Epiploic Appendages Research Articles

Polypoid (Pedunculated) Subepicardial Lipoma: A Cardiac Lesion Resembling the Epiploic Appendage

This report describes a 75-year-old woman with an asymptomatic pedunculated lipoma involving the epicardium of the right atrium. The lipoma was an incidental finding at autopsy. The twisted lesion showed many similarities with the infarcted epiploic appendages observed in the visceral peritoneum.

Laparoscopic Omentectomy for Peritoneal Dialysis Catheter Flow Obstruction: A Case Report and Review of the Literature

Peritoneal dialysis catheter outflow dysfunction frequently is caused by omentum or epiploic appendices blocking the side holes of the catheter tubing. Laparoscopy has been utilized increasingly to remedy mechanical blockage of the peritoneal device. This obviates the need for catheter replacement, permits early return to dialysis, and lowers the patient dropout rate from peritoneal dialysis as a modality for renal replacement therapy. We report a case of laparoscopic subtotal omentectomy to successfully resolve recurrent catheter obstruction that failed previous omentolysis and omentopexy. Using four port sites, the omental resection was accomplished using the harmonic scalpel. The procedure was performed on an ambulatory basis, dialysis was resumed after 1 week, and there were no infectious complications or port site leaks. We define terminology to standardize reporting of omentectomy. Our technique of laparoscopic omentectomy is described and compared to those of previously published reports. The role of laparoscopic omentectomy relative to other commonly used laparoscopic approaches to the obstructed peritoneal dialysis catheter is reviewed.

A case report of vaginal injury with peritoneal perforation from a water-jet accident: the first report of treatment by laparoscopic operation

Objective To describe a unique case of vaginal injury with peritoneal perforation from a water-jet accident that was treated by laparoscopic assisted operation. Subject A woman was transferred to our unit with a vaginal laceration caused by impact of water flow to the perineum after falling off of the back seat of a Jet-ski. A part of the appendix epiploica was seen in the vagina. Interventions In this particular case, by using a laparoscope and washing and draining the pelvic cavity, it was confirmed by the surgeon that there was no intestinal injury despite part of the colon having entered the vagina. The perforated vaginal wound was sutured transvaginally while draining the abdominal cavity. Compared with what would have been the case with laparotomy, the patient's need for pain killers and her recovery time were greatly reduced. Conclusions Patients with vaginal lacerations are often encountered in the emergency room. In treatment it is necessary to stop the bleeding and prevent infection. In the case of vaginal perforation, it is also important to check for intestinal or pelvic injury. Usually, open surgery is performed for these reasons. However, the authors managed to treat the woman using a laparoscopically assisted approach, and therefore the treatment was minimally invasive.

Membranous fat necrosis in appendices epiploicae

Membranous fat necrosis (MFN) is a degenerative process involving mature systemic adipose tissue. It is characterised by the presence of membranocystic foci surrounded by a lipophagic fibro-inflammatory reaction typical of fat necrosis. Membranocystic foci are cysts lined by an eosinophilic membrane with pseudopapillary infoldings having the histochemical staining profile of ceroid. Although MFN is described in an increasing number of adipose tissue sites, it has not been described as a distinct entity in appendices epiploicae (AE). Macroscopically, MFN in AE mimics nodal tuberculosis or metastatic tumour with necrosis and cystic change. Ischaemia, which can be secondary to physiological or pathologic processes, is crucial in the pathogenesis of MFN in AE. Heightened awareness of MFN as a distinct entity in AE is essential for accurate diagnosis and establishment of the pathogenesis of this enigmatic pathological process.

A rare laparoscopic diagnosis in acute abdominal pain: torsion of epiploic appendix.

Torsion of an epiploic appendix is seldom diagnosed preoperatively because of the difficult differential diagnosis with other diseases causing acute abdominal pain, particularly appendicitis. The classic McBurney approach overlooks many infarcted epiploic appendixes. The use of diagnostic laparoscopy in acute abdominal pain can show an infarcted epiploic appendix to be at the origin of pain. Four patients were admitted for acute abdominal pain and moderate tenderness in lower quadrants and were operated on for suspected acute appendicitis. In all cases laparoscopy found the torsion of an epiploic appendix, which was resected, and a normal cecal appendix. Postoperative course was uneventful. In case of acute abdominal pain in the lower quadrants of suspected appendiceal origin, laparoscopy should be routinely performed not only in women but also in men to avoid overlooking other intraperitoneal diseases that can be the cause of symptoms.

Abdominal fat tissue necrosis as a cause of acute abdominal pain. Laparoscopic diagnosis and therapy.

