Greater Omentum Research Articles

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.

ХИРУРГИЧЕСКАЯ КОРРЕКЦИЯ БОКОВЫХ И ПЕРЕДНЕБОКОВЫХ ГРЫЖ ЖИВОТА

Objective: To improve the results of surgical treatment of primary, postoperative and recurrent hernias of the lateral and anterolateral abdominal wall. Methods: Various types of hernioplasty were performed in 68 patients with lateral and anterolateral hernias of the abdominal wall (LALHAW) aged 24 to 67 years. Primary hernias were diagnosed in 10 patients, postoperative – in 30, recurrent – in 28. There were 16 men and 52 women enrolled on the study. Analysis of the anamnesis and medical records revealed that postoperative hernias (30) arose after the following surgical interventions: nephrectomy (11), nephrolithomy (8), appendectomy (4), cholecystectomy (3), drainage of the retroperitoneal space (2), surgery for hepatic echinococcosis (1) and adrenalectomy (1); 24 patients were admitted with recurrent hernia after traditional hernioplasty, and 4 patients – after combined methods of hernioplasty. Results: Among the total number of patients, traditional hernioplasty was performed in 25 (36.8%) patients, tension-free repair – in 5 (7.4%) and combined repair – in 38 (55.8%) patients. Simultaneous operations were performed in 14 cases, such as nephrolithotomy (3), resection of the ovarian cyst (3) and greater omentum (5), supravaginal amputation of the uterus (3). Surgical site complications developed in 12% of cases after traditional hernioplasty, and in 5.2%. after combined methods of operation. Among 5 patients operated using a tension-free method, seroma occurred in one observation. Recurrent hernia after traditional hernioplasty developed in one patient (4% of cases). Conclusion: Surgical treatment of LALHAW is a complicated problem of herniology, due to the complexity of anatomical architectonics of the anterior abdominal wall and limited plastic resources of the surrounding tissues. Currently, the results of traditional hernioplasty remain disappointing, as there is a trend towards increased recurrence and incidence of surgical site complications after its application. The widespread use of the combined methods of surgical treatment of hernias of this localization, along with reliable reinforcement of the hernia defect, provide the most optimal longterm functional results, allowing the patients resume their previous professional activities. The incidence of recurrent hernias after these operations tends to reduce, contributing to an improvement in the quality of life. Keywords: Lateral abdominal hernia, anterolateral abdominal hernia, recurrent hernia, traditional hernioplasty, tension-free hernioplasty.

Treatment of recurrent traumatic sternomediastinitis after cardiac surgery

To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture. The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound. Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p<0.0001) and no cases of arrosive bleeding (p=0.04). Omentoplasty reduces duration of treatment and risk of arrosive bleeding.

Патоморфологическая оценка клинического случая нейроэндокринной опухоли шейки матки

The article describes our own observation of neuroendocrine cervical cancer, which is one of the rare variants of tumors of this localization. With the help of histological and immunohistochemical studies, a small-cell variant of neuroendocrine carcinoma of the vaginal portion of the cervix uteri with invasion into the wall of the cervical canal and into the thickness of the myometrium of the uterine body was verified, with metastases in the fallopian tubes, in the ovaries, in the pelvic lymph nodes and in the greater omentum.

9 СЛУЧАЕВ ЛЕЧЕНИЯ ДЕТЕЙ С ГРЫЖЕЙ АМИАНДА

9 children aged 4 to 14 years underwent a right-sided inguinal hernia repair, at the same time, a vermiform appendix was found in the hernial sac. All patients were hospitalized with a diagnosis of «Congenital right-sided inguinoscrotal hernia», bilateral hernias were not observed. Objectively, there were all signs of the disease, all hernias were reducible. The presence of the appendix in the hernial sac before the operation was not diagnosed either clinically or by ultrasound. The contents of the hernial sac had a thickened and long vermiform appendix, a greater omentum, and in two cases – a cecum of the type of sliding hernia. The children were operated on under general anesthesia: appendectomy and plastic surgery of posterior wall of inguinal canal were performed. No complications were observed in the postoperative period.

