MyMedR

A case of laparoscopic resection of myxoid liposarcoma of the greater omentum

Siow SL, Faqihuddin MH, Mahendran HA

Med J Malaysia, 2020 07;75(4):455-457.

Primary omental liposarcoma is a rare clinical entity with less than 20 cases being reported in the literature. Laparotomy has been the traditional approach for resection, with no reports of laparoscopic resection. A 39-year-old lady presented at the Sarawak General Hospital, Kuching, Malaysia with a history of a progressive, painless left upper quadrant abdominal swelling for a year. CT scan showed a well-defined heterogeneously enhancing cystic mass measuring 7.5x7.5x8.1cm with a poor plane with the adjacent greater curvature of stomach and transverse colon. Upper and lower endoscopy was normal. The tumour was completely dissected from the adjacent transverse colon and removed laparoscopically. Histopathological examination of the resected specimen revealed a myxoid liposarcoma. She had an uneventful recovery and was discharged well on the third postoperative day. She subsequently underwent adjuvant chemotherapy and was well at 1-year follow-up with PET CT showing no evidence of recurrence or metastases.

Matched MeSH terms: Omentum/physiopathology*; Omentum/surgery*

Fulltext Spontaneous Omental Infarction: An Unusual Etiology of Abdominal Pain

Khairuddin A, Teng WW, Azizan N, Hayati F, Sahid NA, Kadir F

Kathmandu Univ Med J (KUMJ), 2019 10 1;17(68):347-349.

PMID: 33311048

A 49-year-old lady with previous scars complained of acute abdominal pain for two days. Her right hypochondrium was tender and guarding upon assessment. The laboratory investigations were unremarkable. Due to a diagnostic incongruity, computed tomography of the abdomen was performed showing a suspicious lesion at anterolateral aspect of the ascending colon. Surgical intervention was decided and intraoperative finding was consistent with spontaneous omental infarction. Omentectomy was undertaken and final histology was compatible with the intraoperative diagnosis. Although it is exceptional, omental infarction should be considered as part of the differential diagnoses of right-sided acute abdominal pain with normal laboratory investigations. This case highlights its unexpected discovery and we describe its literature reviews.

Matched MeSH terms: Omentum*

Successful free omental flap and skin graft reconstruction of scalp avulsion injury

Ramzisham AR, Somasundaram S, Nasir ZM, Ali F, Das S

Clin Ter, 2010;161(5):453-5.

PMID: 20949243

For the management of a full-thickness scalp avulsion injury, thorough wound debridement and immediate primary revascularization or a split-thickness skin graft may be necessary. Graft failure may be common situation thereby predisposing the individuals to unnecessary multiple operations. In the recent times, the use of omental graft has gained much popularity. In the present study, we describe an interesting case of chronic non healing scalp ulcer in a young woman who eventually underwent a free omental flap reconstruction with split-thickness skin graft and had satisfactory outcome.

Matched MeSH terms: Omentum/transplantation

Abnormal peritoneal fold connecting the greater omentum with the liver, gallbladder, right kidney and lesser omentum

Nayak SB

Bratisl Lek Listy, 2009;110(11):736-7.

PMID: 20120448

Abnormal peritoneal folds near the liver are very rare. This case report presents an observation of an abnormal fold of peritoneum that extended from the upper right part of the greater omentum and stomach to the fossa for gallbladder. This fold merged with the lesser omentum on the left and extended to the right kidney when traced posteriorly. The epiploic foramen was entirely absent due to the presence of this fold. However, the lesser sac was there behind the liver, lesser omentum and stomach. The knowledge of abnormal folds like this may be important for surgeons (Fig. 3, Ref. 7). Full Text (Free, PDF) www.bmj.sk.

Matched MeSH terms: Omentum/pathology

Fulltext Splenorrhaphy: omental pouch

Lazim TR, Salleh M, Bakar AS

Med J Malaysia, 1995 Jun;50(2):145-9.

