Epiploic Foramen Research Articles

A simple intra-operative maneuver to decrease a duodenal ulcer hemorrhage temporarily: description and anatomical bases

Intraoperative hemostatic suture to treat a bleeding duodenal ulcer is sometimes difficult when there is massive hemorrhage. The aims of this paper are: (1) to describe a practical and easy intraoperative procedure which quickly decreases a massively bleeding duodenal ulcer, allowing the surgeon to identify the bleeding site clearly and obtain definitive hemostasis by suturing the involved vessels with a low risk of common bile duct lesion; and (2) to study in cadavers the anatomical basis of this surgical procedure already successfully performed on patients. Fourteen patients with massive duodenal ulcer bleeding, after unsuccessful endoscopic hemostasis, were operated on and included in this study. After surgical anterior gastroduodenotomy, the surgeon introduced a finger in a downward and forward direction in the bursa omentalis vestibule through the omental foramen. This simple and quick procedure decreased hemorrhage by compressing the gastroduodenal artery against the first part of the posterior surface of the duodenum. Twenty-four fresh blocks of normal tissue were removed from cadavers and were injected with silicone rubber through the common hepatic artery. The distance between the gastroduodenal artery and the omental foramen was measured. With this maneuver the surgeon can clearly see the exact bleeding site and perform an adequate suture with a minor risk of common bile duct lesion.

Retrospectoive Study the risk factors and prevalence of colic in horses after orthopaedic surgery

The records of 496 orthopaedic operations on 428 horses were reviewed to estimate the prevalence of, and identify the risk factors for, the development of colic in horses after surgery....

Abstract

Cribbing and entrapment of the small intestine in the epiploic foramen in 68 horses Archer, D., Freeman, D. E., Doyle, A. J., Proudman, C. J. & Edwards, G. B. (2004)...

Association between cribbing and entrapment of the small intestine in the epiploic foramen in horses: 68 cases (1991-2002).

To determine whether there was an association between a history of cribbing and epiploic foramen entrapment (EFE) of the small intestine in horses. Retrospective study. 68 horses examined at the University of Illinois or the University of Liverpool veterinary teaching hospitals. For horses examined at the University of Illinois that underwent surgery because of strangulating small intestine lesions, information about cribbing was obtained through telephone calls with owners. For horses examined at the University of Liverpool that underwent surgery for colic for any reason, information about cribbing was obtained through a preoperative questionnaire. 13 of 19 (68%) horses with EFE examined at the University of Illinois had a history of cribbing, compared with only 2 of 34 (6%) horses with other strangulating small intestine lesions (odds ratio, 34.7; 95% confidence interval, 6.2 to 194.6). Similarly, 24 of 49 (49%) horses with EFE examined at the University of Liverpool had a history of cribbing, compared with 72 of 687 (10.5%) horses with colic caused by other lesions (odds ratio, 8.2; 95% confidence interval, 4.5 to 15.1). Results suggest that there may be an association between cribbing and EFE in horses, with horses with a history of cribbing more likely to have EFE than horses without such a history.

Incarceration and impaction of a short segment of ileum into the epiploic foramen in a horse

Incarceration and impaction of a short segment of ileum into the epiploic foramen in a horse

Long-term survival of equine surgical colic cases. Part 1: patterns of mortality and morbidity.

Postoperative complications and mortality can occur many weeks or months after colic surgery. We are interested in the long-term outcome of these cases. This study documents patterns of mortality and morbidity among 341 horses that recovered from colic surgery March 1998-August 2000. The progress of each horse was rigorously followed by periodic telephone and postal questionnaires. Event time data were recorded for each animal and a total of 321 horse years of survival, together with death from all causes, colic-related death and various postoperative complications. Postoperative survival (of all horses excluding grass sickness cases) was triphasic over the first 600 days and there was marked mortality in the first 10 days postoperatively. The probability of survival postoperatively decreased to 0.87 by 10 days, 0.82 by 100 days and declined slowly to 0.75 at 600 days. Horses suffering from epiploic foramen entrapment had a significantly reduced probability of postoperative survival (RR = 2.1, P = 0.033). The causes of death for 104 horses that died postoperatively and the prevalence of postoperative complications are recorded for the study population. Postoperative colic was the most prevalent complication with 100 horses (29%) suffering one or more episodes. However, only 16 horses (4.6%) suffered 3 or more episodes. The incidence of postoperative colic was 0.55 episodes/horse year at risk. This study provides data that will inform the prognosis for postoperative colic cases and identifies epiploic foramen entrapment as carrying a worse prognosis for survival than other strangulating lesions.

