Surgical Treatment for Aseptic Mediastinitis in the Late Phase after Aortic Root and Arch Replacement / 日本心臓血管外科学会雑誌

Objective: A few cases of an aseptic abscess after thoracic aortic surgery have been reported. However, it sometimes requires surgical treatment because the rapid growth of perigraft fluid collection results in exposure towards the body surface. We discuss the results of our treatment of these cases. Methods: This study was a retrospective analysis. Four of 341 cases who underwent thoracic aortic surgery between April 2013 and March 2020 were included. These cases presented with a bulge of the body surface 10.3 (range, 3-27) months after surgery. Results: Although the fluids looked purulent in all cases, no bacteria were detected. We diagnosed them as aseptic abscess, for which omental implantation was performed. No signs of recurrence have been found in any cases even after 5.4 (range, 1-8.5) years. Conclusions: Omental implantation was effective for controlling aseptic abscess for long-term periods.

Internal hernia after laparoscopic left colectomy: case series and review of the literature

Objective: Laparoscopic colectomy has gained acceptance as a standard treatment for benign and malignant colorectal disease, such as diverticular disease and cancer, among others. Same as in open surgery, the laparoscopic approach carries a low risk of small bowel obstruction in the postoperative period, but in laparoscopic surgery, internal hernia after laparoscopic left colectomy may be a cause of small bowel obstruction with a significant risk of morbidity and mortality. This rare complication may be prevented with routine closure of the mesenteric defects created during the colectomy. Methods: We present four cases of internal herniation after laparoscopic colectomy. Two cases were after laparoscopic left colectomy and two after laparoscopic low anterior resection. All four cases had full splenic flexure mobilization. Routine closure of the mesenteric defect was not performed in the initial surgery. Results: The four patients were treated by laparoscopic reintervention with closure of the mesenteric defect. In two of them, conversion to open surgery was necessary. One of the patients developed recurrent internal herniation after surgical reintervention with mesenteric closure of the defect. All patients were managed without need for bowel resection, and mortality rate was 0%. Conclusion Internal herniation after laparoscopic colorectal surgery is a highly morbid complication that requires prompt diagnosis and management and should be suspected in the early postoperative period. Additional studies with extended follow-up are required to establish recommendations regarding its prevention and management. (AU)

An Approach To Demonstrate The Foramen Bursa Omenti Majoris And The Guarding Peritoneal Folds And The Recesses Of Omental Bursa

Background: Development of high-resolution computed tomographic imaging has substantially improved the radiologic examination of the omental bursa or lesser sac. However, dissection procedure to demonstrate the omental bursa and it two recesses in cadaver did not receive adequate attention in past decades. This was a cross-Methods: sectional, observational study on 20 cadavers. Relatively disease-free fresh adult cadavers of both sexes were selected randomly. Omental bursa was exposed through transgastric approach. Photographs taken after proper exposure. Results: In every dissection, omental bursa, superior and inferior recesses, foramen bursa omenti majoris, right and left gastropancreatic folds were clearly understood. In our study, an effort was made to establish a cadavericConclusion: dissection procedure to delineate omental bursa which may add to existing knowledge in medical education technology as well as help the surgoens particularly who are performing minimally invasive surgery (MIS)

A Case of Tubercular Infrarenal Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

The patient was an 81-year-old male. During treatment of a refractory subcutaneous abscess, he was diagnosed with an infection of an infrarenal aortic aneurysm caused by unknown bacteria. Antibiotic administration was initiated, but the infection persisted and there was no improvement of the aortic infection focus or aneurysm morphology. In order to control the infection and avoid rupture of the aortic aneurysm, excision of the infectious abdominal aortic aneurysm, omental plombage, and debridement of the surrounding infected tissue were performed. According to histopathological examination of the extracted sample, findings were consistent with an infection of the aortic aneurysm. Although administration of antibiotics continued, the infection continued to worsen during the postoperative course and an enlarged subcutaneous abscess and miliary tuberculosis were indicated by computed tomography. Therefore, an acid-fast bacteria culture test of the subcutaneous abscess, sputum, and urine and Tuberculous (Tb)-real time polymerase chain reaction (PCR) tests were carried out. According to Tb-PCR test of the subcutaneous abscess, mycobacterium tuberculosis was detected. In the re-evaluation of the extracted sample, granulomatous inflammation with spindle-shaped cell fenestration around the necrotic tissue and the appearance of epithelial cells and multinucleated giant cells were observed. Findings were consistent with a tubercular infection of the aortic aneurysm. Anti-tuberculosis treatment was initiated, and significant improvement of the inflammation and subcutaneous pus in the right chest were observed. On Day 39 after surgery, the patient was discharged from the hospital and walked home with no help. We experienced a successful case of tubercular infection of an infrarenal aortic aneurysm requiring surgery. Infection was controlled and rupture of the aortic aneurysm was avoided with surgical treatment and antituberculosis therapy. (Surgical treatment by excision of infectious abdominal aortic aneurysm, omental plombage, and debridement of the surrounding infected tissue, and antituberculosis therapy were carried out.)