PMID: 7565184

This work studies the efficacy of an autogenous viable omental pouch as a means of splenorrhaphy for saving the traumatised spleen. One sheep and 9 goat spleens were mobilised and their vascular pedicles clamped. All spleens were subjected to AAST grade IV trauma. The injured spleens were put into omental pouches and manual pressure was applied for 10 minutes after removal of the vascular clamp. Bleeding was controlled in 8 animals which became fully active 12-36 hours postoperatively. Two animals died, one due to aspiration of gastric contents during surgery and the other due to bleeding 24 hours postoperatively. All remaining spleens were harvested after 6 weeks. They were surrounded by a fibrous capsule and the previously inflicted injuries were easily identifiable. Viable omental pouch based on left epiploic vascular pedicle offers itself as a good autogenous alternative other methods used for saving the injured spleen. This method has been used in two humans so far.

Matched MeSH terms: Omentum*

Fulltext Omental transposition flap and split skin graft for locally advanced breast carcinoma

Lee SH, Cheah DS, Krishnan MM

Singapore Med J, 1990 Jun;31(3):217-20.

PMID: 2392698

Locally advanced or recurrent carcinoma of the breast poses difficult management problems. These fungating and discharging tumours severely impair the quality of life in these unfortunate patients. We report two cases successfully treated with omental transposition flaps and split skin grafts. The operation is described in detail and the results discussed. This technique was found to be safe, effective and rewarding.

Matched MeSH terms: Omentum/surgery*

Fulltext Anomalous peritoneal band connecting greater omentum to the ascending colon: a possible cause for dilation of ascending colon

Nayak SB, Soumya KV

Anat Cell Biol, 2020 Sep 30;53(3):372-375.

PMID: 32647076 DOI: 10.5115/acb.20.082

Anomalies of the peritoneum and the colon are quite common. Some of these anomalies can disturb the normal digestive and absorptive functions of the intestine and the others might result in formation of volvulus or impede the blood supply of the intestine. We report a rare, combined variation of peritoneum and ascending colon. In a 70-year-old male cadaver, the greater omentum was very small and extended only for about an inch below the transverse colon. From its lower end, a fibrous band extended to the right wall of the upper part of ascending colon. There was a deep constriction on the right wall of the ascending colon at the site of attachment of the fibrous band. The ascending colon was grossly dilated. Further, the ascending colon was mobile and presented a small ascending mesocolon along its left edge. We discuss the possible embryological basis and clinical and surgical relevance of the case.

Matched MeSH terms: Omentum

Fulltext A rare discovery of Spigelian-cryptorchidism syndrome in adult

Gurung R, Ali AA, Lee FY, Mra A, Hayati F

Urol Case Rep, 2021 Sep;38:101687.

PMID: 33996498 DOI: 10.1016/j.eucr.2021.101687

Spigelian hernia (SH) occurs due to the protrusion through a congenital or acquired defect or weakness in the Spigelian aponeurosis. SH accounts for only 0.1-0.4% of occurrence and a 17-24% risk of strangulation. We hereby report a case of a 34-year-old gentleman presented with concomitant incarceration of the omentum with small intestine and testis in Spigelian hernia sac. We have successfully operated on this patient via a transperitoneal approach with a small incision over the hernia site. This incision could be an alternative to midline laparotomy as a safe and effective method in managing incarcerated SH in an emergency setting.

Matched MeSH terms: Omentum

Fulltext Perforated incisional littre’s hernia: a rare content of a common hernia

Kumarappan, A.l., Norly, S., Samuel Tay, Vicknesh, C.

International Medical Journal Malaysia, 2016;15(2):81-84.

MyJurnal

Anticipation of complications is of paramount importance for a surgeon. Incisional hernia is a well-known
complication for abdominal surgeries. Risk factors such as increasing age, obesity, male gender are well
known. Intestinal obstruction, strangulation and perforation are imminent complications of this type of
hernia if they become incarcerated. Common contents of a ventral incisional hernia are small bowel, large
bowel and omentum. Even though Meckel’s diverticulum is a common gastrointestinal anomaly, it is rarely
found to be the content of a hernial sac. A hernia sac containing Meckel’s diverticulum is also known as
Littre’s hernia. Only a few cases have been reported in the literature. Thus here we present a case of
perforated Meckel’s diverticulum that was entrapped in the ventral incisional hernia.

