Greater Omentum Research Articles

Assessment of the prognostic significance of clinical and morphological factors on the survival of patients with locally advanced gastric cancer after radical surgical treatment: The experience of the Russian Center.

e16062 Background: Various staging systems are used to form a prognosis and determine an effective treatment strategy in patients with locally advanced gastric cancer (GC). Among these, the most widely used is the TNM UICC/AJCC staging system. However, even within the same stage, GC can vary significantly in terms of prognosis after surgery. The aim of our study was to assess the influence of clinical and pathomorphological biomarkers on the survival rate of patients with locally advanced GC after radical surgical treatment. Methods: For retrospective analysis, 124 patients were selected at the age from 29 to 86 years (mean age 65.69±10.09; 95% CI 63.90-67.49) with a diagnosis of stage I-III of GC who received only surgical treatment from 2015 to 2018. In 32 (26.1%) patients, the primary tumor was localized in the region of the cardioesophageal junction, in 61 (48.9%) - in the region of the stomach body, in 31 (25.0%) - in the pylorus. All patients underwent radical surgical treatment with subsequent staging of the disease according to the TNM system (6th edition), additional assessment of the lesion of the greater/lesser omentum. In 18 (14.5%) patients, stage IA was registered, in 10 (8.1%) - IB, in 23 (18.5%) - IIA, in 15 (12.1%) - IIB, 27 (21.8%) - IIIA, 26 (21.0%) - IIIB and 5 (4.0%) - IIIC. Results: We had a significant predictive value of the degree of metastatic lesions of the lesser and greater omentum (p <0.0001). The median OS in patients without omentum lesions at the time of assessment was not reached (follow-up period 42.0-54.0 months). The median OS in patients with only the greater omentum was 55.0 months (95% CI 6.5-55.0), which was 21.0 months higher than the median OS in patients with isolated lesions of the lesser omentum (24.0 months, 95% CI 19.0-57.0) and by 41.0 months exceeded the median OS of patients with combined lesions of the lesser and greater omentum (14.0 months, 95% CI 25.5-57). All factors that showed a significant effect on OS in the course of univariate analysis were included in the Cox proportional hazards model: the size of the primary tumor (T), the level of lesion of the regional lymphatic system (N), and the presence of lesions of the greater or lesser omentum. In general, the significance of the entire model was undeniable: p <0.0001. Significant prognostic influence was exerted by indicators characterizing the prevalence of the tumor process: T criterion (p=0.0090) and N criterion (p=0.0016). Conclusions: Despite the fact that, in multivariate analysis, the lesion of the greater and lesser omentum did not show a significant effect on OS in patients with locally advanced GC, this issue requires further study, since in the Cox model, the lesion of the lesser omentum, rather than the greater omentum, had a more favorable effect on the OS index. which allows you to increase RH by 12-60% (p=0.4046).

Greater-omentum lesion-score (GOLS) as a predictor of residual disease in different regions of the peritoneal cavity in patients undergoing interval cytoreductive surgery for advanced ovarian cancer and its potential clinical utility

Background and aimThe greater omentum(GO) is a common site of residual disease in patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer. The presence of tumor in the GO could predict presence of disease in other peritoneal regions. The goal of this study was to perform a correlation between the greater-omentum lesion-score(GOLS) and presence of disease in different peritoneal regions and determine its potential utility in guiding interval cytoreductive surgery(CRS). MethodsThis prospective study included 134 patients undergoing interval CRS from July 1, 2018 to June 30, 2020.Each region of Sugarbaker's Peritobneal Cancer Index(PCI) was given a lesion score(LS) from 0 to 3 according to the diameter of the largest tumor in the region. The GOLS was recorded separately from other structures in the region. Correlation between the GOLS and surgical and pathological LS in each region was performed. ResultsAs the GOLS increased, the incidence of disease(surgical LS) in other regions of the peritoneal cavity increased. Receiver operating characteristic(ROC) curves showed area under curve more than 80% for regions 1–2 and 7–8 indicating a high probability of disease in these regions in patients with GOLS 1–3. The positive predictive value(PPV) of preoperative imaging for GOLS was 95.7%. No cut-off of the GOLS could predict presence of disease on pathology with more than 70% accuracy. ConclusionsPresence of disease in the GO warrants performing upper abdominal exploration and/or cytoreduction and interval CRS should be planned accordingly in these patients. Imaging has a high PPV in detecting disease in the GO.

