Morphological Characteristics of the Results of Experimental Modeling of Septic Peritonitis

SUMMARY: Experimental studies devoted to the study of the mechanisms of the pathogenesis of acute peritonitis and the development of new methods of medical and surgical treatment are becoming increasingly relevant. Today, experimental medicine knows many different ways to modeling septic peritonitis and eliminate it, but the role of the local immune system is underestimated, whereas it takes a direct part in inflammation. The objective of our work to study morphological features of results of experimental modeling of septic peritonitis in white rats. The study included 15 sexually mature white male rats weighing 276.75±6.56 grams. A simulation of septic peritonitis was performed by perforating the upper part of the cecum with four punctures with a G16 injection needle. As a result of the experiment, after examination of the peritoneal cavity, all 15 animals were diagnosed with omentum tamponade of perforated damage to the caecum. In 11 cases, the perforated wall of the caecum was covered by the greater omentum (73.34 %), and in the other 4 animals, tamponade was performed by one of the epididymal omentum (26.66 %). The initial stage of tamponade with the greater or epididymal omentums of a perforated caecum begins on the first day of the experiment and consists of tight interstitial consolidation between them, as well as in the invasion of blood vessels from the omentum side to the focus of infection, which ensure the delivery of the appropriate immunocompetent cells. As a result of this process, intensive lymphoid infiltrates are formed in this area, as well as the growth of adipose tissue, which isolates the inflammatory focus from the peritoneal cavity with a thick layer.

Las investigaciones experimentales dedicadas al estudio de los mecanismos de patogénesis de la peritonitis aguda y el desarrollo de nuevos métodos de tratamiento médico y quirúrgico son cada vez más relevantes. Hoy en día, la medicina experimental conoce muchas formas diferentes de modelar la peritonitis séptica y eliminarla, pero se subestima el papel del sistema inmunológico local, mientras que él participa directamente en la inflamación. El objetivo de nuestro trabajo fue estudiar las características morfológicas de los resultados del modelado experimental de peritonitis séptica en ratas blancas. El estudio incluyó 15 ratas macho blancas, sexualmente maduras que pesaban 276,75 ± 6,56 gramos. Se realizó una simulación de peritonitis séptica perforando la parte superior del ciego con cuatro punciones con una aguja de inyección G16. Como resultado del experimento, después del examen de la cavidad peritoneal, a los 15 animales se les diagnosticó taponamiento del omento o lesión perforada del ciego. En 11 casos, la pared perforada del ciego fue recubierta por el omento mayor (73,34 %), y en los otros 4 animales el taponamiento se realizó por uno de los epidídimos (26,66 %). La etapa inicial del taponamiento con omento mayor o epidídimo de un ciego perforado comienza el primer día del experimento y consiste en una estrecha consolidación intersticial entre ellos, así como en la invasión de los vasos sanguíneos desde el lado del omento hasta el foco de infección, que aseguran la entrega de las células inmunocompetentes apropiadas. Como resultado de este proceso, se forman intensos infiltrados linfoides en esta zona, así como el crecimiento de tejido adiposo, que aísla el foco inflamatorio de la cavidad peritoneal con una gruesa capa.

Abdomen agudo por torsión de epiplón mayor simulando una apendicitis aguda / Acute abdomen due to torsion of greather omentun simulating acute appendicitis

La torsión del epiplón mayor es una patología poco frecuente con una clínica inespecífica, por lo que históricamente su diagnóstico es realizado en el quirófano ya que simula patologías como la apendicitis o colecistitis. Los métodos auxiliares de diagnóstico como las ecografías o las tomografías son de mucha utilidad para la sospecha de esta patología, aunque no cuenta con signos patognomónicos de la enfermedad, las imágenes asociadas a la clínica del paciente pueden llevar a un diagnóstico preciso. Presentamos el caso de un paciente joven de sexo masculino, que acudió al servicio de urgencias por cuadro de dolor abdominal tipo cólico de moderada intensidad en fosa iliaca derecha, acompañado de sensación febril, sin alteración de la analítica sanguínea, sin hallazgo de valor en la ecografía abdominal, que ante la persistencia del dolor y la fiebre se realizó una tomografía contrastada en la que se observó un empastamiento del epiplón sometiéndose a una laparoscopía exploradora con el hallazgo de una torsión del epiplón mayor.