Progress in surgical treatment of lower limb lymphedema after gynecological malignant tumour radical operation / 中华显微外科杂志

The progress in the treatment of gynecological malignant tumours has prolonged the survival time of postoperative patients, but lower limb lymphedema as a complication has seriously affected the health and quality of life of postoperative patients. In recent years, secondary lymphedema of lower extremities after radical resection of gynecological malignant tumours has attracted more and more attention. This paper reviews the progress of surgical treatment, introduces the application, indications, existing issues and matters that requir attentions and various surgical methods, and to puts forward a possible development direction in the future.

The left gastro-omental vessels are able to maintain the entire spleen blood supply / Os vasos gastromentais esquerdos são capazes de manter o suprimento sanguíneo de todo o baço

Abstract The spleen is supplied by blood flow through the splenic artery and vein. The purpose of this communication is to report an ectopic spleen supplied only by reverse flow through the left gastro-omental vessels. A 14-year-old boy presented with pelvic splenomegaly supplied only by the left gastro-omental artery and veins connected to the inferior polar vessels, which were the only vessels communicating with the spleen. After detorsion of the spleen and splenopexy, the spleen returned to normal dimensions. The patient had uneventful follow-up. In conclusion, the left gastroepiploic vessels are able to maintain the entire spleen blood supply.

Resumo O baço é suprido pelo fluxo sanguíneo da artéria e veia esplênicas. O objetivo desta comunicação é apresentar um baço ectópico suprido apenas pelo fluxo sanguíneo reverso proveniente dos vasos gastromentais esquerdos. Um paciente de 14 anos apresentou esplenomegalia pélvica suprida apenas por artéria e veia gastromentais esquerdas, conectadas aos vasos polares inferiores, que eram os únicos presentes nesse baço. Após a distorção do baço e a esplenopexia, o baço voltou às dimensões normais. Não houve intercorrências no acompanhamento do paciente. Em conclusão, os vasos gastromentais esquerdos são capazes de suprir o fluxo sanguíneo de todo o baço.

Omental lipoma in pediatric age group: clinical presentation, image findings and management

ABSTRACT A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.

An unusual case of primary peritoneal adenocarcinoma

Primary peritoneal adenocarcinoma is sporadic with few cases cited in pre-existing literature. This cancer arises from the peritoneal epithelium lining of the abdomen, which is derived from extra ovarian mesothelium. It generally carries a poor prognosis. The treatment strategies are similar to ovarian serous papillary carcinoma. Report an incidental finding of primary peritoneal adenocarcinoma in a 39-year-old female army personnel, currently undergoing her chemotherapy and thriving. Exploratory laparotomy was done given the incidental finding of a mass on the contrast-enhanced computed tomography scan (CT). The mass was attached to the greater omentum, however, did not invade the mucosa of the transverse colon. Given this, part of greater omentum was removed. The findings of the immunohistochemical studies of the tumour are described within this report. The diagnosis of a primary peritoneal adenocarcinoma, stage II was established as no other primary site were found upon further investigation. The patient was treated with chemotherapy (carboplatin/paclitaxel) which was planned for 6 cycles. Otherwise, the patient had an uneventful postoperative course, is underway her chemotherapy regime and is planned for interim CT study to assess chemotherapy response. To conclude, isolated solitary primary peritoneal adenocarcinoma without peritoneal carcinomatosis, gastrointestinal manifestations and ascites are rare. This case, however, demonstrates the importance of its diagnosis, accurate evaluation and management.