Ultrasound enhances the therapeutic potential of mesenchymal stem cells wrapped in greater omentum for aristolochic acid nephropathy

BackgroundMesenchymal stem cells (MSCs) have been reported to promote regeneration in both subjects with acute kidney injury (AKI) and chronic kidney disease (CKD), but their efficacy remains limited, probably because most of the cells accumulate in the lungs, liver, and spleen after an intravenous infusion. Therefore, ultrasound-guided administration of MSCs represents a possible approach to solve this problem. The greater omentum is used to promote cell survival due to its rich vasculature. We hypothesized that ultrasound-guided administration of MSCs combined with greater omentum might be more curative than currently available approaches.MethodsIn this study, we established an aristolochic acid nephropathy (AAN) model by intraperitoneally administering aristolochic acid I sodium salt (AA-I) at a dose of 5 mg/kg body weight on alternate days for 4 weeks. Subsequently, a laparotomy was performed, and the left kidney from which the capsule had been removed was wrapped with the greater omentum. A dose of 2 × 107 MSCs was injected into the space between the greater omentum and the left kidney. Equal amounts of MSCs were administered under ultrasound guidance every second week for a total of 4 treatments. Mice were sacrificed 4 weeks after surgery. Serum creatinine and blood urea levels were measured to assess renal function. qPCR, Western blot, and histological analyses were conducted to further investigate the therapeutic mechanism of MSCs.ResultsUltrasound-guided injection of MSCs into the greater omentum that surrounds the kidney enriched cells in the kidney region for up to 5 days. Renal function tests indicated that MSCs improved renal function to a great extent, as reflected by decreased blood urea nitrogen and serum creatinine levels. In addition, histological analyses showed that MSCs noticeably attenuated kidney injury, as evidenced by the amelioration of tubular necrosis and peritubular interstitial fibrosis. Mitigation of renal interstitial fibrosis was further confirmed by immunohistochemistry, qPCR, and western blotting after MSC treatment. Moreover, immunofluorescence staining revealed that MSCs alleviated inflammatory responses by increasing the counts of CD206+ cells and decreasing the counts of CD68+ cells. MSC migration was initiated in response to AA-I-treated renal epithelial cells in an in vitro migration assay.ConclusionsThese findings suggested that administration of MSCs into the cavity formed by the injured kidney and the greater omentum under ultrasound guidance improved renal function, attenuated kidney injury, and mitigated renal interstitial fibrosis and inflammatory responses. Thus, this approach might be a safe and effective therapy for CKD.

Infrahepatic Implantation of an Ectopic Pregnancy

Background: Ectopic pregnancies occur predominantly in the fallopian tubes or ovaries. Very rarely, the distal part of the greater omentum may have close contact to the fallopian tubes and implantation of the embryo may occur in this part of the greater omentum. In the absence of signs of pregnancy in the uterus or the fallopian tubes, the greater omentum has to be closely examined for ectopic pregnancy. Case Presentation: A 22-year-old woman in her 4th week of pregnancy presents with spotting and severe pain in the right lower abdomen with a history of 2 cesarean sections. The sonographic examination showed a normal uterus with a thin endometrial line. The uterine cavity did not present with any signs of a gestational sac. A great amount of free fluid in the Douglas cavity suspicious of a hemoperitoneum. ßhCG-values in serum was highly elevated up to 16749 mU/ml and confirmed the suspicion of an ectopic pregnancy. A diagnostic laparoscopy was performed, during which a blood clot reaching from the right lower abdomen to the greater omentum was detected. After removing the blood clot, a normal-sized uterus with regular ovaries and no signs of a pregnancy in the fallopian tubes were seen. However, an abdominal adhesion in the right upper part of the omentum close to the liver with bleeding was seen. While examining the abdominal cavity for the cause of bleeding, a small cystic lesion adherent to the greater omentum – close the offspring from the colon – representing an ectopic pregnancy became apparent. A partial omentectomy of 9,5 cm x 5,5 cm x 2,5 cm was performed with the finding of trophoblast and embryoblast implantated in the infrahepatic part of the greater omentum. Conclusion: In cases of ectopic pregnancy with hemoperitoneum, special care has to be taken examining not only the fallopian tubes or ovaries but also the greater omentum, which may harbour an implanted trophoblast and embryoblast – even in the upper part directly beneath the liver – as presented in this case. In cases of ruptured ectopic pregnancy of the greater omentum, the cases may be dealt with laparoscopic partial omentectomy if the case is early detected.