Torsion of the greater omentum is a rare pathology with non-specific symptoms, so historically its diagnosis is made in the operating room since it simulates pathologies such as appendicitis or cholecystitis. Auxiliary diagnostic methods such as ultrasound or tomography are of very useful for the suspicion of this pathology, although it does not have pathognomonic signs of the disease, the images associated with the patient's symptoms can lead to a precise diagnosis. We present the case of a young male patient who came to the emergency department due to moderately intense colic-like abdominal pain in the right iliac fossa, accompanied by a feverish sensation, without alterations in blood tests, without any finding of value in the abdominal ultrasound, due to the persistence of pain and fever, a contrast-enhanced tomography was performed in which a filling of the omentum was observed, undergoing an exploratory laparoscopy with the discovery of a torsion of the greater omentum.

A rare case of extragonadal immature teratoma mimicking as subserosal pedunculated myoma

Immature teratomas are usually derived from a malignant transformation of mature teratoma. The pure immature teratoma accounts for less than 1% of all ovarian cancers. It is the second most common germ cell malignancy and accounts for 10-20% of all ovarian malignancies seen in women younger than 20 years of age. Extragonadal origin are extremely rare and the most common extragonadal site of these teratomas is the omentum. We hereby describe a case report of a 29-year-old lady who presented with abdominal pain and her imaging with an ultrasound revealed a mass with features suggestive of a subserosal fibroid. She underwent a laproscopic myomectomy. A histopathologic diagnosis of Immature teratoma was made following her primary surgery. She subsequently underwent a staging laparotomy which was followed by chemotherapy. Immature teratomas predominantly occur in young patients, and preservation of fertility is an important factor in its management. Treatment should be initiated as soon as possible after surgery, preferably within 7-10 days, in those patients who require chemotherapy.

Topographical anatomy of the greater omentum and transverse mesocolon: a study using human fetuses / 대한해부학회지

Effect of Electroacupuncture on Serum Ins and the Fat Content in Male and Female Experimental Obesity Rats / 上海针灸杂志

Objective To explore the difference in the regulating effect of electroacupuncture on serum insulin (Ins) and fat consumption between male and female simple obesity rat and the possible mechanism of its action.Methods A rat model of simple obesity was made by induction with sodium glutamate. The rats were randomized into model and electroacupuncture groups (male and female), 10 rats each. A normal group of 10 rats (male and female) was established as a control. Points Quchi, Zhongwan, Guanyuan, Housanli, Fenglong and Sanyinjiao were selected in the electroacupuncture group. Stimulation with a low frequency of 2 Hz was provided after needle insertion. The treatment was given once daily for 28 consecutive days. Serum Ins content, and greater omentum, pericardiac and perirenal fat weights were measured in the male and female groups of rats before and after electroacupuncture intervention. The comparisons were made.Results Serum Ins content, and greater omentum, pericardiac and perirenal fat weights were significantly lower in the electroacupuncture male and female groups of rats than in the model male and female groups of rats (P<0.01) and also in the electroacupuncture male group of rats than in the electroacupuncture female group of rats (P<0.05).Conclusions Electroacupuncture has different degrees of weight-reducing effect in both male and female obesity rats. The reducing effect on serum Ins content, and greater omentum, pericardiac and perirenal fat weights is better in male obesity rats.

Clinicopathological analysis of 39 cases with primary fallopian tube cancer / 实用肿瘤学杂志

Objective The objective of this study was to investigate the clinicopathological features and rational treatment of primary fallopian tube cancer(PFTC).Methods The clinical and pathological data of 39 patients with primary fallopian tube cancer from January 2006 to July 2016 in Beijing Tongren Hospital of Capital University were retrospectively analyzed.Results There were 39 cases of undifferentiated carcinoma,including 1 case of undifferentiated and transitional cell carcinoma,37 cases of undifferentiated adenocarcinoma,or 29 cases of simple adenocarcinoma and 10 cases of mixed type.Among them,7 cases were treated with clear cell carcinoma,endometriosis in 2 cases,combined with transitional cell carcinoma in 1 case.Extra-pelvic metastases were the most common site of the omentum with 17 cases.The preoperative test CA125 was increased in 13 cases and 38 patients received postoperative chemotherapy.The 5-year overall survival rate of 39 patients was 51.3%.Univariate analysis showed that postoperative pathologic stage(Ⅰ~Ⅱ vs.Ⅲ,P<0.001),intraoperative residual lesion size(P<0.001),omentum metastasis(P<0.001),ovarian metastasis(P=0.034),retroperitoneal lymph node metastasis(P=0.018)and preoperative CA125 elevation(P=0.002)were associated with prognosis,while age(P=0.310)and pathological grade(P=0.663)were not associated with prognosis.Multivariate analysis showed that the number of patients with postoperative lymph node metastasis(P=0.018)and preoperative CA125 elevation(P=0.002)were correlated with prognosis(HR=1.202,95% CI:2.354~63.290,P=0.003) and pathological stage(HR=3.810,95% CI:1.202~12.079,P=0.023).They were associated with prognosis as independent prognostic factors.Conclusion Tumor pathologic staging and omentum metastasis are important prognostic factors influencing the prognosis of patients with primary fallopian tube cancer.Early diagnosis and complete operation can improve the prognosis of patients.