Robotic pancreaticoduodenectomy in a patient with a replaced right hepatic artery

Presenter: Sharona Ross MD | AdventHealth Tampa Background: Ductal adenocarcinoma of the pancreas carries a poor prognosis. Resection with adjuvant therapy remains the sole chance for cure. A minimally invasive approach can improve perioperative outcomes by attenuating postoperative pain, reducing blood loss, and increasing the availability of curative intent to more patients. We present a case of robotic pancreaticoduodenectomy of ductal adenocarcinoma of the pancreatic head in a patient with a replaced right hepatic artery. We hope the stratagems demonstrated can assist other surgeons in providing minimally invasive resection for their patients. Methods: A 78 year old man presented with painless jaundice and weight loss. CT scan demonstrated a 4cm pancreatic head mass without metastasis. Endoscopic ultrasound and fine needle aspiration revealed a ductal adenocarcinoma without evidence of vascular invasion. He underwent robotic pancreaticoduodenectomy after initiation of an Enhanced-Recovery After Surgery (ERAS) protocol. Results: Operative duration was 6 hours. After Kocherization of the duodenum and division of the gastroduodenal artery, we divided the gastrocolic omentum and duodenum post pylorus. Next, the pancreatic neck was transacted. The dissection was carried from the jejunal mesentery to the SMV, SMA, and portal vein, carefully preserving the replaced right hepatic artery coming off the SMA. The gallbladder was dissected off the liver bed, the cystic artery ligated & divided, and the common hepatic duct divided as well. Once the specimen was removed and negative margins confirmed, we began the reconstruction. The choledochojejunostomy, pancreaticojejunostomy, and duodenojejunostomy anastomoses were completed with v-lock sutures. No blood transfusions were required. The final pathology showed a moderately differentiated pancreatic ductal adenocarcinoma, T3N1 with negative margins. The patient recovered uneventfully and was discharged home on postoperative day 4. Conclusion: The patient’s rapid and uneventful recovery resulted in adjuvant FOLFIRINOX initiation on post-operative day 27. Robotic resection, when utilized safely, provides adequate oncologic outcomes with good and quick postoperative recovery.

A case of metastatic invasive lobular carcinoma of the greater omentum with signet ring cells in the ascitic fluid, which was difficult to distinguish from gastric cancer

A case of metastatic invasive lobular carcinoma of the greater omentum with signet ring cells in the ascitic fluid, which was difficult to distinguish from gastric cancer

Abdominal cystic lymphangioma mimicking ovarian mass: A case report and literature review.

Cystic lymphangiomas are uncommon benign lesions extremely rare in the adult population. Most cases are found in the neck and axillary regions; while <1% of patients present with cystic lymphangiomas in the mesentery, greater omentum and retroperitoneum. The present report describes a rare case of large omental lymphangioma mimicking ovarian mass. A 40-year-old G2P2 female patient presented without symptoms for routine gynecological examination. Transvaginal ultrasound examination revealed a cystic mass with a maximum diameter of 10 cm localized at the right parametrium space, suggestive of large cystic lesion of the right ovary. Further preoperative evaluation by magnetic resonance imaging indicated that the mass was either cystic lymphangioma or mesenteric cyst. Complete excision of the cyst without need for gastrectomy was performed via laparotomy under general anaesthesia. Histology revealed omental lymphangioma. Most abdominal lymphangiomas are initially asymptomatic. The role of synchronous imaging examinations, such as ultrasonography and magnetic resonance imaging, in diagnosis of these lesions is crucial. Full preoperative differential diagnosis evaluation in cases of large intraabdominal lesions is required in order to decide the appropriate surgical approach and management.