An experimental study on autologous transplantation of fresh ovarian tissue in sheep

ObjectiveTo investigate current autologous transplantation methods and sites of ovarian tissues in sheep. MethodsSheep ovaries were resected. Ovarian cortices were sliced and transplanted orthotopically into the ovarian mesangial latum and heterotopically into the greater omentum and under groin skin. The grafts were removed two months after transplantation and examined to evaluate the survival of follicles (hematoxylin-eosin staining) and help determining feasible graft sites and transplantation methods. ResultsGraft nodules were found in the transplanted sites. HE staining of the grafts showed that multiple primordial follicles were able to survive in the grafts on both sides of the ovarian mesangial latum, the right side of the greater omentum, and the left inguinal subcutaneous tissue. Secondary or cystic follicles were found in almost all of the grafts. ConclusionThe ovarian mesangial latum, the greater omentum and the inguinal subcutaneous tissue can be used as autologous transplantation sites, where sheep ovarian tissue can survive and the follicles grow and develop in good condition.

Gastrointestinal manifestations of Talaromyces marneffei infection in an HIV-infected patient rapidly verified by metagenomic next-generation sequencing: a case report

BackgroundThe manifestation of Talaromyces marneffei infection in some HIV-infected patients may be atypical. Cases with gastrointestinal involvement have rarely been reported. It is hard to make a diagnosis when patients are lacking the characteristic rash and positive blood culture.Case presentationHere, we described a patient living with HIV who complained of fever and abdominal pain, and was rapidly diagnosed with Talaromyces marneffei infection by metagenomic next-generation sequencing (mNGS) using formalin-fixation and paraffin-embedded (FFPE) samples of omentum majus tissue. We also reviewed reported related cases.ConclusionsTalaromyces marneffei is an unusual cause of clinical presentations involving obvious abdominal pain and lower gastrointestinal bleeding, but can be included in the differential diagnosis. As an important diagnostic tool, the significance of mNGS using FFPE samples of lesions provides a more targeted diagnosis.