Management of full-length complete ureteral avulsion

ABSTRACT Introduction Complete ureteral avulsion is one of the most serious complications of ureteroscopy. The aim of this report was to look for a good solution to full-length complete ureteral avulsion. Case presentation A 40-year-old man underwent ureteroscopic management. Full-length complete avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed 6 hours after ureteral avulsion. The patient was followed-up during 34 months. Double-J tube was removed at 3 months after operation. Twenty three months after the first operation, the patient developed hydronephrosis because of a new ureter upside stone, then rigid ureteroscopy and holmium laser lithotripsy were used successfully. Conclusion Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis may be a good choice for full-length complete ureteral avulsion.

Effect of omental flap wrapping of pancreaticoduodenectomy on postoperative pancreatic fistula and intra-abdominal bleeding: a meta-analysis / 中华内分泌外科杂志

Objective To determine the effect of omental flap wrapping of pancreaticoduodenectomy on postoperative pancreatic fistula and intra-abdominal bleeding in patients undergoing pancreaticiduodenectomy through meta-analysis of published studies.Methods Articles about whether omental flap wrapping could prevent postoperative pancreatic fistula and intra-abdominal bleeding were searched in databases of MEDLINE,PUBMED and EMBASE.14 English article were found and according to including and excluding criteria,4 eligible articles with a total of 2971 patients were selected.Random effects model was used to analyze odds ratios and 95％ confidence intervals (CIs).Results 1129 patients were in omental wrapping group,and 1842 patients in nonomental wrapping group.Omental roll-up during pancreaticoduodenectomy could not prevent postoperative pancreatic fistula (OR =0.81,95 ％ CI 0.40～1.63,P＞0.05) or postoperative abdominal bleeding (OR=0.67,95％ CI 0.28～1.59,P＞0.05).The sensitivity analysis showed the pancreatic fistula rate was lower in the nonomental roll-up group than that in the omental roll-up group (OR=1.24,95％ CI 1.03～1.50,P＜0.05).Conclusions Omental wrapping can not decrease the risk of pancreatic fistula and abdominal bleeding after pancreaticoduodenectomy.Further randomized controlled trials are needed to identify the effect of omental wrapping technique for pancreaticoduodenectomy.

The MSCT findings of greater omentum blunt trauma / 实用放射学杂志

Objective To improve the accuracy of diagnosis of the greater omentum blunt trauma(GOBT)by analyzing the MSCT findings and pathological features.Methods The MSCT appearances of 5 1 cases of GOBT with operation and (or)pathological con-firmed were analyzed retrospectively.All patients were underwent MSCT plain scan in whole abdomen.Two experienced radiolo-gists blinded to the clinical diagnosis,reached a diagnosis from the MSCT findings by two ways of plain and plain joint post-process-ing MSCT images.The detection rates of GOBT were compared by two-related-samples Fisher exact probability chi-square test.Re-sults Fifty-one cases of GOBT were distributed over the intestine,in the superior abdominal cavity,the left and the right abdominal cavity,those cases were 27,18,3 and 3 respectively.The MSCT findings of GOBT mainly consist of greater omentum(GO)streak-ing,GO hematoma and fluid around GO.Those detectable rates were 80.3%,68.6%and 90.2 % respectively.The accuracy in di-agnosis of GOBT with MSCT was 94.1%(48/51)in our study.The detection rate of GOBT by two ways was significant (P=0.04).The detection rate of GOBT was increased obviously by the way of plain joint post-processing MSCT images.Conclusion MSCT manifestations of GOBT has some characteristics.A more accurate diagnosis of GOBT could be made according to the MSCT findings by plain joint post-processing MSCT images.