Spleen arterial vascularization in fur-bearing animals in cages

The spleen is an unpaired parenchymal organ located in the abdominal cavity, performing immunological, filtration and hematopoietic functions and, in connection with the listed functional features, plays an essential role in the organism. Authors obtained detailed information on the arterial vascularization of the spleen of fur-bearing animals of Carnivora, since the information available in the special literature on the morphological aspects of the blood supply of the named organ is fragmentary. A comprehensive study of the spleen was carried out, which made it possible to confirm the general morphological patterns, to reveal the characteristic specific and intraspecific features of the vascularization of the spleen in fur-bearing animals in cages. The new data obtained on the morphology of the vessels vascularizing the spleen are original and give a complete picture of the organ. Analyzing the material obtained from own research, and comparing it with information from special literature, allows to assert that the blood supply to the spleen in fur-bearing animals of cellular content (silver-black fox, blue fox, sable and American mink) is carried out through the splenic artery, which also gives off branches to the stomach, pancreas and great omentum. If in the methods of branching of the splenic artery in the studied animals we note a great similarity, then in the number of branches branching from it there are significant differences. As a result of the study, it was found that the spleen is vascularized by the splenic artery extending from the celiac artery.

Is Emergency Appendicectomy Better Than Elective Appendicectomy for the Treatment of Appendiceal Phlegmon?: A Review.

Appendiceal phlegmon is considered to be sequelae to acute appendicitis which presents as an appendiceal mass composed of the inflamed appendix, the adjacent bowel loops, and the greater omentum. The definitive diagnosis can be obtained by a CT scan of the abdomen. Though conservative management was the most practiced approach, recent studies have shifted the trends towards immediate appendicectomy for the management of appendiceal phlegmon. Thus, the management of appendiceal phlegmon has been debatable. Evidence to support this review was gathered via the PubMed database as this database uses the Medline, PubMed Central, and NLM databases and also offers a quick diverse search with up-to-date citations and numerous open-access free articles focused on Medicine. We did not include other databases like Google Scholar, Embase, and Scopus due to its limited access to free articles, recent articles, and citation information. Search terms used were combinations of "Appendicitis," "Appendiceal phlegmon", "Appendiceal phlegmon (AND) appendicectomy ". The resultant studies were reviewed and cross‐referenced for additional reports. Emergency appendicectomy is defined as appendicectomy carried out during the same, initial admission. An elective or interval appendicectomy is an appendicectomy carried out four to six weeks after the initial episode at a later admission. The interval is bridged by antibiotics and conservative management. Emergency appendicectomy is considered to have a higher rate of complications when compared to conservative management for appendiceal phlegmon. However, interval appendicectomy requires multiple re-admissions, leads to delayed diagnosis of any underlying pathology, and an increased risk of recurrent appendicitis. In our review, we aimed to compare and contrast the effectiveness of the different treatment modalities available for appendiceal phlegmon. Though the meta-analyses showed an increased association of complications with emergency appendicectomy, they included studies conducted before the laparoscopic era. Emergency appendicectomy decreases the financial burden, re-admission rate, and aids in the early diagnosis of any underlying pathology. In the laparoscopic era, we can consider the shifting trends towards emergency appendicectomy for the management of appendiceal phlegmon.

Castleman disease of the greater omentum: a rare unicentric variant.

Castleman disease of the greater omentum: a rare unicentric variant.

Diagnosis and treatment of pneumatosis cystoides intestinalis

Pneumatosis cystoides intestinalis (PCI) is a rare disease, which is characterized by the accumulation of gas cysts located in the submucosa or subserosa of the gastrointestinal tract. It can occur in the whole or part of the gastrointestinal tract from the esophagus to the rectum, but clinically the main involved sites are the colon and small intestine. PCI can also appear in other sites such as mesentery, the greater omentum and the hepatogastric ligament. In recent years, with the renewal of imaging method, the detection rate of PCI has been on the rise. Most patients with PCI have no obvious symptoms or only non-specific symptoms of the digestive tract like abdominal distension, abdominal pain, diarrhea, hematochezia, etc. The atypical clinical symptoms of PCI can easily lead to missed diagnosis or misdiagnosis. A small amount of patients would have complications like peritonitis and even perforation of the digestive tract. The therapeutic principle for these patients is different from that for patients with acute abdomen. The prognosis of PCI depends on its severity and comorbidities. In this article, a literature review would be conducted on the epidemiological characteristics, etiology and pathogenesis, clinical manifestations, diagnosis and treatment of PCI, which might help clinical doctors with diagnosis and treatment of the disease.