Atypical Manifestation of Crohn’s Disease in a Teenage Girl

Crohn’s disease (CD) is nonspecific granulomatous inflammatory disease of all layers of the intestinal wall, characterized by a variety of clinical forms, heterogeneity of age groups of children and extraintestinal manifestations. The diagnosis of the disease is difficult due to the presence of many symptoms specific to a number of other surgical diseases of the abdominal cavity organs. This diagnosis is often made intraoperatively. In this study we report a case of treatment of a teenage girl who was admitted with complaints of a mass in the right iliac region extruding above the skin surface, instability of body weight, an increase in body temperature to 37.2° C for one month. As a result of laboratory and instrumental examination, the etiology was not established. Laparoscopy revealed abdominal infiltrate, consisting of the cecum, the distal ileum and a part of the greater omentum, tightly fixed to the anterior abdominal wall, which led to the destruction ofthe peritoneum, muscle tissue and aponeurosis with further infiltration into the sub-cutaneous fat. Appendectomy and separation of the infiltrate were performed. After that, the girl was discharged due to the categorical refusal of the parents of the further treatment.Twelve days later the patient had abdominal pain again, the dynamics of the pain syndrome intensified, the body temperature was febrile. After examination and detection of signs of peritonitis, emergency laparotomy, subtotal resection of the greater omentum, separation of the abdominal infiltrate (repeated), sanitation and drainage of the abdominal cavity were performed. During the surgery, the access to the abdominal cavity was performed with technical difficulties due to the fact that a conglomerate of intestinal loops and omentum was fixed to the anterior abdominal wall from the interior. The conglomerate was separated from the anterior abdominal wall by blunt dissection. The size of the conglomerate was up to 12–15 cm, formed by the transverse colon, the ileum and the greater omentum. The walls of the transverse colon and ileum in the area of the conglomerate had the cartilaginous density. For the purpose of further examination and determination of tactics for further treatment, the child was transferred to the Gastroenterology Department with a diagnosis of “Terminal ileitis. Purulent omentitis. Serous peritonitis. Mild normochromic anemia of mixed origin. Crohn’s disease?” After the additional examination in a specialized hospital, the diagnosis of CD was confirmed.

Solitary fibrous tumor of the greater omentum: case report and review of literature

BackgroundSolitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin occurring most often in the visceral pleura, however, it has been described in almost every anatomic location of the human body. While most SFTs have a benign behavior, they can potentially be locally aggressive and demonstrate a malignant behavior.Case presentationA 63 year-old male patient presented with lower abdominal pain and nausea and was noted on CT to have a large, heterogeneous lower abdominal mass with no evidence of metastatic disease. A surgical resection was performed and the mass appeared to be connected to the greater omentum with a vascular pedicle. It was not invading any intra-abdominal or pelvic organs. Pathology revealed an SFT of omental origin. The mitotic count was less than 4 per 10 high-power fields and all pathologic characteristics did not meet the criteria for a malignant SFT.ConclusionsWe report an extremely rare case of SFT originating from the greater omentum. A multidisciplinary team approach was followed to plan the patient’s management strategy.

Abdominal elastotic lesions. A clinicopathologic study of 23 cases.

Abdominal elastotic deposits are uncommon lesions that often presents as polyps. They show three histological patterns: fibroelastosis, angioelastosis, and elastofibroma. We describe 23 cases including rare locations, such as mesentery, greater omentum, hernia sac, spleen, peripancreatic fat, and hypodermal fat. The age of the patients ranged from 49 to 93 years (mean, 76.8 years). Most lesions were discovered incidentally in the microscopic study. The most frequent locations were peritoneal subserosa (43.5%) and mesentery/mesocolon/greater omentum (39.1%). The most common pattern was fibroelastosis (69.6%) followed by angioelastosis (26.1%). We observed one case of omental elastofibroma. A review of the 14 abdominal elastofibromas described including our case revealed that the age of the patients ranged from 45 to 88 years (mean, 68.5 years). Female predominance is striking (M:F, 1:12). The most common site was the stomach (50%). The greater omentum (14.3%), small intestine (7.1%), and pancreas (7.1%) are very rare sites for this lesion. Only one case before ours has been published in the greater omentum. The size of the lesions ranged from 0.7 cm to 8 cm (mean 3.2 cm). In 36.4% of the cases located in the digestive tract, the mucosa did not show alterations. Ulcerations (36.4%) or polypoid excrescences (18.2%) were mostly observed. Six (42.9%) cases were asymptomatic and six (42.9%) cases simulated a neoplasm. Two cases were associated with elastofibromas in other locations. Differential diagnosis includes amyloidoma, elastofibrolipoma, mesenteric elastic vascular sclerosis in neuroendocrine tumors, diverticular disease elastosis, pseudoxanthoma elasticum, pulse granuloma, and digestive lesions in patients treated with D-Penicillamine.