Infarctions of the greater omentum and of the epiploic appendages are rare etiologies of acute abdominal pain. The aims of the study were to determine the incidence of abdominal fat tissue necroses and to discuss the clinical features and the role of laparoscopy in the treatment of these conditions. A retrospective study in 563 consecutive patients with acute abdominal pain was performed. In all patients diagnostic laparoscopy was indicated. The incidence of abdominal fat tissue necroses in 563 patients with acute abdominal pain was 1.1%. Six patients had either infarctions of the omentum or of the epiploic appendages. Pain was the predominant clinical symptom and the preoperative diagnosis depended upon the location of the omental or epiploic necroses. Diagnosis and treatment were performed laparoscopically without morbidity. The incidence of abdominal fat tissue necroses in our patients was increased compared to the prelaparoscopic period. Omental and epiploic necroses are significant in the differential diagnosis of appendicitis, acute cholecystitis, and diverticulitis.

Torsion of an epiploic appendage presenting as adnexal torsion in pregnancy

Torsion of an epiploic appendage presenting as adnexal torsion in pregnancy

Laparoscopic diagnosis and treatment of an infarcted epiploic appendage

A patient experienced acute abdominal pain that was diagnosed at laparoscopy as being due to an infarcted epiploic appendage. To our knowledge, this is the second report of laparoscopic diagnosis and treatment of an epipolic disorder. Infarcted epiploic appendages may be associated with bowel obstruction and abscess formation. Therefore, they should be looked for at the time of diagnostic laparoscopy for acute abdominal pain of unclear etiology, and removed if present.

Laparoscopic Diagnosis and Treatment of an Appendix Epiploica in Torsion

ABSTRACT Torsion of the appendix epiploica is a rare cause of acute abdominal pain. A 35-year-old woman came to the emergency room with acute abdominal pain, mild fever, and left lower quadrant abdominal tenderness with rebound signs. Pelvic ultrasound revealed a left ovarian cyst. Preoperative diagnosis was torsion of an ovarian cyst. Explorative laparoscopy revealed a functional ovarian cyst and a torted appendix epiploica of the rectosigmoid. The appendix epiploica was removed laparoscopically. A thorough bowel examination is recommended in every explorative laparoscopy. (J GYNECOL SURG 12:65, 1996)

TORSION OF THE APPENDICE EPIPLOICAE -A CASE REPORT-

We encountered a case of torsion of the appendice epiploicae, which was suspected of acute appendicitis preoperatively. A 30-year-old male was seen at the hospital for a right lower abdominal pain. a preoperative diagnosis of acute appendicitis was made and an emergency surgery was performed. At surgery, the appendix was normal but reddish appendice epiploicae 15 mm in diameter arising from the ascending colon was found, twisted tightly at the pedicle. The epiploicae and appendix were removed. The appendices epiploicae are peritoneal-encases, fat-filled, pedunculated structures along the entire length of the large bowel, with the exception of the lower rectum. Torsion of the appendice epiploicae may produce symptoms of peritoneal irritation severe enough to require surgery. On rare occasions, due to marked torsion of the pedicle, the peritoneal covering of the may become tightly drawn forming a web, any may present features of intestinal obstruction. Infarction of the appendices epiploicae may produce hemorrhage and inflammation with subsequent peritonitis, causing an acute abdomen. Therefore, every surgeon should be aware of this condition because lack of familiarity with its surgical pathology can lead to make an erroneous diagnose.

Torsion, Necrosis, and Inflammation of an Epiploic Appendix of the Large Bowel

We present the case of a young patient with abdominal pain of 3 weeks' duration and a preoperative presumptive diagnosis of acute appendicitis, diverticulitis, colon perforation, or possibly neoplasm. Even after resection of a large mass involving the right colon, the diagnosis was not confirmed until surgical pathology identified torsion, partial necrosis, and inflammation of an epiploic appendix of the right colon.

A CASE OF EPIPLOIC APPENDAGITIS MIMICKING ACUTE APPENDICITIS

Epiploic appendagitis is a rare inflammatory disease of the epiploic appendage and is thought to caused by impaired circulation due to volvulus of the epiploic appendage. Only 27 cases have been seen in the Japanese literature as far as we could review. Recently we experienced a case of epiploic appendagitis mimicking acute appendicitis. A 33-year-old man was admitted to the hospital because of right lower abdominal pain. Acute appendicitis was suspected from clinical symptoms and the patient underwent laparotomy. During surgery no evidence of acute appendicitis was found but a pedunculated epiploic appendage of the cecum with the size of tip of the thumb discoloring to black was revealed. It could be determined epiploic appendagitis of impaired circulation type due to volvulus. The lesion was removed. Histopathologically, the appendage showed marked congestion and slight bleeding with infiltration of inflammatory cells, suggesting the ischemic change. It is difficult to made distinction among acute appendicitis, diverticulitis and epiploic appendagitis before operation. In fact, no correct preoperative diagnosis has been made in the 27 cases of epiploic appendagitis reported in Japan. When we encounter a case of acute abdomen in which laparotomy findings do not coincide with clinical findings, we should bear a possibility of the disease in mind to explore the surrounding epiploic appendage.

