorged vessels surrounding the umbilicus. Caput medusae is a hallmark of portal hypertension and advanced liver dysfunction, as seen in end-stage liver disease.

Rectal bleeding is a common presenting complaint in the emergency department (ED), most frequently due to benign conditions like hemorrhoids, anal fissures, and diverticulitis. Malignancies are a less common cause, with colorectal adenocarcinomas being more typical. Melanomas, malignant tumors of melanocytes, primarily occur on the skin but can arise in less visible sites, including mucosal surfaces and rarely as pelvic masses. We report a case of a 56-year-old female who presented to the ED with rectal bleeding. Initial examination did not reveal a mass, and a prior history of hemorrhoids led to an initial discharge without further workup. However, subsequent presentation with abdominal pain prompted further investigation, revealing significant leukocytosis and anemia. Imaging studies, including chest radiography and CT of the chest, abdomen, and pelvis, demonstrated multiple metastatic lesions in the lungs and liver, as well as a large retrorectal mass. Biopsies of a liver lesion and a rectal mass confirmed the diagnosis of metastatic melanoma. The patient was treated with immunotherapy but experienced clinical deterioration and ultimately elected for comfort measures, passing away approximately three months after the initial presentation, likely due to bowel obstruction secondary to the retrorectal melanoma. This report highlights the rare presentation of a stage IV retrorectal melanoma with initial rectal bleeding, emphasizing the importance of considering unusual malignancies in the differential diagnosis of this common symptom, particularly when initial assessments are non-diagnostic.

This study evaluates the clinical utility of transperineal 3D ultrasound in diagnosing pelvic floor dysfunction (PFD) and assessing uterine morphological changes in women. A total of 150 women with PFD and 100 healthy controls were examined. Measurements included anterior-posterior diameter, transverse diameter, and bladder neck and cervical mobility during Valsalva movement. No significant differences were found in demographic indicators between the groups. However, the observation group showed larger pelvic diaphragm fissures at rest, during tension, and anal contraction compared to controls, while anal levator muscle thickness was significantly lower. During Valsalva, bladder neck mobility and cervical descent were more pronounced in the PFD group, with statistically significant differences (p < 0.05). These findings indicate that transperineal 3D ultrasound provides an accurate, efficient, and detailed visualization of pelvic floor structures, aiding in diagnosis and treatment planning for PFD. The technique holds promise for broader clinical application.

In the surgical treatment of hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas, inadvertent damage to the nerves or muscles responsible for bowel control may potentially lead to varying degrees of fecal incontinence (FI). Surgeons need to conduct preoperative assessments based on the patient's individual condition to select an appropriate surgical plan, aiming to minimize the incidence of postoperative FI and improve the patient's postoperative quality of life as much as possible while effectively treating the disease. Additionally, the proficiency of the surgeon's skills, appropriate preoperative dietary adjustments for the patient, regular bowel habits, and exercises targeting the pelvic floor muscles all contribute to reducing the incidence of postoperative FI in patients. For patients who have already developed FI after surgery, on the basis of suitable diet, regular bowel habits, and medication, clinical practitioners can adopt such methods as biofeedback, pelvic floor muscle exercise, sacral nerve stimulation, percutaneous tibial nerve stimulation, acupuncture, injectable bulking agents, anal or vaginal inserts, transanal irrigation, surgical interventions, psychological support, etc., to individualized treatment for patients' conditions. This article, combining the literature, summarizes the current status of common diseases that may lead to postoperative FI. It elaborates on strategies for the prevention and treatment of postoperative FI, aiming to serve as a reference for peers in the field.

Levator ani syndrome (LAS), also known as levator ani spasm, puborectalis syndrome, chronic proctalgia, pyriformis syndrome and pelvic tension myalgia, produces chronic anal pain. The levator ani muscle is susceptible to the development of myofascial pain syndrome, and trigger points may be elicited on physical examination. The pathophysiology remains to be fully delineated. The diagnosis of LAS is suggested primarily by the clinical history, physical examination and the exclusion of organic disease that can produce recurrent or chronic proctalgia. Digital massage, sitz bath, electrogalvanic stimulation and biofeedback are the treatment modalities most frequently described in the literature. Pharmacological management includes non-steroidal anti-inflammatory medications, diazepam, amitriptyline, gabapentin and botulinum toxin. The evaluation of these patients can be challenging due to a diversity of causative factors. The authors present the case of a nulliparous woman in her mid-30s presenting with acute onset of lower abdominal and rectal pain radiating to her vagina. There was no history of trauma, inflammatory bowel disease, anal fissure or altered bowel habit. Each pain episode lasted longer than 20 min and was exacerbated by sitting. Neurological examination showed no evidence of neurological dysfunction. Rectal examination was unremarkable. During vaginal examination, palpation of the levator ani muscles elicited pain indicating pelvic floor dysfunction. Laboratory investigations including a full blood count and C reactive protein were within normal range. Further investigation with a transabdominal ultrasound scan, CT of the abdomen and pelvis and MRI of the lumbar spine were unremarkable. She commenced treatment with amitriptyline 20 mg once daily. She was referred for pelvic floor physiotherapy. Functional pain syndromes, such as LAS, should be regarded as diagnoses of exclusion and considered only after a thorough evaluation has been performed to rule out structural causes of pain. Knowledge of the pelvic floor and pelvic wall muscles may enable the physician to identify LAS, a possible cause of chronic pelvic pain.