Comparison of biological characteristics of adipose-derived stem cells from different parts / 中国组织工程研究

BACKGROUND: Whether the differences exist between adipose-derived stem cells isolated from different parts of rats when cultured in vitro has been poorly understood. OBJECTIVE: To compare the growth characteristics and adipogenic ability of adipose-derived stem cells isolated from different parts of rats. METHODS: Freshly isolated adipose-derived stem cells were obtained from 5 mL inguinal groove and greater omentum adipose tissue of F344 rats using type Ⅰ col agenase digestion method. Then, adipose-derived stem cells were counted and cultured in vitro. Morphological and growth characteristics of adipose-derived stem cells derived from the two sites were observed. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was utilized to examine the doubling time of adipose-derived stem cells from different parts. The passage 2 adipose-derived stem cells were induced adipogenical y. Fourteen days after being induced, the differentiated cells were stained with oil red O and the positive cells were counted. The adipogenic differentiation ability of adipose-derived stem cells from the different parts was assessed. RESULTS AND CONCLUSION: (1) The number of adipose-derived stem cells from the greater omentum fat tissue in the same group was (281±10)×107/L, which was significantly higher than that from the inguinal groove fat tissue [(85±10)×107/L] (P < 0.01). Adipose-derived stem cells from the greater omentum and inguinal groove fat tissue achieved the exponential growth period on days 5 and 6, respectively, and achieved the platform period on days 9 and 10, respectively. The corresponding doubling time was 50 hours and 60 hours, respectively. After being passaged, adipose-derived stem cells grew in fibroblast-like shape actively. The adipogenic differentiation rate of adipose-derived stem cells from the greater omentum fat tissue was higher than that from the inguinal groove fat tissue [(38.90±2.86)% vs. (35.30±3.29)%, P < 0.01]. This shows that the number and the adipogenic differentiation ability of adipose-derived stem cells from different parts of the same F344 rat are different.

Follicular Dendritic Cell Sarcoma of the Omentum: Multidetector Computed Tomography Findings

We report computed tomography (CT) findings for a rare case of follicular dendritic cell sarcoma of the greater omentum from a 47-year-old female patient. The tumor presented ash a palpable mass lesion in the umbilical region for the last two months. Multidetector CT scan of the abdomen showed a 14-cm soft-tissue mass with calcification and necrosis within the greater omentum. As a result, a follicular dendritic cell sarcoma should be considered in the differential diagnosis of a solitary omentum mass, especially one with coarse and chunk-like calcifications.

Effect of adipose tissue extract of greater omentum on human fibroblasts in vitro / 中华肝胆外科杂志

Objective To study effect of the adipose tissue extract of greater omentum on human fibroblasts. Method The effect of the adipose tissue extract of greater omentum on human fibroblasts was observed by inverted microscope, MTT, flow cytometry, transmission electron microscope. Results The growth of fibroblasts was inhibited by the adipose tissue extract of greater omenturn. The apoptosis of fibroblasts was not inhibited, and the cell function of fibroblasts was inhibited and the mitosis of fibroblasts was affected. Conclusions The growth of fibroblasts can be inhibited by the adipose tissue extract of greater omentum. The formation and development of biliary cicatricial constriction may be affected by the adipose tissue extract of greater omentum.

Applied anatomy of the greater omentum in transplantation / 中华显微外科杂志

ObjectiveTo observe the shape, size, position and vessels of greater omentum. To explore the design of greater omentum and clarify its clinical significance. MethodsThree fresh and 12 formalin-fixed cadaveres were dissected. All of them had no damage nor injury. 1. Macro-micro-dissection: The shape, size and position of greater omentum were observed. The vessels of the greater omentum were studied.2.Lead oxide-gelatin injection technique and three-dimensional reconstruction.Results The length of greater omentum was(24.7±6.9)cm,the width was(28.3+2.8)cm. It could be divided into 3 types: thin type,middle type and thick type, the occurrence rate was 33.3％, 46.7％ and 20.0％ respectively. The blood supply of greater omentum mainly came from the gastroepiploic arch composed of the left gastroepiploic artery and the right gastroepiploic artery.There were 4 main arteries of the greater omentum: ①The right epiploic　artery: The external diameter at origination was (1.0±0.4)mm. ② The middle epiploic artery: The external　diameter at origination was(0.7 + 0.3)mm. ③The left epiploic artery:The external diameter at origination was　(1.2±0.4)mm.④ The accessary epiploic artery:The external diameter at origination was (0.5 ± 0.1)mm.ConclusionAccording to the characteristic of the anterior arch and posterior arch,the position of the middle epiploic artery divarication and the method of spread,the greater omentum is divided into 5 types.It should be according to the characteristic, when the greater omentum is designed and clipped.