Matched MeSH terms: Omentum

Fulltext An omental fibroma resembling a testicular tumour but presented as an irreducible inguinal hernia

Khoo PJ, Jacob S

J Surg Case Rep, 2017 Aug;2017(8):rjx161.

PMID: 28852466 DOI: 10.1093/jscr/rjx161

We present a case of omental fibroma, which posed a surgical diagnostic dilemma. Primary tumours of the omentum are uncommon, and omental fibromas account for 2% of these. The rarity of omental fibroma and paucity of available information hamper an accurate diagnosis. In this particular case, the diagnostic process was misleading. The history was classical of an irreducible inguinal hernia, but the physical examination and imaging studies were suggestive of a testicular tumour. However, intraoperatively, an omental tumour and a normal testicle were found in the scrotum. Histopathological examination proved the tumour to be a fibroma. The presentation of an omental fibroma in an inguinal hernia sac had never been reported in literature. Due to the rarity of such cases, a thorough history, detailed examination, and objective investigation are the pillars to attain the correct diagnosis.

Matched MeSH terms: Omentum

Laparoscopic repair of perforated peptic ulcers: the sutured omental patch and focused sequential lavage technique

Siow SL, Mahendran HA

Surg Laparosc Endosc Percutan Tech, 2014 Apr;24(2):134-9.

PMID: 24686348 DOI: 10.1097/SLE.0b013e31828fa951

We propose a standardized technique of repair and lavage with the outcomes of 50 consecutive patients treated at our institution. The perforation was closed primarily and reinforced with omental patch. It was then followed by peritoneal lavage in a focused sequential manner that involved quadrant to quadrant lavage with tilting of operating table and changing of position between the surgeon and the camera surgeon. None of our patients had postoperative intra-abdominal complications, but unfortunately 1 patient succumbed to respiratory complications. Respiratory complications was the most common postoperative complication in our series (9 patients), whereas 2 patients had ileus. There were no leaks or reoperations in our series. Laparoscopic repair and sutured omentoplasty, followed by focused sequential lavage in a systematic manner, if performed diligently, will yield good outcomes.

Matched MeSH terms: Omentum/transplantation*

Primary torsion of the greater omentum

Gul YA, Jabbar MF, Moissinac K

Acta Chir. Belg., 2001 Nov-Dec;101(6):312-4.

PMID: 11868511

Primary or idiopathic greater omental torsion remains a rare cause of acute surgical abdomen in adults and children. The aetiology is as yet unknown and the treatment of choice, once diagnosis is established, is resection of the torted omentum. We report our experience with three such cases encountered over the last five years, two of which were diagnosed and subsequently managed laparoscopically. The performance of diagnostic laparoscopy for acute abdominal pain of an undetermined origin may lead to an increased detection of this condition and subsequent therapeutic intervention.

Matched MeSH terms: Omentum/blood supply*

Gastrointestinal: Solitary fibrous tumor from lesser omentum: An elderly from Malaysia with an unusual huge painful intra-abdominal mass

Ng CS, Luqman M, Wong ZQ, Ngiu CS, Raja Affendi RA

J Gastroenterol Hepatol, 2017 Oct;32(10):1664.

PMID: 28948703 DOI: 10.1111/jgh.13721

Matched MeSH terms: Omentum*

Omental folding: a novel laparoscopic technique for salvaging peritoneal dialysis catheters

Goh YH

Perit Dial Int, 2008 11 5;28(6):626-31.

PMID: 18981393

BACKGROUND: Omental wrap is a common cause of catheter obstruction. Current laparoscopic techniques for correcting obstruction include omentopexy and omentectomy. This study evaluates the efficacy of a new laparoscopic technique for revision of obstructed peritoneal dialysis catheters.

METHODS: Between November 2005 and November 2006, the technique was applied in 18 patients (6 female, 12 male; median age 50 years, range 16 - 73 years) on continuous ambulatory peritoneal dialysis with catheter malfunction secondary to omental wrap. Pneumoperitoneum was induced under general anesthesia. Three ports were inserted. The catheter was released from the omentum and repositioned in the pelvis. The omentum was then folded onto itself in a cephalad direction using silk sutures. This shortened the omentum. The risk of catheter migration was minimized with a polypropylene sling passed through the abdominal wall and around the catheter, then knotted subcutaneously. The sling allowed catheter removal without a new laparoscopy. The outcomes were prospectively evaluated.