Демонстрация возможностей реконструктивных оперативных вмешательств по укрытию открытых костей лицевого скелета и свода черепа по поводу дефектов различной этиологии

Introduction Surgical treatment of patients with tissue defects of the scalp and face is challenging for surgeons. It is an integral part of the social and labor rehabilitation of such patients. Exposure of the skull bones after extensive polyetiological resections creates a difficult task for reconstruction of complete or partial loss of soft tissues of the head. Autologous dermoplasty, simple in its technical implementation, is impractical on the bones of the facial and cerebral skull because insufficient vascularization of the wound bed creates a risk of early rejection of the graft. The aim of the study was development and evaluation of the effectiveness of the method of restoring the integrity of the skin of the head and face inh extensive defects with exposure of the bones of the skull. Materials and methods Аnalysis of the methods and results of reconstructive surgical treatment of three patients with extensive defects in the tissues of the scalp and face at the Research Institute of the Ochapovsky Regional Clinic Hospital No.1 in 2018-2020. Results The immediate result of surgical treatment was a complete restoration of the skin with the maximum possible preservation of underlying deep anatomical structures after a radical one-step removal of non-viable tissues, both soft and bony. Subjectively, the patients were satisfied. The aesthetic result obtained in all cases satisfied both the patients and the surgical team. Conclusion The treatment of extensive defects of the soft tissues of the face and bones of the skull is a doable task, provided certain conditions are met. Removal of the affected tissues with simultaneous plasty of the resulting wound defect with a autologous greater omentum and skin autografts allows one to simultaneously solve the problem of plastic closure of wound defects of such localization. When performing osteonecrectomy of the outer cortical plate of the skull to the bleeding layer, conditions are created for survival of a free skin autograft on the bone.

Carinal sleeve resection: last exit for bronchial insufficiency-a 17-year, single-centre experience.

Bronchopleural fistula after pneumonectomy and dehiscence of an anastomosis after sleeve lobectomy are severe complications. Several established therapeutic options are available. Conservative treatment is recommended for a small fistula without pleural infection. In patients with a bronchopleural fistula and subsequent pleural empyema, surgical management is the mainstay. Overall, the associated morbidity and mortality are high. Carinal sleeve resection is the last resort for patients with a short stump after pneumonectomy or anastomotic dehiscence after sleeve resection near the carina. All patients with bronchopleural fistula after pneumonectomy or sleeve resection who underwent secondary carinal sleeve resection between 2003 and 2019 in our institution were evaluated retrospectively. Patients with anastomotic dehiscence after sleeve lobectomy underwent a completion pneumonectomy. The surgical approach was an anterolateral thoracotomy; the anastomosis was covered with muscle flap, pericardial fat or omentum majus. In case of empyema, povidone-iodine-soaked towels were introduced into the cavity and changed at least twice. A total of 17 patients with an initial sleeve lobectomy in 12 patients and pneumonectomy in 5 patients were treated with carinal sleeve resection in our department. Morbidity was 64.7% and 30-day survival was 82.4% (n = 14). A total of 70.6% of the patients survived 90 days (n = 12). Median hospitalization was 17 days and the median stay in the intensive care unit was 12 days. Carinal sleeve resection is a feasible option in patients with a post-pneumonectomy fistula or anastomotic insufficiency following sleeve lobectomy in the absence of alternative therapeutic strategies. Nevertheless, postoperative morbidity is high, including prolonged intensive care unit stay.

Interstitial incisional hernia of greater omentum: An incidental finding during routine cadaveric dissection

Omental herniation, located between the rectus abdominis muscle and the anterior blade of the rectus sheath, can be triggered after a transverse suprapubic incision. It causes the development of an incisional interstitial hernia (IIH), which is an extremely rare and poorly understood condition. Based on this information, our work presents the first anatomical description of incisional interstitial hernia found during routine dissection at the Human Anatomy Laboratory of the Federal University of Ceará in a formalized female corpse.