This study was aimed at exploring the application value of ultrasound technology and rehabilitation training based on artificial intelligence algorithm in postpartum recovery of pelvic organ prolapse. Sixty patients diagnosed as mild and moderate pelvic organ prolapse by pelvic organ prolapse quantification evaluation were selected as the research objects. The patients were randomly divided into experimental group (30 cases) and control group (30 cases). The patients in the control group were given routine guidance and postpartum health education 42 days after delivery and given no pelvic floor rehabilitation training, waiting for natural recovery. 42 days after delivery, the patients in the experimental group received pelvic floor rehabilitation training based on the patients in the control group. All patients underwent ultrasonography, the convolution neural network (CNN) algorithm was used for image denoising and edge feature extraction, and the performance of the algorithm was evaluated by the Dice coefficient, positive predictive value, sensitivity, and Hausdorff distance. The thickness of levator ani muscle, anterior and posterior diameter of perineal hiatus, pelvic floor muscle strength, and imaging data were compared between the two groups. The results revealed that the thickness of levator ani muscle in the experimental group was significantly greater than that in the control group after one month and three months of treatment (0.633 ± 0.26 cm vs. 0.519 ± 0.234 cm, 0.7 ± 0.214 cm vs. 0.507 ± 0.168 cm, P < 0.05). After one month and three months of treatment, the anterior and posterior diameter of perineal fissure in the experimental group was obviously smaller than that in the control group (4.76 ± 0.513 cm vs. 5.002 ± 0.763 cm, 4.735 ± 0.614 cm vs. 4.987 ± 0.581 cm, P < 0.05). The pelvic floor muscle strength of the experimental group was remarkably higher than that of the control group after one month and three months of treatment (3.183 ± 1.47 vs. 2.41 ± 1.57, 3.365 ± 1.53 vs. 2.865 ± 1.69, P < 0.05). The ultrasonic image was clearer, the focus was more prominent, and the image quality was significantly improved after being processed by artificial intelligence algorithm. The Dice coefficient, positive predictive value, sensitivity, and Hausdorff distance of the proposed algorithm were better than those of the traditional algorithm. Thus, artificial intelligence algorithm had a good effect in ultrasonic image processing. Pelvic floor rehabilitation training had a good effect on postpartum nursing of patients with pelvic organ prolapse.

Anorectal and perineal pain Abstract. Anorectal pain is a common clinical challenge in the outpatient office. Anal fissures, anal venous thrombosis, proctitis or neoplasms are frequent etiologies for proctalgia. After exclusion of somatic disorders by diagnostic imaging and endoscopy, functional anorectal pain or pathologies like interstitial cystitits, chronic prostatitis, coccycodynia or pudendal neuralgia should be considered. The Rome IV criteria distinguish proctalgia fugax, a sharp paroxysmal pain lasting for maximum 30 minutes, and the levator ani syndrom. Latter is characterized by a tender puborectal muscle on digital rectal examination and pain lasting for more than 30 minutes. Treatment consists in reassurance, sitz bathes, topical vasodilators and anal massage. Biofeedback is a further option for levator ani syndrome. Painful palpation of the ox coccygis leads to the diagnosis of coccycodynia, a non-functional disorder. Therapy consists in anti-inflammatory medications, os coccygis mobilisation and infiltration therapy. Urologic chronic pelvic pain (chronic prostatitis and interstitial cystitis) as well as pudendal neuralgia, both neurogenic pelvic pain syndromes, can cause pain radiating into the after and perineum. The diagnosis and discrimination from functional rectal pain is difficult. Patients with neurogenic anorectal pain are best treated with anti-inflammatory medications, pain modulating antidepressives, anticonvulsives or local infiltration therapy. Interdisciplinary management of complex pain patients is mandatory.

To evaluate the mechanical properties of the tissues and muscles in the anal region with the shearwave elastography for anal fissure etiology.