RESULTS: Median operating time was 90 minutes (range 35 - 160 minutes). Adhesiolysis was performed in 4 patients: 1 patient had port-site leakage of dialysate, which settled with abdominal rest; 1 patient had bleeding during adhesiolysis and laparoscopic hemostasis was successful; 1 patient had recurrent catheter obstruction 2 weeks post-operatively and was converted to hemodialysis; and 1 patient had recurrent malfunction secondary to small bowel wrap after 5.5 months; re-salvage was successful. The success rate of the first salvage procedure was 89%(16/18). The catheters were still functioning after a mean follow-up of 16.5 +/- 6.3 months (range 0.5 - 24 months). The 1-year catheter survival rate was 83.3%.

CONCLUSIONS: Omental folding is a safe and effective technique for salvaging peritoneal dialysis catheters.

Matched MeSH terms: Omentum/surgery*

An unusual cause of abdominal pain. Omental torsion

Khine M, Roslani AC

Ann Acad Med Singap, 2009 Feb;38(2):180.

PMID: 19271056

Matched MeSH terms: Omentum*

Fulltext Inflammatory Pseudotumour of Stomach in an old lady: a rare case report

Azhar, A.H., Pasha, M.A., Hassan, S., Zainal, M., Rashidi, A.

International Medical Journal Malaysia, 2009;8(1):45-48.

MyJurnal

Inflammatory pseudotumour (IPT) is a rare benign solid tumor in adults and children. The prevalence, etiology and pathogenesis of this condition are still uncertain. Despite the use of modern laboratory techniques and imaging, it is often difficult to make the diagnosis of IPT. Besides, occasionally the nonspecific morphological appearance and clinical presentation of the mass may mimic other more common primary or secondary neoplasms. IPT is commonly encountered in the lung and mediastinum. Other sites include abdomen (liver, pancreas, stomach, omentum), retroperitoneum, pelvis (bladder) and extremities in children. We report a rare case of gastric inflammatory pseudotumour in a 65-year-old female patient. Clinical presentations and its management along with review of literatures are presented.

Matched MeSH terms: Omentum

A 35 Year Old Bangladeshi Lady with Hereditary Mucinous Ovarian Cancer, Complicated with Omental Metastasis

Islam MJ, Roshid B, Pervin S, Kabir S, Chigurupati S, Hasan MN

Mymensingh Med J, 2019 Apr;28(2):484-489.

PMID: 31086172

Approximately 80% ovarian tumors are benign, and these arise mostly in young adult females. Malignant tumors are more prevalent in ageing women, between the ages of 45-65 years. Mucinous ovarian cancer represents about 5% of epithelial ovarian cancers (EOC). We have reported a case of mucinous cystadenocarcinoma in 35-year-old lady with metastasis to momentum. Imaging (Radiograph & CT scan) studies showed a large right sided pelvic mass with probable origin in the right ovary. Cancer antigen-125 was elevated, while carcinoembrionic antigen and alpha-fetoprotein were normal. Mutational profiles shown distinct finding, as KRAS mutations positive nevertheless p53 and BRCA mutations are absent. She had undergone total abdominal hysterectomy with bilateral salphingo-oopherectomy along with pelvic dissection for removal of lymph nodes at the age of 35. She was given 3 cycles of chemotherapy with cisplatin and paclitaxel. To the best of our knowledge, this is the one of the little cases of ovarian mucinous cystadenocarcinoma being reported at a relatively young age and the first case being reported from Bangladesh.

Matched MeSH terms: Omentum/pathology*

Composite mucinous and granulosa-theca-cell tumour of the ovary: an unusual neoplasm

Chandran R, Rahman H, Gebbie D

Aust N Z J Obstet Gynaecol, 1993 Nov;33(4):437-9.

PMID: 8179566

This case represents a unique primary ovarian tumour consisting of malignant mucinous elements and granulosa-theca-cell elements, the histogenesis of which remains uncertain. It also underscores the need for thorough sampling of mucinous tumours in order to discover a possible coexisting, different neoplastic component.

Matched MeSH terms: Omentum

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