CORRECTION OF MORPHOFUNCTIONAL DISORDERS IN EXPERIMENTAL PREECLAMPSY BY COMBINED USE OF TRIMETAZIDINE AND PURIFIED MICRONIZED FLAVONOID FRACTION AS WELL AS THEIR COMBINATIONS WITH METHYLAMPSY

The aimof the experiment was to determine the effectiveness of the combined use of trimetazidine and a purified micronized flavonoid fraction, as well as their combinations with methyldopa, in comparison with monotherapy with the same drugs in the correction of morphofunctional disorders arising in the conditions of experimental preeclampsia. An integrated/multimethodology approach is the most effective way of treatment for preeclampsia. Therefore, an urgent task of modern pharmacology is to study the effectiveness of new drugs when used in combinations, as well as the drugs included in the standards for treatment.Materials and methods. The study was carried out at the Research Institute of Pharmacology of Living Systems of Belgorod State National Research University. The experiment was performed on 200 female Wistar rats, weighing 250–300 g, in which an ADMA-like model of preeclampsia had been reproduced. To assess the degree of correction of emerging morphological and functional disorders, the following parameters were involved: blood pressure, a coefficient of endothelial dysfunction, microcirculation in the placenta, proteinuria, fluid contents in the greater omentum, morphometric indicators of placental tissues and fetal height and weight parameters.Results. The combined use of trimetazidine (Preductal® MB) 6 mg/kg and a purified micronized flavonoid fraction (Detralex®) 260 mg/kg, as well as their combination with methyldopa (Dopegit®) 86 mg/kg, leads to a more pronounced decrease in the blood pressure, compared with a decrease in the coefficient of endothelial dysfunction by 2.22, 2.19 and 1.94 times, respectively, in relation to “untreated” animals. There was an increase in microcirculation indices in the placenta by 2.35, 2.21 and 2.03 times, respectively. In addition, there was an improvement in morphological parameters in the placenta and fetuses.Conclusion. The results of the study showed a greater effectiveness of the combined use of the studied drugs in experimental preeclampsia compared to their monotherapy. This indicates the prospects for the use of trimetazidine and purified micronized flavonoid fraction in the complex therapy for preeclampsia and the need for further research in this direction.

Bioluminescence Imaging In Vivo Confirms the Viability of Pancreatic Islets Transplanted into the Greater Omentum.

The liver is the most widely used site for pancreatic islet transplantation. However, several site-specific limitations impair functional success, with instant blood-mediated inflammatory reaction being the most important. The aim of this study was to develop a preclinical model for placement of the islet graft into a highly vascularized omental flap using a fibrin gel. For this purpose, we tested islet viability by bioluminescence imaging (BLI). Pancreatic islets were isolated from luciferase-positive and luciferase-negative rats, mixed at a 1:1 ratio, placed into a plasma-thrombin bioscaffold, and transplanted in standard (10 pancreatic islets/g wt; n = 10) and marginal (4 pancreatic islets/g wt; n = 7) numbers into the omentums of syngeneic diabetic animals. For the control, 4 pancreatic islets/g were transplanted into the liver using the standard procedure (n = 7). Graft viability was tested by bioluminescence at days 14, 30, 60, and 90 post transplant. Glucose levels, intravenous glucose tolerance, and serum C-peptide were assessed regularly. Nonfasting glucose levels < 10 mmol/l were restored in all animals. While islet viability in the omentum was clearly detected by stable luminescence signals throughout the whole study period, no signals were detected from islets transplanted into the liver. The bioluminescence signals were highly correlated with stimulated C-peptide levels detected at 80 days post transplant. Glucose tolerance did not differ among the 3 groups. We successfully tested a preclinical model of islet transplantation into the greater omentum using a biocompatible scaffold made from autologous plasma and human thrombin. Both standard and marginal pancreatic islet numbers in a gel-form bioscaffold placed in the omentum restored glucose homeostasis in recipients with diabetes. Bioluminescence was shown promising as a direct proof of islet viability.