Free Strand of the Greater Omentum in Surgical Practice and its Morphological Characteristics

Free Strand of the Greater Omentum in Surgical Practice and its Morphological Characteristics

Clinical characteristics and outcomes of 17 cases of inflammatory myofibroblastic tumor at a University Hospital in China.

The aim of the present study was to explore the clinical and pathological characteristics, diagnosis, and treatment of inflammatory myofibroblastic tumor (IMT). A total of 17 patients with IMT diagnosed between July 2010 and February 2020 were included in the present study, and the clinical characteristics, pathological features, treatment and prognosis were analyzed retrospectively. The cohort consisted of 17 participants, including 12 men and 5 women, with a mean age of 34.76 years. The most common locations of tumors were the bronchi and the lungs (9 cases, including 1 case involving the mediastinum), followed by the colon and bladder (2 cases each), and the omentum majus, mesocolon, stomach and peritoneal cavity (1 case each). Immunohistochemical staining demonstrated that the tumor cells exhibited positive staining for anaplastic lymphoma kinase p80 (13/17), smooth muscle actin (12/17), cytokeratin pan (6/17), vimentin (5/17) and desmin (4/17). The follow-up time was 18–114 months. A patient with epithelial inflammatory myofibroblast sarcoma (EIMS) succumbed to the disease, 1 case was lost to follow-up, 2 cases relapsed and the other 13 cases were considered cured. IMTs may be malignant or low-grade. EIMS is a rare and invasive variant of IMT. The clinical and imaging manifestations are often unique and vary among individuals. Once confirmed by pathology, radical surgery should be the first choice of treatment.

AGE-RELATED EXTERNAL STRUCTURE OF HUMAN GREATER OMENTUM

&#x0D; Currently, the greater omentum is widely used in surgery as a source of grafts in reconstructive plastic surgery. Postmortem studies of the greater omentum taken from male and female died individuals of the second mature, elderly and senile age with brachiomorphic, mesomorphic and dolichomorphic body types were carried out. The methodology included aomatoscopic, morphometric methods and the methods of anatomical preparation. It has been established that the greater omentum consists of two parts: secured and unsecured. The secured part of the greater omentum is located between the great curvature of the stomach and the omental band of the transverse colon and is called the gastrocolic ligament. In the second mature, elderly and senile age, the shape and size of the greater omenta are not dependent on the human body type. At the same age periods, the greater omenta of the quadrangular, triangular and irregular shapes are found in women and men. Quadrangular greater omenta occupy the largest area; while the area occupied by the greater omenta of triangular and irregular shape is less. The quadrangular shape of the greater omentum is more favourable for obtaining the graft for transplantation to organs with a large defect. At all ages, the intensity of the development of the adipose tissue in the greater omentum depends on the prominence of subcutaneous adipose tissue, especially in overweight individuals. In the presence of adipose tissue, the following types of the greater omentum have been identified: 1) the greater omentum without adipose tissue; 2) the greater omentum with moderately developed adipose tissue; 3) the greater omentum with excessively developed adipose tissue. The greater omenta without adipose tissue are plastic with clearly visible vessels and their branching. The adipose tissue is located along the vessels, and the areas without adipose tissue are transparent, resembling a thin lace. In greater omenta with excessively developed adipose tissue, the vessels were not verified due to the numerous fat particles that cover the entire surface of the omentum in a continuous layer. The greater omentum with excessively developed adipose tissue becomes thick and loses its flexibility. Before omentoplasty, laparoscopic examination of the greater omentum of overweight patient is advisable in the preoperative period. One of the causes of bowel entrapment there are through holes in the unsecured part of the greater omentum.