Equine surgical colic: risk factors for postoperative complications.

The reason for undertaking this study was that postoperative complications of colic surgery lead to patient discomfort, prolonged hospitalisation and increased cost. Potential risk factors for the 6 most common postoperative complications (jugular thrombosis, ileus, re-laparotomy, wound suppuration, incisional herniation and colic) were evaluated using multivariable models. Jugular thrombosis was associated significantly with heart rate greater than 60 beats/min and with increased packed cell volume (PCV) at admission. The risk of postoperative ileus also increased with increasing PCV at admission and was higher in horses recovering from pedunculated lipoma obstruction. Incisional herniation was strongly associated with wound suppuration and with increasing heart rate at admission. The emergence of cardiovascular parameters as risk factors for several postoperative complications is consistent with the hypothesis that endotoxaemia is important in the development of these complications. Early referral of colic cases, prior to the development of severe endotoxaemic shock, may minimise the risk of some postoperative complications. Horses that have suffered epiploic foramen entrapment, are more than 4 times as likely to undergo re-laparotomy than other horses. Horses that have suffered postoperative ileus have a similarly increased risk of undergoing re-laparotomy. The risk of postoperative colic is significantly associated with horses recovering from large colon torsion (>360 degrees) and with having undergone re-laparotomy. Hazard ratios (with 95% confidence intervals) for these last two effects are 3.1 (1.7, 5.7) and 3.4 (1.9, 6.2), respectively. Knowledge of the risk factors for postoperative complications allows more accurate prognostication postoperatively and suggests ways in which the risk of postoperative complications can be minimised.

Long-term survival of equine surgical colic cases. Part 2: modelling postoperative survival.

Colic surgery is a frequently performed operation with high postoperative mortality. This study was undertaken to identify variables associated with decreased postoperative survival. We used data from 321 horse years of postoperative survival time to model the probability of survival following recovery from colic surgery. Continuous variables were modelled using a 6 variable, penalised Cox regression model. This demonstrated approximately linear relationships between survival and the following variables: increase in packed cell volume (PCV), intestinal resection length, time to surgery (interval between onset of colic and surgery) and duration of surgery. No significant decrease in survival was demonstrated with increasing age of the patient or with heart rate. The only categorical variable to be significantly associated with decreased survival was epiploic foramen entrapment. The final, fixed effects Cox proportional hazards model of postoperative survival included the variables epiploic foramen entrapment, PCV, resection length and duration of surgery, each variable adjusted for the nonlinear relationship with time to surgery. Residual variation in postoperative survival attributable to professional personnel (referring veterinary surgeon, anaesthetist and surgeon) was explored by fitting each as a random effects term in the model. Little of the residual variation could be attributed to any category of personnel. Model diagnostics indicated little influence by individual outliers on model parameters and little evidence of subjects poorly predicted by the final model. The study highlights factors influencing the long-term survival of horses recovering from colic surgery and proposes a model that can be used to inform prognosis.

Herniation of the Hepatic Flexure through the Foramen of Winslow: A Case Report

Herniation through the foramen of Winslow is among the rarest of internal hernias. Predisposing factors include an enlarged epiploic foramen, a mobile cecum and ascending colon, and an abnormal length of small bowel mesentery. Obstruction, strangulation, and perforation with associated metabolic and septic sequelae are the major complications associated with this disease. We report a case of herniation through the foramen of Winslow in which the diagnosis was established preoperatively.

Entrapment of large colon through the epiploic foramen in a horse

Entrapment of large colon through the epiploic foramen in a horse

Intraabdominal nonvascular operations combined with abdominal aortic aneurysm repair.