Experience of management of abdominal cysts

Benign intra-abdominal cystic masses in children are rare and they have diverse etiopathogenesis, clinical presentation. The present study highlights the experience in the management of benign intra-abdominal cysts pertaining to the diverse etiologies associated with these lesions. The medical records of our hospital between November 2016 to November 2019 were retrospectively reviewed. Patients with cystic abdominal masses were studied with respect to less different clinical presentations, localization of masses, diagnostic tests, surgical aapproaches, histopathological examinations and outcome. Out of the 55 cases, most common lesion was a choledochal cyst. Miscellaneous diagnosis includes an omental cyst, urachal cyst and a pedunculated bile duct cyst. All the cystic lesions of the abdomen need to be considered as close differentials in clinical practice due to the common presentations and similar symptoms produced by these lesions. All the lesions were managed by exploratory laparotomy except two ovarian cysts which were managed with laparoscopic approach.

Primary omental infarction: a report of a series of cases in an Indian tertiary care hospital

Primary omental infarction is a relatively rare and often presents as right sided abdominal pain. It is often diagnosed as appendicitis and is usually picked up intra-operatively, or - as often seen nowadays - on imaging. We describe a series of four cases of primary omental infarction that presented to us with varying clinical features. Three of them had a short history of right sided abdominal pain, whereas the fourth patient had a longer history of left sided abdominal pain. All 4 were managed operatively, with the fourth having presented with an intra-abdominal abscess that required laparotomy. Primary omental infarction is a diagnosis which must be considered in any case of acute abdomen. Cases diagnosed with certainty on imaging may be managed conservatively but must be followed up closely. Need for surgical intervention should be considered in select cases.

Open versus laparoscopic repair of perforated duodenal ulcer: a comparative study

Background: Surgery is the mainstay of the treatment for perforated duodenal ulcer by closing the perforation with or without omental patch. There are no controversies in the surgical treatment of perforated duodenal ulcer but the best approach to surgery is still debatable. Advances in minimal access surgery has made it possible to close the perforated duodenal ulcer laparoscopically. The present study was conducted to compare the results of open and laparoscopic repair of perforated duodenal ulcer in terms of operative time, postoperative pain, hospital stay, and post-operative complications etc.Methods: The study was conducted in Dr. V. M. Government Medical College and Hospital located in Solapur (Maharashtra) from December 2008 to December 2010. It was a prospective comparative study. Patients were randomly divided into 2 groups alternately where group A and B were operated by conventional and laparoscopic techniques respectively and their outcomes were compared.Results: Most commonly affected age in this study was 51 to 60 years with male preponderance. Post-operative pain, analgesic requirement, wound infection, hospital stay, was significantly less in laparoscopic group as compared to open group (p<0.05).Conclusions: Laparoscopic repair of perforated duodenal ulcer is safe and feasible in properly selected patients and has superior results as compared to open surgery.

Giant peptic ulcer perforation- omentopexy versus omental plugging: a comparative study

Background: Giant peptic ulcer perforation is a life-threatening surgical emergency with high mortality rate. This study compares two different surgical techniques omentopexy and omental plugging for the treatment of giant peptic perforation.Methods: This study was a prospective study comparing the efficacy of omental plugging and omentopexy. The study was done at Emergency Department of General Surgery in Nalanda Medical College and Hospital, Patna over one-year period from October 2017 to September 2018. Patients were randomly allocated to two groups: one for omental plugging (cases) and other for omentopexy (controls).Results: A prospective non-randomized study of 12 patients with giant peptic perforation (≥2 cm in diameter) was carried out over a period of 24 months. The highest incidence was seen in males over 50 years of age. Biliary leak rates were 33% in the omentopexy group compared to no leak in the omental plugging group. This rate when calculated on standard error of proportion was significant at 5% level (p<0.05). Mortality rate was higher in omentopexy group compared to omental plugging group.Conclusions: Omental plugging seems to be associated with low rates of biliary leak compared to omentopexy and hence should be the procedure of choice in giant peptic ulcer perforation compared to omentopexy.

