Part Of Omentum Research Articles

Omental torsion as a possible cause of acute abdomen.

Primary torsion of large omentum is a rare cause of abdominal pain. The knowledge of this disease is essential for surgeons. It plays an important role in differential diagnosis of acute abdomen. The authors present two cases of primary omental torsion. They describe the diagnostic and therapeutic process. Diagnosis of omental torsion is difficult. Frequently, it presents with abdominal pain and imitates other acute abdominal diseases such as acute appendicitis in most cases. It is difficult to diagnose before surgical revision is approached. Laboratory and paraclinical examinations may not provide any clear findings. Laparoscopic revision is the method of choice, with confirmation of the diagnosis and laparoscopic resection of the ischemic part of omentum.

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 Acquired Diaphragmatic Hernia Masquerading as Lumbar Hernia: a Case Report

Diaphragmatic hernia can be congenital or acquired. Usual clinical presentation may range from asymptomatic cases to serious respiratory or gastrointestinal symptoms. This case report discusses a middle-aged male presenting to us with a radiological diagnosis of lumbar hernia turning out to have diaphragmatic hernia intraoperatively. A 58-year-old gentleman presented to us, 6 months back, with a slowly progressing painless lump in the left lumbar region. The ultrasonography was suggestive of lipoma. The lump was excised under general anaesthesia, and intraoperatively it was a giant lipoma of size around 12 × 10 cm2 in subcutaneous plane. Two months later, he developed swelling at the same site where he had been subjected to ambulatory excision of a lipoma. The swelling was insidious in onset and gradually progressing over the period of next 4 months, and he again visited to us. Examination revealed an ill-defined fullness in the left lumbar region with suspicious positive cough impulse. Computed tomography scan of abdomen reported it to be a large incisional hernia in the left lumbar region (in view of history of lipoma surgery in the past). The chest X-ray revealed slight blunting of left costophrenic angle, and baseline blood investigation were normal. He was electively posted and proceeded for diagnostic laparoscopy. He had a rent in left hemidiaphragm anterolaterally, and only a part of omentum was adhered to its edge. The defect was laparoscopically suture repaired with polypropylene and strengthened with a polypropylene mesh with ProTack fixation. The postoperative recovery was uneventful. This paper describes a unique presentation of spontaneous diaphragmatic hernia mimicking a lumbar hernia. To our knowledge, no similar case has been reported and published.

CASE OF DU PERFORATION WITH SECONDARY OMENTAL NECROSIS- A RARE CASE REPORT

Introduction: The Omentum is rich in blood supply. Omental Infarction can be classified as primary or secondary depending on the pathogenesis.
 Aims and Objectives: To report a case of DU perforation with secondary Omental Infarction.
 Case Details: A 21 year old male patient came with complaints of generalized dull aching abdominal pain, associated with persistent vomiting and high grade fever since 3 days. On examination, he was drowsy, BP was not recordable and peripheral pulses were not palpable. Abdominal examination revealed guarding and rigidity. X-ray erect abdomen showed gas under the right dome of the diaphragm (pneumoperitoneum).
 The patient was taken up for an exploratory laparotomy. Intraoperatively, findings included: 1) A 0.5*0.5cm in size perforation over the anterior first part of the duodenum, 2) approximately 3L of haemorrhagic peritoneal fluid 3) necrosed omentum and 4) petechial patches over the parietal wall of peritoneum. Primary repair of the DU perforation with omental plug (modified graham’s repair) with omentectomy of the necrosed part of omentum was done.
 The HPE report of excised specimen of omentum was suggestive of intense congestion and necro-inflammatory reaction of the omentum with necrosis and netrophilic infiltrate.
 Conclusion: A rare case of DU perforation with secondary omental necrosis is being reported.
 Keywords: DU Perforation; Omental Necrosis; Omental Infarction; Modified Graham’s patch
 Abbreviations: OI- Omental Infarction, DU- Duodenum.

Management of Incidental Bochdalek Hernia in An Asymptomatic Adult: A Case Report

Bochdalek hernia is a type of Congenital Diaphragmatic Hernia (CDH) that typically presents in childhood. It rarely occurs in adults and most of them are asymptomatic. In this article, we report a case of a 30-year-old male with left-sided Bochdalek hernia who was incidentally diagnosed on chest radiograph. His chest radiograph showed features suggestive of left-sided diaphragmatic hernia, which was confirmed using contrast enhanced Computed Tomography (CECT) of chest and abdomen. The patient underwent left thoracotomy, wherein an 8x10 cm postero-lateral diaphragmatic defect with herniation of the small bowel, spleen, part of stomach, and colon with no peritoneal sac through the opening was found. The contents were reduced into the peritoneal cavity, although a part of omentum had to be sacrificed due to loss of domain and to achieve a tension free repair. The diaphragmatic defect was closed with Dacron patch and sutured to diaphragm with non-absorbable sutures.

English

INTRODUCTION: Less than 10 mm port-site herniation is a rare complication after laparoscopic surgery. We report a case of complicated herniation through the 5-mm suprapubic trocar port site. CASE REPORT: A 58-year old obese male was admitted due to intestinal obstruction. He has undergone the laparoscopic appendicectomy 1 year ago. On examination, abdomen was bloated and roughly 10 cm size mass was palpable on the suprapubic area. Plane radiogram of the abdomen showed signs of intestinal obstruction. Since conservative treatment was ineffective, the patient was operated on. The laparotomy revealed a protrusion of a part of right large intestine and greater omentum into the subcutaneous space through the abdominal wall defect. There was a dilatation of intestines proximally incarcerated colon. It was released and a part of omentum was resected. The peritoneum and fascia-muscular defect was closed by interrupted vicryl sutures. CONCLUSION: Acute herniation through a 5 mm size most lateral trocar port site is a rare complication of laparoscopic surgery requiring prompt differential diagnosis.

A case report of incisional hernia through a 5 mm lateral port site following laparoscopic cholecystectomy

INTRODUCTION:Less than 10 mm port-site herniation is a rare complication after laparoscopic surgery. We report a case of complicated herniation through the 5-mm lateral trocar port site.CASE REPORT:A 63-year old obese female was admitted due to intestinal obstruction. She has undergone the laparoscopic cholecystectomy 1 year ago. On examination, abdomen was bloated and roughly 10 cm size mass was palpable on the right subcostal area. Plane radiogram of the abdomen showed signs of intestinal obstruction. Since conservative treatment was ineffective, the patient was operated on. The laparotomy revealed a protrusion of a part of right large intestine and greater omentum into the subcutaneous space through the abdominal wall defect below right subcostal margin. There was a dilatation of intestines proximally incarcerated colon. It was released and a part of omentum was resected. The peritoneum and fascia-muscular defect was closed by interrupted vicryl sutures.CONCLUSION:Acute herniation through a 5 mm size most lateral trocar port site is a rare complication of laparoscopic surgery requiring prompt differential diagnosis.