Laparoscopic repair of hepatic herniation through a ventral incisional hernia: a case report

BackgroundVentral incisional hernia is a common problem after abdominal surgery. Most patients with these hernias present with greater omentum and gastrointestinal prolapse. However, hepatic herniation through a ventral incisional hernia is a rare phenomenon that has been seldom reported in the literature. We report the case of a ventral incisional hernia with hepatic herniation treated with laparoscopic repair.Case presentationA 68-year-old Japanese women with a history of myocardial resection for hypertrophic cardiomyopathy 1 year earlier was admitted to our hospital with symptoms of vomiting and epigastric pain. Physical examination showed a 4-cm epigastric mass. Abdominal computed tomography revealed left hepatic lobe herniation through the lower edge of a mid-sternal incision. We diagnosed the patient with a ventral incisional hernia with hepatic herniation. The patient underwent laparoscopic hernia repair. During an 18-month follow-up, no recurrence or symptoms have been observed.ConclusionsTo the best of our knowledge, this is the first case report of laparoscopic repair of ventral incisional hernias with hepatic herniation. Laparoscopic repair was useful and suitable for this rare herniation due to its minimally invasive nature and ability to achieve sufficient visibility of the surgical field. Laparoscopic repair could be a potential treatment option for elective surgery for this disease, which is often treated conservatively.

Abdominal paragonimiasis after consumption of wild boar meat

A 60-year-old man presented with a 10-day history of abdominal and back pain. Abdominal contrast-enhanced computed tomography showed an intraperitoneal abscess (Figure 1). Antibiotic therapy with flomoxef resulted in reduced size but not the total disappearance of the abscess. Laparoscopic surgery was performed. In addition to the mass-like structure in the greater omentum (Figure 2A), numerous white nodules were found on the peritoneum (Figure 2B). Pathological examination showed granulomatous inflammation around parasite eggs (Figure 2C and D). The patient had eaten raw wild boar meat 7 months ago. Total serum immunoglobulin E was elevated (433.9 IU/mL), but total white blood cell and eosinophil counts were within the reference intervals. Serological examination revealed a positive reaction to Paragonimus antigens. A diagnosis of abdominal paragonimiasis was made. The patient’s symptoms resolved after the surgery. Praziquantel (75 mg/kg/daily for 3 consecutive days) was administered postoperatively. The patient has been free from symptoms for 3 months of follow-up.Figure 2Laparoscopic view of a mass-like structure (main lesion) with the long diameter of about 30 mm in the greater omentum (A), with white nodules (∼1 mm in diameter) observed on the surface of the peritoneum (B); low-power (C) and high-power (D) microscopic views of the main lesion containing parasite eggs (78 × 49 μm in average size) (Hematoxylin & eosin staining; scale bars: 500 and 50 μm, respectively).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Although the adult Paragonimus primarily inhabits the lung, it may also reach various ectopic sites, including the greater omentum (Jeong et al., 2002Jeong W.K. Kim Y. Kim Y.S. Park D.W. Park C.K. Baek H.K. et al.Heterotopic paragonimiasis in the omentum.J Comput Assist Tomogr. 2002; 26: 1019-1021Crossref PubMed Scopus (10) Google Scholar), and cause extrapulmonary paragonimiasis. Wild boar meat is 1 of 2 major food sources of infection, as in this case, the other is freshwater crabs in Japan (Nagayasu et al., 2015Nagayasu E. Yoshida A. Hombu A. Horii Y. Maruyama H. Paragonimiasis in Japan: a twelve-year retrospective case review (2001-2012).Intern Med. 2015; 54: 179-186Crossref PubMed Scopus (46) Google Scholar). On behalf of all authors, the corresponding author states that there is no conflict of interest.

A RARE CASE OF LEFT SIDED UNCOMPLICATED MORGAGNI HERNIA IN AN ADULT

Diaphragmatic hernias of Morgagni are anatomical defects in the anterior diaphragm that allow herniation of abdominal viscera into the thorax. They are the rarest of congenital diaphragmatic hernias and usually present in childhood with respiratory symptomatology. Adults are often asymptomatic or present with strangulation of visceral contents. We describe the case of a 60-year female presenting with chronic chest pain and diagnosed with a left sided Morgagni hernia, with stomach and greater omentum as its contents. She underwent thoracotomy repair of the hernia and the defect was repaired using polypropylene mesh. Keyword: Morgagni Hernia, Adult, Thoracotomy, Mesh Repair