Primary omental gangrene presenting as acute abdomen

Primary omental gangrene is a very rare but important cause of an acute abdomen. We came across a case of an acute abdomen which was taken up for emergency laparoscopic appendicectomy. On laparoscopy, torsion of the free part of the omentum, leading to distal gangrene, was found. Intraoperative diagnosis of primary omental gangrene was made. Preoperative diagnosis of this condition is difficult. Through our case report, we want to highlight about this rare cause of pain abdomen as knowledge of this pathology is important to the surgeon because it mimics the other common causes of the acute surgical abdomen.

Pro-vascularization of tubular graft of bone marrow mesenchymal stem cells and bladder acellular matrix wrapped up in omentum / 西安交通大学学报(医学版)

Objective: To study the vascularization of tubular graft of bone marrow mesenchymal stem cells (BMSCs) and bladder acellular matrix (BAM) wrapped up in omentum. Methods: We planted BMSCs on the BAM and made it into tubular grafts. Thirty healthy New Zealand white rabbits were randomly divided into three groups with 10 rabbits in each. Rabbits in experimental group received BMSCs-BAM tubular graft wrapped in omentum. Rabbits in control group received BAM tubular graft wrapped in omentum. Rabbits in blank group were planted with silicone catheter wrapped in omentum. Vascular endothelial growth factor (VEGF) protein, CD34 expression and microvessel density of the graft were measured at weeks 4 and 8, respectively. Results: ① The expression of VEGF protein was higher in the experimental group than in the control group and the blank group, and the expression of VEGF protein was higher in the control group than in the blank group; the differences among the three groups were statistically significant [F(2,15)=5.314, P=0.017]. ② The microvessels with positive CD34 expression were denser in the experimental group than in the other two groups, and the blood vessels were closely connected with each other. The microvessels with positive CD34 expression were also much denser in the control group than in the blank group. ③ The microvessel density was higher in the experimental group than in the control group and the blank group, and it was also higher in the control group than in the blank group. The differences among the three groups were statistically significant [F(2,12)=6.172, P=0.021]. Results: Omental wrapping promotes vascularization of BAM, and planting BMSCs on the BAM is more conducive to vascularization of BAM.

Ultrasonographic findings and diagnosis of omental dedifferentiated liposarcoma: a case report / Journal of Rural Medicine

Liposarcoma is one of the most common types of soft tissue sarcomas and can develop at any site, although omental liposarcoma is extremely rare. Omental liposarcoma has a poor prognosis because the diagnosis is difficult, until it presents as a large tumor causing severe noticeable clinical symptoms. A 51-year-old male with lower abdominal pain was referred to our clinic. Abdominal ultrasonography revealed an ill-defined, solid, heterogeneous, and hypoechoic tumor deep in the lower abdomen. Generally, liposarcomas are hyperechoic, though 20% of liposarcomas present as hypoechoic tumors. This variation might occur depending on the pathological classification. We should consider the possibility of a dedifferentiated component if ultrasonography reveals typical features of soft tissue sarcoma with hypoechoic lesion.

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

@#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.

Laparoscopic excision of large omental cyst at department of pediatric surgery in Sanglah general hospital, Bali, Indonesia

Omental cyst is rare. All conditions most likely being of congenital or benign neoplastic lymphatic origin. Patients with Omental cysts usually present with abdominal distention and a painless abdominal mass. The most common physical finding of an omental cyst is a freely movable abdominal mass. The diagnostic procedure include CT scans. Complete excision by open or laparoscopically of the cysts is considered as the treatment of choice. Recurrence and malignant deterioration of omental cysts are rare. A case report of a large omental cyst which had been laparoscopically-treated using morcellator. Laparoscopic morcellation  is a technique used in gynecological surgeries such as hysterectomy and myomectomy to remove uteri and uterine fibroids (leiomyomas) through a small abdominal incision. Authors present a case of 3 year old female with pre-operative assessment tumor intra-abdominal suspect abdominal cyst. Subsequently, laparoscopic resection of omental cyst with morcellator was performed. The histopathological report was omental cyst. Omental cysts are rare, but can be shown to have atypical abdominal symptoms and radiologic findings, so clinicians must keep in mind that omental cysts causing abdominal symptoms can be misdiagnosed as simple ovarian cysts of inflammation. Omental cysts can be removed safety laparoscopically with morcellator without bowel or vessel injury.