The therapeutic approach to a patient who has an abdominal aortic aneurysm (AAA) and an intraabdominal nonvascular surgical disorder simultaneously remains controversial. To establish guidelines for the management of those patients, a retrospective review of patients who had concomitant AAA and intraabdominal nonvascular surgical disorders was undertaken. During the period January 1988 to December 1997 a series of 162 patients underwent surgical repairs of AAA in our hospital. Among them 16 patients (9.9%) had several kinds of intraabdominal nonvascular surgical disorders, and 13 underwent one-stage operation for both diseases. That is, cholelithiasis coexisted in five patients, inguinal hernia in four, gastric cancer in two, and retroperitoneal tumor and renal tumor in one each. All AAAs were the infrarenal type, and there were no inflammatory or ruptured aneurysms. In cases of cholelithiasis coexistent with AAA, aneurysmectomy was performed first. After tight closure of the retroperitoneum, cholecystectomy was done. In cases of cholelithiasis coexistent with AAA, aneurysmectomy was performed first. After tight closure of the retroperitoneum, cholecystectomy was done. In cases of inguinal hernia coexistent with AAA, the AAA was first replaced with a prosthetic vascular graft and a residual piece of the graft was used as a patch for hernioplasty. This procedure was similar to laparoscopic hernioplasty. In two cases of gastric cancer concomitant with AAA, the AAA was first replaced. Subtotal gastrectomy with D2 lymphatic dissection was done after tight closure of the retroperitoneum. A drain was inserted into the epiploic foramen to detect anastomotic leakage. A retroperitoneal tumor coexisting with AAA was dissected and resected en bloc with the aneurysmal wall because the tumor firmly adhered to the aneurysm. The abdominal aorta was then replaced with a prosthetic graft. In a case of renal tumor concomitant with AAA, nephrectomy was done first to perform a complete lymphatic dissection around the renal artery. Then AAA repair was performed with a conventional procedure. There were no fatal complications, such as pneumonitis, hemorrhage, anastomotic leakage, or graft infection. All 13 patients were discharged from our hospital and are currently free from recurrence of malignancy or hernia. In summary, properly selected one-stage operations for intraabdominal nonvascular surgical disorders and AAA may be safe and bring physical and economic benefit to the patient.

Parietal hernia of the small intestine into the epiploic foramen of a horse

Parietal hernia of the small intestine into the epiploic foramen of a horse

A CASE OF WINSLOW FORAMEN HERNIA INCARCERATED IN THE ISTHMUS OF BURSA OMENTALIS

Winslow foramen hernia is an extremely rare disease of all entoceles. We report our recent experience with a case of Winslow foramen hernia. A 25-year-old woman was admitted to the hospital because of upper abdominal pain on August 6, 1995, and was kept under close medical observasion. Two days later the abdominal pain was intensified. An emergency operation was carried out with a diagnosis of strangulated ileus 39 hours after the onset of the symptom. Upon laparotomy the center of the small intestine passed through the Winslow foramen and was incarcerated into the isthmus of bursa omentalis. By incising a part of the isthmus of bursa omentalis, the strangulation was relieved. Enterectomy was not necessary because the circulation of the small intestine was improved after reduction. In this case, we could not diagnose before the operatrion. Looking back this case retrospectively, we think that we should be able to diagnose before the operation if we entertained the possible presence of Winslow foramen hernia. Preoperative abdominal CT and ultrasonography that visualized the intestine passing through posterior side of the hepatoduodenal ligament strongly suggested this disease.

Internal hernia. Report of nine cases

Internal abdominal hernias are rare and develop when one or more viscera protrude through an intraperitoneal orifice while remaining within the peritoneal cavity. This orifice may be normal (Winslow's foramen) or paranormal (peritoneal fossae); these hernias possess a sac and are true hernias. Protrusion may be through a pathologic hole, without a sac, realizing an internal prolapse or procidentia. The clinical diagnosis is always difficult and leads to an urgent operation for intestinal obstruction. The treatment is often simple and the results are generally excellent.

Laparoscopic anatomy of the equine abdomen

Abstract Laparoscopy was performed on 6 horses (2 mares, 2 geldings, 2 stallions) to determine the normal laparoscopic anatomy of the equine abdomen. After withholding feed for 36 hours, horses were examined from the left and right paralumbar fossae, and the visceral anatomic structures were recorded by videotape and photography. One mare developed emphysema located subcutaneously at the primary laparoscopic portal; otherwise, there were no complications. The anatomic structures of diagnostic importance that were observed in the left half of the abdomen were the hepatic duct; left lateral and quadrate lobes of the liver; stomach; spleen; left kidney with the associated nephrosplenic ligament; segments of jejunum, descending colon, and ascending colon; left side of the male and female reproductive tracts; urinary bladder; vaginal ring; and mesorchium. Important structures observed in the right side of the abdomen were portions of the common hepatic duct; left lateral, quadrate, and right lobes of the liver; caudate process of the liver; stomach; duodenum; right dorsal colon, epiploic foramen; omental bursa; right kidney; base of the cecum; segments of jejunum, descending colon, and ascending colon; urinary bladder; right half of the male and female reproductive tracts; and rectum.