Huge myxosarcoma arising from the greater omentum in a dog

A 13-year-old intact Pomeranian bitch presented with a 2-month history of abdominal distension and anorexia. Ultrasonography and computed tomography revealed a large tumor in the abdominal cavity without metastases. The tumor was surgically resected and histopathologically characterized by spindle-shaped to atypical-shaped neoplastic cells with basophilic stroma in the omental adipose tissue. Immunohistochemistry revealed that the neoplastic cells were positive for vimentin but negative for cytokeratin, S-100 protein, and α-SMA. The bitch was diagnosed as a myxosarcoma arising from the greater omentum. Postoperatively, metronomic chemotherapy with cyclophosphamide and piroxicam was initiated. The tumor recurred on postoperative day 49. Although the bitch died 102 days after the initial examination, her general condition was maintained until death.

Robotic extended distal pancreatectomy with splenectomy for pancreatic adenocarcinoma

Presenter: Sharona Ross MD | AdventHealth Tampa Background: This video describes our technique of an extended distal pancreatectomy for locally advanced post neoadjuvant chemoradiation. Methods: This video is of a 72-year-old woman who presented with epigastric pain and was found to have a pancreatic body mass. Preoperative workup included triple phase CT scan and EUS/FNA showing abutment < 180 degrees of SMV/SMA and encasement of the splenic artery and vein. Patient progressed after 6 months of neoadjuvant chemotherapy and 30 sessions of radiation therapy. Results: The operation began by taking down the gastrohepatic ligament followed by the gastrocolic omentum. The short gastric vessels were taken down and the stomach retracted. An intraoperative ultrasound was utilized to identify the location of the tumor mass and the pancreas was dissected along its inferior edge. The colonic mesentery area along the inferior edge of the pancreas and the common hepatic artery was excised and sent to pathology which returned negative for malignancy. The neck of the pancreas was dissected, and the pancreas was divided with a robotic hook cautery. The left side of the SMV and portal vein was dissected. All the tissue surrounding the celiac trunk, the splenic artery and common hepatic artery were dissected. Next, we arrived at the splenic artery and vein which was divided with two clips on either side. The specimen was removed off the SMV, SMA, portal vein and the celiac trunk. Lastly the pancreas was dissected, medial to lateral, and all the attachments to the spleen were taken down. Conclusion: Operative duration was 3.5 hours with 50 ml of estimated blood loss. Final pathology showed microscopic focus of viable ductal carcinoma of the pancreas in the pancreatic body, associated with extensive fibrosis with zero nodes positive for malignancy. Patient had an uneventful postoperative stay and was discharged on postoperative day 4. This video shows that the robotic approach is safe and efficacious for resection of locally advanced pancreatic carcinoma following neoadjuvant therapy.

Giant Hernia with Incarceration

Introduction: Giant hernias induce changes which reduce the quality of life of patients and make their surgical management complex. Adequate preoperative preparation of the patient guarantees good postoperative progress. It is necessary to avoid resorting to a technique of separation of the compartments during the cure. Here we report the case of a patient who benefited a successful cure using the Ramirez technique. Observation: We report the case of a 60-year-old patient admitted to an outpatient clinic for abdominal swelling evolving for 30 years without the notion of trauma gradually increasing in volume. The interrogation and physical examination led to the diagnosis of a giant white line hernia with incarceration. A preoperative assessment and a preanesthetic consultation were carried out. Intraoperatively, the cecum, transverse colon, sigmoid, jejunum and greater omentum were incarcerated in the bag. After adhesiolysis we proceeded to resect the bag and cure it using the Ramirez technique. The consequences were simple and the patient was discharged on day 4 after her dressing and was seen on day 15, 1 month, 3 months and 1 year. The patient benefited from the placement of an abdominal compression sheath for 3 months. Conclusion: Success in the management of prosthetic material in the absence of prosthetic material depends on good preoperative preparation and the mastery of certain surgical techniques.