The lesser omentum approach for laparoscopic pancreatic enucleation / 中华外科杂志

Objective@#To evaluate the feasibility and strategy of the lesser omentum approach for laparoscopic pancreatic enucleation.@*Methods@#Between June 2011 and October 2013, 6 laparoscopic pancreatic enucleations were performed by lesser omentum approach.The average age was 42 years, including 1 male and 5 female.The preoperation diagnosis of 6 cases were pancreatic islet cell tumors determined by abdominal CT/MRI, ultrasound and digital subtraction angiography.The tumors of 3 cases located in pancreatic neck, 2 tumors located in neck and body of pancreas, and 1 tumor located in pancreatic body.Their biggest tumor diameter were 0.8-2.5 cm.@*Results@#Among the 6 cases, all laparoscopic pancreatic enucleations were successfully performed.None of the patients were converted to open operation.Eestimated blood loss was (26.7±18.6)ml, operating time was (82.5±19.4)minutes, and postoperative length of stay was (5.17±1.17)days.Additionally, postoperative complication included grade A pancreatic fistula in 1 case.After 36-64 months followed-up, there was no tumor recurrence and clinical symptom disappeared.@*Conclusion@#For the islet cell tumors located in pancreatic neck and body, the lesser omentumapproach may contribute to good surgical view and operative space, which can make pancreatectomy safer and easier for clinical application.

CT manifestation of lesser omentum invasion by gastric carcinaoma and the influence of lesser omentum on the gastric carcinoma spread / 实用放射学杂志

Objective To investigate the CT manifestations of gastric carcinoma invasion to lesser omentum and to assess the im-pact of lesser omentum on the spreading of gastric carcinoma.Methods We retrospectively reviewed CT findings in 48 patients with gastric carcinoma and lesser omentum involved for primary tumor and the lesser omentum abnormalities.The influence of lesser o-mentum on the extension of gastric carcinoma as well as the accompanied ascites were also analyzed.Results CT manifestations of lesser omentum involvement in gastric carcinoma included the following items:① direct infiltration (35.4%,1 7/48),which was mainly shown as increased density of fatty tissue and the development of mass within the lesser omentum,including spreading into the liver through the lesser omentum directly in two cases;② omental seeding (25.0%,12/48),including smudged appearance (1 1 cases)and omental caking (1 case);③ metastasis of lymph nodes (64.6%,31/48),including enlargement and increase of lymph nodes (27 cases)and cystic mass (4 cases).Ascites was found in 1 1 patients and fluid collection in the lesser sac was shown in 3 of these 1 1 patients.The lesser omentum forms the anterior wall of the lesser sac and separates the fluid collection in the lesser sac from the ascites in the greater peritoneal cavity.Ascites was associated with the omental seeding statistically.Conclusion CT scan is helpful for detecting lesser omentum invasion by gastric carcinoma.The imaging features consist of mass sign,enlargement of lymph nodes,smudged andcakingappearance,and so on.Lesser omentum may also play a certain role in both the extension of gastric carcinoma and the compartmentalization of ascites due to gastric carcinoma.

Cystic Lymphangioma of the Lesser Omentum

A case of cystic lymphangioma of the lesser omentum is described herein. The patient was a 46-year-old man who initially presented with an abdominal mass. Abdominal computed tomography (CT) detected an 11.6x4 cm, lobulated, contoured, low density lesion on the lesser sac. Excision of the mass, including the lesser omentum, and pyloroplasty were performed. The mass was semitranslucent and cystic, and it measured 10x9x2.5 cm in size. The external surface was smooth, but partly enclosed within adipose tissue. The oligolocular cysts contained clear and milky fluid. To our knowledge, this is the first case of lymphangioma of the lesser omentum in the Korean literature. A brief review of the literature is presented following the case report.

Cystic Lymphangioma of the Lesser Omentum

A case of cystic lymphangioma of the lesser omentum is described herein. The patient was a 46-year-old man who initially presented with an abdominal mass. Abdominal computed tomography (CT) detected an 11.6x4 cm, lobulated, contoured, low density lesion on the lesser sac. Excision of the mass, including the lesser omentum, and pyloroplasty were performed. The mass was semitranslucent and cystic, and it measured 10x9x2.5 cm in size. The external surface was smooth, but partly enclosed within adipose tissue. The oligolocular cysts contained clear and milky fluid. To our knowledge, this is the first case of lymphangioma of the lesser omentum in the Korean literature. A brief review of the literature is presented following the case report.

A case of primary leiomyosarcoma of the lesser omentum

Leiomyosarcoma is a rare tumor that originates in the smooth muscle, usually in the gastrointestinal tract, the retroperitoneum and the genitourinary tract. The omentum has been rarely reported as a primary site of occurrence with leiomyosarcoma. A 72 year-old woman, with palpable mass on the left upper quadrant of abdomen and weight loss, was admitted to St. Paul's Hospital. Abdominal CT scan showed a 12 x 8 x 8 cm-sized cystic mass in the left upper quadrant of the abdomen. Endoscopic ultrasonography showed a large cystic mass between the stomach and the liver, which was 1.6 cm length in wall thickness. Laparotomy and resection of the mass was performed. A 12 x 8 x 8 cm-sized mass, originated from the lesser omentum, was discovered near the lesser curvature of the stomach. Microscopic examination revealed spindle-shaped cells with 7-8 mitoses per high power field. She was diagnosed as primary leiomyosarcoma originated from the lesser omentum.