Preventive effect of mitomycin C injection via great omentum vein during resection of intrahepatic cholangiocarcinoma against carcinoma recurrence / 第二军医大学学报

Objective: To estimate the preventive effect of mitomycin C (MMC) injection via great omentum vein during resection of intrahepatic cholangiocarcinoma (IHCC) against the recurrence of IHCC. Methods: The clinical data of 73 IHCC patients, who were treated in our hospital form Jan. 2000 to Jun. 2004, were retrospectively analyzed. Thirty-eight patients were injected with 10 mg MMC via great omentum vein during operation; thirty-five patients who received no chemotherapeutic agents were taken as controls. The recurrence of the disease was followed up and was statistically analyzed. Results: Patients in the 2 groups were matchable in sex, age, viral hepatitis, liver cirrhosis, tumor diameter, tumor number, preoperative transcatheter arterial chemoembolization (TACE) or percutaneous ethanol injection therapy (PEIT), blood transfusion, portal vein or bile duct thrombus and postoperative TACE (P>0.05). Multivariate analysis showed that the recurrence was related to the number and diameter of the tumors, with the hazard ratios being 1.877 (P=0.001) and 1.391 (P=0.029 4), respectively; injection of MMC had no influence on the recurrence. There was no significant difference in the time of disease-free survival (DFS)between the 2 groups, with the median time of DFS of MMC injection group being 5 months and of control group being 3 months after the first operation(P=0.125 3). The recurrence rates in the MMC group and control group were 65. 79% vs 68.57% (P=0.800 4) 6 months after operation, 81.58% vs 94.29%(P=0.099 0)1 year after operation, 89.47% vs 97.14% (P=1.679 55) 2 years after operation and 92.11% vs 97.14% (P=0.344 7)3 years after operation. Conclusion: Injection of 10mg MMC via great omentum vein during resection of IHCC may have no definite effect on the recurrence of IHCC; however, perspective study is needed to verify this finding.

Angiofibrolipoma de omento mayor: informe de un caso y revisión de la literatura / Angiofibrolipoma of the greater omentum: case report and literature review

Introducción: Los tumores sólidos primarios del omento son extremadamente raros. Como tumores benignos del omento se han descrito los lipomas, leiomiomas, fibromas, y neurofibromas, pero no el angiofibrolipoma. Caso clínico: Varón de 39 años de edad, con dolor abdominal de tres días de evolución localizado en cuadrante inferior derecho del abdomen, acompañado de náusea y vómito, así como dolor en fosa iliaca derecha, signo de McBurney, psoas, obturador y Markle positivos. El laboratorio documentó leucocitosis y bandemia; el ultrasonido abdominal, líquido libre en cavidad y masa no bien definida sugestiva de apendicitis aguda complicada; la laparotomía de urgencia, tumoración de omento mayor con zonas de isquemia, necrosis y hemorragia; el examen histológico, angiofibrolipoma de omento mayor. Conclusiones: El angiofibrolipoma del omento mayor se puede presentar como una urgencia quirúrgica debido a la torsión sobre su propio eje. Ante el hallazgo transoperatorio de una tumoración del omento, la escisión completa con omentectomía es el tratamiento de elección, en tanto se recibe el examen histológico definitivo.

BACKGROUND: Primary solid tumors of the greater omentum are extremely rare. Lipomas, leiomyomas, fibromas, and neurofibromas have been described as benign tumors of the greater omentum, but angiofibrolipomas have not. CLINICAL CASE: We present the case of a 39-year-old male with a 3-day evolution of right lower quadrant abdominal pain associated with nausea and vomiting. McBurney, Psoas, Obturator and Markle signs were all positive. Laboratory analysis revealed leukocytosis and bandemia. Abdominal ultrasound showed free fluid and an undefined mass suggestive of complicated acute appendicitis. Emergency midline laparotomy demonstrated a tumor of the greater omentum with areas of ischemia, necrosis and hemorrhage. Histological exam revealed angiofibrolipoma of the greater omentum. CONCLUSIONS: Angiofibrolipoma of the greater omentum may present as a surgical emergency due to torsion. When a tumor of the omentum is found during surgery, complete excision is the treatment of choice when a definitive histology result is received.