A study on the non-infectious complications of continuous ambulatory peritoneal dialysis

Introduction: Patients with end-stage renal disease (ESRD) are treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).Non-infectious complications of CAPD are increasing in relative importance due to success in decreasing the rate of peritonitis. Aims and objectives: Our aim was to study the non-infectious complications in patients of ESRD on CAPD and to study the impact of the non-infectious complications in the survival of CAPD catheters. Materials and Methods: A prospective study has been conducted at Regional institute of medical science, Imphal in a total of 71patients of ESRD who are already on CAPD or newly diagnosed ESRD who have undergone CAPD catheter implantation. Their detailed history, clinical examination and relevant laboratory investigations were done and the different non-infectious complications were identified and analysed. Result: Out of the 71 patients studied 39 patients had complications like hypokalemia (15 patients), omental wrap (10 patients), catheter tip migration (6 patients), haemoperitonium (2 patients), hydrothorax (2patients), exit site leak(2patients), abdominal wall edema (1patient), catheter block(1patient). Conclusion: In our study the most common non-infectious complication was hypokalemia followed by omental wrap and catheter tip migration. Knowledge about the common prevalent non-infectious complications of CAPD alerts the treating doctor to take up the specific corrective steps at an earlier stage, thus preventing the morbidity associated with the same. We conclude that the majority of non-infectious complications in these patients were treatable and did not interfere with the catheter survival.

Iatrogenic vesicovaginal fistula repair-experience at Prince Hussein Urology and Organ Transplant Center

Background: Despite the advances in technology in urology practice, and the surgical approach in dealing with iatrogenic vesicovaginal fistula repair, the most important is to achieve continent rate with minimum morbidity.Methods: From January 2006 to December 2017, the medical records and operative notes of 52 female (mean age 37 year) who had undergone transabdominal transvesical operative repair of their vesicovaginal fistula (VVF) at this institution were reviewed retrospectively. CT urography and diagnostic cystourethroscopy were the modalities of diagnostic tools. Trans-abdominal, transvesical repair with omental flap interposition were performed within 4-6 months in all cases. Patients were evaluated at two to three weeks initially, then at three months interval and later annually.Results: In present study, the most common presentation of VVF was urine leakage through vagina. In two third of the patients the etiology was due to hysterectomy procedure, regarding the location of the fistula, 94.2% of the fistulas located high in the posterior wall of the urinary bladder (supratrigonal), with the mean size of 2.2cm (range 5-25mm). 49 patients had single fistula (94.2%). The mean operative time was 110 minutes (range 60-130 minutes) and the mean post-operative urethral catheterization was 21 days (range 17-24 days). Almost all patients were continent after a mean of five months.Conclusions: Iatrogenic VVF is one of the distressing complications of gynecological procedure; delayed transabdominal transvesical approach with omental flap interposition is associated with excellent and durable results with minor morbidity. Standardization of the technique is a key success in the outcome of the repair.

Open Repair without Esophagectomy for an Aortoesophageal Fistula after Thoracic Stent Grafting / 日本心臓血管外科学会雑誌

An aortoesophageal fistula is a critical condition with high operative mortality. A case of aortoesophageal fistula following thoracic endovascular aneurysm repair is reported. The patient was a 72-year-old man complaining of dysphagia who underwent stent grafting for a saccular aneurysm of the descending aorta that was compressing the esophagus four months earlier. Endoscopic examination showed perforation of the aneurysm into the esophagus with severe stenosis. The aneurysmal sac was filled with thrombus. Aortography demonstrated a type I endoleak from the lesser curvature of the aortic arch, draining into the aneurysmal sac. The patient was afebrile with moderate elevation of C-reactive protein, and the white blood cell count was normal. The patient underwent closure of the aneurysmal entry with healthy aortic wall and replacement of the descending aortic aneurysm with a prosthetic graft. The graft was isolated from the fistula by an omental flap. The patient's postoperative course was uneventful. Computed tomography performed 4 years after the surgery showed shrinkage of the aneurysmal sac. The patient has had a healthy life for 9 years since the operation.