Bone tissue engineering in the greater omentum with computer-aided design/computer-aided manufacturing scaffolds is enhanced by a periosteum transplant.

Aim: This study aimed to evaluate two different vascularized bone flap scaffolds and the impact of two barrier membranes for the reconstruction of critical-size bone defects. Materials & methods: 3D-printed scaffolds of biodegradable calcium phosphate and bioinert titanium were loaded with rhBMP-2bone marrow aspirate, wrapped by a collagen membrane or a periosteum transplant and implanted into the greater omentum of miniature pigs. Results: Histological evaluation demonstrated significant bone formation within the first 8weeks in both scaffolds. The periosteum transplant led to enhanced bone formation and a homogenous distribution in the scaffolds. The omentum tissue grew out a robust vascular supply. Conclusion: Endocultivation using 3D-printed scaffolds in the greater omentum is a very promising approach in defect-specific bone tissue regeneration.

419P Surgical treatment of malignant tumours and metastatic lesions of the chest wall

Tumors of the chest wall are relatively rare. Malignant tumors of the chest wall make up 4% of the structure of cancer and 1-2% of all primary tumors. Malignant tumors of the ribs and sternum made up 13% of the number of patients with bone tumors. The main treatment for chest wall tumors is surgical treatment. Unlike primary, metastatic bone tumors occur 2-4 times more often. From 2010 to 2019, in KazIOR provide operations for 78 patients with chest wall tumors, in which 60(76.9%) malignant bone tumors (chondrosarcoma 26(33.3%) and osteogenic sarcoma 34(43.6%), 2(2.6%) metastatic bone lesions, 16(20.5%) soft tissue tumors. The average age was 46.4years, the ratio of men and women 1: 1. 16(20.5%) patients underwent resection of the sternum (manubrium 2(2.6%), body 5(6.4%), xiphoid process 3(3.9%), middle third of the sternum 2(2.6%), the sternum and clavicle 2(2.6%), the xiphoid process of the sternum+costal arch of both sides+diaphragm and peritoneum in 1(1.2%) patient, middle third of the sternum+clavicle+3 ribs 1(1.2%)) and 62(79.5%) resection of the ribs (1 rib 14(17.9%), 2 ribs 12(15.5%), 3 ribs 3(3.9%), 4 ribs 3(3.9%), 5 ribs 1(1.2%), costal arch 1(1.2%), 28(35.9%) patients combined resection of ribs with nearby bones of the chest wall, various structures of the mediastinum and visceral organs. After resection of 3 ribs or more along the anterolateral surface and total or subtotal resection of the sternum 39(50%) patients underwent reconstructive plastic surgery. In 25(32%) cases used prolene mesh, in 2(2.6%) a displaced skin-fat flap, in 2(2.6%) a thoracodorsal flap (TDL), in 2(2.6%) a greater omentum and in 8(10.2%) combined plasty (prolene mesh+rectoabdominal flap in 2(2.6%) patients, prolene mesh+displaced pectoral flap in 4(5.1%), prolene mesh+TDL in 1(1.2%), prolene mesh + skin-fatty flap in 1(1.2%). Due to the radical removal of the tumor in combination with the reconstruction of postoperative extensive defects of the chest wall, the quality of life of patients is improved and good functional results are achieved - ease of construction and at the same time the required rigidity of the frame. Despite a significant amount of experimental work research in this area is ongoing.