A CASE OF WINSLOW FORAMEN HERNIA

Entocele represents only about 1% of all causes for ileus, and Winslow foramen hernia which represents about 8% of all entoceles is extremely rare. This paper presents a recent experience with such a rare case of Winslow foramen hernia with a review of the literature. A 43-year-old man was seen at the hospital because of abdominal pain. Abdominal plain X-ray film revealed small bowel air forming air-fluid level at a high location of inside portion of the lesser curvature of the stomach. Ileus was suspected and the patient was emergently admitted to the hospital. Abdominal CT visualized a intestine-like shadow with thickened wall incarcerating into the omental bursa from the dilated Winslow foramen. The patient was diagnosed as strangulated hernia due to Winslow foramen hernia. An emergency operation was carried out. Upon operation the ileum by about 30cm incarcerated into the omental bursa from the Winslow foamen and strangulated at 1m distant from the terminal ileum. Reduction of the ileus improved vascular disturbance, and hence excision of the intestine did not demanded. It has been said that the disease presents difficulty in preoperative diagnosis, but in this case abdominal CT greatly contributed to early diagnosis and early treatment.

Incarceration of the large colon through the epiploic foramen in a horse

Equine Veterinary JournalVolume 25, Issue 6 p. 550-551 Incarceration of the large colon through the epiploic foramen in a horse M. STEENHAUT, M. STEENHAUT Large Animal Surgical Clinic, Faculty of Veterinary Medicine, University of Ghent, Casinoplein 24, B-9000 Gent, Belgium.Search for more papers by this authorI. VANDENREYT, I. VANDENREYT Large Animal Surgical Clinic, Faculty of Veterinary Medicine, University of Ghent, Casinoplein 24, B-9000 Gent, Belgium.Search for more papers by this authorM. VAN ROY, M. VAN ROY Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, University of Ghent, Casinoplein 24, B-9000 Gent, Belgium.Search for more papers by this author M. STEENHAUT, M. STEENHAUT Large Animal Surgical Clinic, Faculty of Veterinary Medicine, University of Ghent, Casinoplein 24, B-9000 Gent, Belgium.Search for more papers by this authorI. VANDENREYT, I. VANDENREYT Large Animal Surgical Clinic, Faculty of Veterinary Medicine, University of Ghent, Casinoplein 24, B-9000 Gent, Belgium.Search for more papers by this authorM. VAN ROY, M. VAN ROY Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, University of Ghent, Casinoplein 24, B-9000 Gent, Belgium.Search for more papers by this author First published: November 1993 https://doi.org/10.1111/j.2042-3306.1993.tb03013.xCitations: 20AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume25, Issue6November 1993Pages 550-551 RelatedInformation

Transection of the pelvic flexure to reduce incarceration of the large colon through the epiploic foramen in a horse

Transection of the pelvic flexure to reduce incarceration of the large colon through the epiploic foramen in a horse

Laparoscopically Assisted Implantation of Ventriculoperitoneal Shunts

Laparoscopically-assisted minimally invasive procedures have been applied to a broad spectrum of abdominal interventions. Neurosurgeons performing ventriculoperitoneal shunt operations for hydrocephalus used to place the peritoneal catheter by performing an upper abdominal midline or subcostal incision. In this report, to reduce the patient's inconvenience caused by the laparotomy wound, three consecutive ventriculoperitoneal shunts were implanted, assisted by laparoscopy. By means of three incisions (one 10 mm supraumbilical for the camera and two 5 mm in the right hypochondric region for instrumentation) the peritoneal catheter was placed next to the epiploic foramen. After subcutaneous pull-through of the catheter to the right supraclavicular region, the operation was continued by the neurosurgeon. The postoperative course was uneventful in all cases. The patients were dismissed 3-7 days after surgery. Short time follow-up (212, 202, and 169 days after surgery) showed no complications and perfect function of the ventriculoperitoneal shunts.

Subacute colic caused by epiploic foramen incarceration of the small intestine in a horse

Equine Veterinary EducationVolume 3, Issue 1 p. 13-15 Subacute colic caused by epiploic foramen incarceration of the small intestine in a horse J. P. WALMSLEY, J. P. WALMSLEY The Equine Veterinary Hospital, Forest Mere, Liphook, Hants., GU30 7JG, UK.Search for more papers by this author J. P. WALMSLEY, J. P. WALMSLEY The Equine Veterinary Hospital, Forest Mere, Liphook, Hants., GU30 7JG, UK.Search for more papers by this author First published: March 1991 https://doi.org/10.1111/j.2042-3292.1991.tb01458.xCitations: 6AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume3, Issue1March 1991Pages 13-15 RelatedInformation