Infarction of an Epiploic Appendage

Disease of the epiploic appendage remains a diagnostic challenge. We have seen a patient whose main preoperative findings were limited to an abnormal small bowel loop with thickened folds on a small bowel series, an association not previously reported, to our knowledge. We review the pertinent medical and radiological literature.

Endoscopic Removal of an Infarcted Appendix Epiploica

Infarction of an appendix epiploica is a rare event that is seldom diagnosed preoperatively. Report herein is a case of a 76-year-old male complaining of abdominal pain. The etiology of this pain was unclear but the diagnosis of epiploitis was preoperatively suspected. The infarcted epiploic appendix was identified and resected laparoscopically.

A Pseudolipoma on the Diaphragmatic Surface of the Liver in a Female B6C3F1 Mouse

A Pseudolipoma on the Diaphragmatic Surface of the Liver in a Female B6C3F1 Mouse

Sonographic Findings in an Infarcted Sigmoid Appendix Epiploica During Pregnancy

An infarcted sigmoid appendix epiploica in a pregnant patient with left lower quadrant pain was identified as a hypoechoic extrauterine mass on ultrasound examination. Ultrasound can help identify more common causes of pain in pregnancy, such as ectopic pregnancy, placental abruption, or degeneration of a leiomyoma. When these are excluded, rare causes of abdominal pain in the pregnant patient, including infarcted appendix epiploica, need to be considered.

Case report: Pericolic abscess secondary to torsion of an appendix epiploica

Torsion of the appendices epiploicae is a rare condition which may present with acute abdominal pain and mimic appendicitis. Untreated, peritonitis or intestinal obstruction may result. We present a case in which torsion of an appendix epiploica led to the development of a pericolic abscess communicating between the colon and lesser sac. To our knowledge these radiological findings have not been described previously.

A CASE OF SIGMOID PERFORATION TO THE EPIPLOIC APPENDAGE ASSOCIATED WITH RETROPERITONEAL GAS

An 81-year-old woman was admitted to the hospital because of abdominal fullness and melena. Endoscopic examination revealed a perforation of the sigmoid colon. Although abdominal X-ray film showed no free air, retroperitoneal gas was noticed besides intestinal gas. Perforation of the sigmoid colon was suspected, and emergency operation was performed. No abnormal exudate was seen, but retroperitoneal gas was confirmed. Because some volume of gas was noted in a part of epiploic appendage, the epiploic appendage was resected, when a perforation of the intestinal wall was confirmed which was primarily closed. Etiology of the perforation was unknown, but perforation of the diverticulum was suspected because another diverticulum was noted close to the lesion. Though perforation of diverticulum has often been reported so far, perforation into the epiploic appendage was rare.

A CLINICAL CASE OF EPIPLOIC APPENDAGITIS OF THE SIGMOID COLON

This paper presents an case of appendagitis of the sigmoid colon together with a review of the Japanese literature. A 55-year-old woman was admitted to the hospital because of a left lower abdominal mass. Laparotomy was performed under a diagnosis of abdominal mass of unknown origin. The tumor adhered to the peritoneum. Then the peritoneum was incised to free the tumor. Exploration revealed that the tumor originated from one of epiploic appendages on the sigmoid colon. The epiploic appendage was excised at the root and the tumor was exterpated. Pathologic examination revealed inflammation of the epiploic appendage infiltrated with numerous polymorphonuclear leucocytosis. The diagnosis was panniculitis. Epiploic appendagitis frequently occurs in middle-aged, especially fatty persons. This disease can be classified into two etiologic types, namely, impaired circulation and not-impaired circulation types. The former is thought to be caused by inflammation secondary to ischemic change due to torsion of the epiploic appendage. Preoperative diagnosis of this disease is very difficult and no case which was diagnosed preoperatively have been reported in Japan sG far. It is important to entertain a possible existence of this disease, when we encounter a patient complaining of abdominal pain and abdominal tumor.

Appendices epiploicae of the colon: radiologic and pathologic features.

Appendices epiploicae are adipose structures protruding from the serosal surface of the colon. They can be seen with abdominal radiography and cross-sectional imaging if the colonic wall is surrounded by intraperitoneal contrast material, ascites, or blood. Normal appendices epiploicae appear as lobulated masses of pericolic fat, usually 2-5 cm long and 1-2 cm thick. Their enlargement, deformity, or altered radiopacity may result from various pathologic processes that can originate locally or extend from adjacent viscera. In a series of 22 cases, appendices epiploicae were affected by spontaneous torsion and hemorrhagic infarct, calcification due to aseptic fat necrosis, primary or secondary inflammation, enlargement by lipomas or metastases, and incarceration in hernias. Disorders of appendices epiploicae are often manifested by nonspecific clinical signs and symptoms (eg, torsion is often mistaken for appendicitis or diverticulitis). These entities should be included in the differential diagnosis of any unexplained abdominal pain or pericolic lesions in adults.