Structure and function of proximal segment of the dorsal mesogastrium: from the perspective of radical resection of gastric carcinoma

The bursa sac and greater omentum were considered as the dorsal mesogastrium more than 100 years. Bursectomy and omentectomy has been used as an essential part of radical gastrectomy with extended lymphadenectomy. However, structure of the bursa sac and omentum were difficult to be consistent with the definition and deduction of the mesentery. Also, it was hard to be proved that bursectomy and omentectomy could get oncological benefit from clinical randomized control trials recent years. We proposed a model of the proximal segment of dorsal mesogastrium (PSDM) here to compared with bursa model. It was demonstrated that the PSDM was consisted by the right gastric mesentery, right gastroepiploic mesentery, left gastric mesentery, left gastroepiploic mesentery, posterior gastric mesentery, and short gastric mesentery. The complete PSDM excision have been proved efficient in decreasing bleeding during operation and preventing cancer leak from PSDM during lymphadenectomy, as well as limiting the surgical hazard and developing oncological benefit. So that, PSDM model was presented as an alternative model for surgeons to practice and prove, even more evidences are still on the way.

Осложненные кисты урахуса. Особенности диагностики и лечения у взрослых пациентов

Introduction. Urachal cyst is a congenital malformation, presented by a closed cavity filled with serous fluid in the urachus. Although a morphological picture of the urachal malformation is well known and is quite common in different patients, each case with a complicated cyst has unique clinical features, requiring a differential diagnosis. Aim. To demonstrate differential diagnosis of two cases with congenital urachal malformations, presenting different clinical features. Materials and methods. The study describes 2 clinical cases. A 65-year-old patient presented with non-intensive hematuria and fever up to 37.5 ° C, symptoms appeared 2 weeks after blunt abdominal and chest trauma with 7-10th ribs fractured on the left side. Ultrasound revealed a cystic formation of the urachus, up to 6 cm in size. The 2nd patient - 62-year-old with a bladder tumor. MSCT revealed a mass (tumor of the urachus) with signs of invasion into the bladder anterior-superior wall, with signs of involvement in the process of one loop of the small intestine and the proximal part of sigmoid colon. Results. The first patient underwent an open surgery: partial midline laparotomy with excision of an umbilical hernia, containing a portion of the greater omentum. The 62-year-old patient also underwent an open surgery - lower midline laparotomy with removal of the urachal tumor, bladder upper hemisphere, and a part of the small intestine. Conclusions. In the first clinical case, the complicated urachal cyst simulated bladder cancer. Visual differential diagnosis of urachal festering cyst with its possible malignant neoplasm directly during the surgery was hampered by secondary tissue changes and other organs involvement. In the second clinical case actinomycosis was identified, which probably provoked inflammatory changes in the urachal cyst. This manifested the clinical picture and required radical surgical treatment.

Apendagite epiploica: um diagnóstico diferencial: relato de caso

Objetivo: Descrever um caso de apendagite epiploica em paciente atendido na Clínica Gastromed, enfatizando os aspectos clínicos, propedêuticos e o tratamento adotado. Metodologia: Trata-se de um estudo retrospectivo que irá abordar o caso de paciente com apendagite epiploica, utilizando para isso o prontuário do paciente em questão. Será realizada durante todo período de estudo consultas a literatura disponível e pertinente ao assunto, tais como: artigos científicos, livros, revistas, etc. Resultados: Paciente masculino, 38 anos, procura atendimento em 20/05/2019 com queixa de diarreia, febre não aferida e mialgia. Ao exame do abdomem, desconforto a palpação superficial e profunda em fossa ilíaca esquerda, não apresentando dor à descompressão brusca, sem outras alterações. A tomografia computadorizada de abdomem inferior revelou estrutura ovoide com densidade de gordura, com a dimensão de 1,5 x 0,8 cm, com a região central hiperdensa, na porção antimesentérica do colón, sugerindo apendagite epiploica incipiente, no colón esquerdo. Foi submetido a acompanhamento domiciliar com antiinflamatório não esteroidal e antiespasmódico, com evolução favorável. Conclusão: Nas condições que foram realizados o presente estudo podemos concluir que apendagite epiplóica é uma condição clínica incomum que inclui em seu diagnóstico diferencial diversas patologias cujo tratamento é cirúrgico ilustrando a importância do raciocínio clínico adequado.