Clinical Characteristics of Incarcerated Inguinal Hernias of the Greater Omentum

PURPOSE: Incarcerated inguinal hernia may have very unusual hernial sac contents. In this study we aim to present clinical characteristics about incarcerated inguinal hernia of the greater omentum. METHODS: We retrospectively analyzed hospital records of 643 adult patients who underwent inguinal hernia repair from November 2001 to January 2009. The age, sex, location, type, symptom duration, body mass index (BMI), comorbidity, type of anesthesia, operative time, postoperative hospital stay and complications were reviewed. RESULTS: Of the 643 cases, 18 cases were omental incarcerated inguinal hernia group (O group). Seventeen in 18 cases of O group were male patient (NS). In O group, 16 cases were indirect type and 2 cases were femoral type (P=0.021). Mean age was younger in O group than in non-omental incarcerated inguinal hernia group (N group) (P=0.017). Duration of symptom was longer (P=0.013), and body mass index (BMI) was larger in O group (P=0.042). Operative time was longer in O group than in N group (P=0.006). CONCLUSION: The patients with omental incarcerated inguinal hernia mostly had long durations of protruding mass without pain. In these patients, operation was relatively difficult due to severe adhesion between the hernial sac and greater omentum. In addition, operative time took approximately 10 minutes longer. Therefore, general and spinal anesthesia is more feasible than local anesthesia.

A Case of an Omental Infarction in a Child / 대한소아소화기영양학회지

An omental infarctions is an uncommon cause of an acute abdomen and a rare entity in children. The etiology is still unclear and the symptoms mimic acute appendicitis. We recently encountered a case of a 10-year-old boy who had a previous surgical history of a manual reduction for intussusception. He complained of abdominal pain and right upper quadrant tenderness without fever or anorexia. An abdominal ultrasonography suggested an omental infarction and computed tomography confirmed the diagnosis. Conservative management was adopted with a rapid and uneventful recovery. Non-operative treatment is a safe and effective treatment of choice for omental infarction.

A case of a primary segmental omental infarction in an adult / 대한내과학회지

A rare primary segmental omental infarction in an adult. Infarction of a part of the greater omentum has been recognized as an uncommon condition that may mimic other acute abdominal conditions, particularly acute appendicitis and acute cholecystitis. The presentation and course are seldom typical of appendicitis or cholecystitis. A greater omental infarction may occur without a recognizable cause, and may be termed "primary" (idiopathic), but in some cases, a cause is discovered, such as; mechanical interference with the blood supply to the omentum secondary to torsion, or systemic disorders such as cardiac, vascular, and hematological disease. The inflammatory necrotic mass resulting from the infarction produces somatic pain at its location in the abdomen. For unknown reasons the infarction occurs most commonly in the right half of the abdomen, especially the lower quadrant. An sign of peritoneal irritation, tenderness, and muscle guarding are the principal findings elicited on palpitation of the abdomen. Occasionally, a point of exquisite tenderness may be detected; this usually corresponds to the site of the infarction. Recognizing the typical imaging featuresan ovoid or cake-like mass in the omental fat with surrouding inflammatory changesof this condition is important, as most cases can be managed without surgery. We report a case of an adult patient with acute abdominal pain who was diagnosed with a right-sided segmental omental infarction.

Primary Torsion of Greater Omentum in Children: Report of Two Cases

Two cases of primary torsion of the greater omentum were described. The first patient was a 5-year-old boy who was admitted to the hospital because of severe abdominal pain for 1 day. The The clinical features were similar to perforated acute appendicitis. Laparotomy revealed a normal appendix and the greater omentum twisted around its pedicle. The second patient was a 7-year-old girl admitted to the hospital because of abdominal pain in right lower quadrant for 2 days. The clinical features were that of acute appendicitis. Laparotomy revealed a normal appendix and primary torsion of greater omentum around its pedicle. In both cases, resection of twisted omentum and incidental appendectomy were done. The microscopic findings in two cases consisted of congestion and vascular hemorrhage. Both patients recovered uneventfully. Torsion of the greater omentum, therefore, may be added to the entities to consider in the differential diagnosis of acute appendicitis.