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.

A Different Origin of the Right Gastro-omental Artery / Un Origen Diferente de la Arteria Gastro-omental Derecha

The gastro-omental artery is one of the branches of the common hepatic artery. Alterations in the embryonic development of the ventral splanchnic arteries can cause marked variations. A rare variant of the right gastro-omental artery was observed during dissection of a 50-year-old male cadaver. The occurrence of this variant has not been reported in the specialized literature. This case of a different origin of the gastro-omental artery is described in detail in order to provide information that may contribute to upper abdominal surgeries.

La arteria gastro-omental es una de las ramas de la arteria hepática común. Las alteraciones en el desarrollo embrionario de las arterias ventrales pueden causar variaciones marcadas. Se observó una variante rara de la arteria gastro-omental derecha durante la disección de un cadáver de un hombre de 50 años de edad. La presencia de esta variante no se ha informado en la literatura especializada. Este caso de origen diferente de la arteria gastro-omental se describe detalladamente con el fin de proporcionar información que pueda contribuir a la cirugía abdominal superior.

case of parasitic leiomyoma with serpentine omental blood vessels: an unusual variant of uterine leiomyoma

Leiomyoma is considered as the commonest benign tumor of the genital tract. This case represents a multiparous woman who presented with a history of progressive abdominal distension. On examination, a mobile ill-defined centrally located intra-abdominal mass was noticed. At laparotomy a parasitic fibroid attached to the greater omentum was seen. Resection of the mass and partial omentectomy was performed which was reported as leiomyoma by the histological examination. The patient had an uneventful post-operative recovery. She has been followed up for twelve months with no evidence of recurrence or residual disease

A morphometric study of the intestinal mucosa of rats submitted to omentoenteropexy / Estudo morfométrico da mucosa intestinal de ratos submetidos a omentoenteropexia

CONTEXT: The omentoenteropexy technique was developed as an alternative method for intestinal neovascularization, due to the angiogenic properties of factors from the omentum. OBJECTIVES: This study investigated changes in intestinal villi heights and crypts depths due to surgical techniques: seromiotomy with and without omentoenteropexy. METHOD: Thirty rats were operated on, after being divided into three groups, namely GI, GII and GIII with 10 rats each. In the GI rats were submitted to omentoenteropexy; rats in GII were submitted only to a seromiotomy, and in the GIII only laparotomy. Sixty days after the first surgery, the animals were sacrificed and a segment of intestine was removed for histology using Masson's trichrome technique and morphometric study of intestinal mucosa. RESULTS: The histological findings showed that seromiotomy with or without omentoenteropexy increased the length of intestinal villi when compared with GIII (only laparotomy) (analysis of variance: P = 0.0068; GI 38.88 ± 4.17; GII 39.41± 6.33; GIII 31.85 ± 5.56; GI = GII P>0.05; GII>GIII P<0.05; GI>GIII P<0.001). CONCLUSION: No differences were demonstrated in relation to crypt depths between the groups (P = 0.60). Ongoing studies are being set forth by our group to add more data on the role of omentopexy as a tool to promote neovascularization and intestinal mucosal growth.

CONTEXTO: a omentoenteropexia foi desenvolvida como técnica alternativa para a neovascularização intestinal, devido às propriedades angiogênicas de fatores provenientes do omento. OBJETIVO: Investigar as alterações nas alturas vilositárias e profundidades de cripta na mucosa intestinal de ratos submetidos a seromiotomia com e sem omentopexia. MÉTODOS: Trinta ratos foram operados após serem divididos em três grupos com 10 animais cada um. No grupo I (GI) os ratos foram submetidos seromiotomia seguida por omentoenteropexia; no grupo II (GII) foi realizada apenas a seromiotomia, e no grupo III (GIII) apenas a laparotomia. após 60 dias, os animais foram sacrificados e seus intestinos examinados histologicamente, corados pelo tricrômio de Masson, sendo realizado também estudo morfométrico da mucosa intestinal. RESULTADOS: O estudo mostrou que a altura vilositária é maior nos grupos submetidos a seromiotomia, com ou sem omentopexia, do que no grupo em que se realizou laparotomia apenas, porém entre os dois primeiros grupos não houve diferença significante (análise de variância: P = 0,0068; GI 38,88 ± 4,17; GII 39,41 ± 6,33; GIII 31,85 ± 5,56; GI = GII P>0,05; GII>GIII P<0,05; GI>GIII P<0,001). CONCLUSÕES: Não foram demonstradas diferenças quanto às profundidades de criptas entre os grupos (P = 0,60). Novos estudos estão sendo realizados por este grupo para acrescentar mais dados sobre o papel da omentopexia como forma de promover neovascularização e crescimento da mucosa intestinal.

Adipocyte morphometric evaluation and angiogenesis in the omentum transposed to the breast: a preliminary study

OBJECTIVE: The purpose of this study was to describe the probable mechanism of the volume increase of laparoscopically harvested omentum flaps used to treat breast deformities. METHODS: A histological analysis of omentum samples was performed to study the volume increase of laparoscopically harvested omentum flaps. Samples were harvested immediately after the transposition of the omentum from the abdominal cavity to the breast region and during the second surgical procedure for breast symmetrization of eight patients submitted to the transposition of the omentum flap. Changes in the morphometric measurements of the adipocytes (perimeter, diameter, and area), microvascular density (as measured by the CD31 endothelial marker), and immunohistochemical expression of VEGF were documented. RESULTS: The increases in adipocyte size and microvascular density were statistically significant (P < 0.012). The expression levels of VEGF were lower in the second set of samples when compared to the first set, but the differences were not statistically significant (P < 0.093). CONCLUSION: These results demonstrate an increase in cellular volume as measured by adipocyte perimeter, diameter, and area. Moreover, the increase in the number of vessels in the second set of samples suggests that neoangiogenesis was stimulated by the initial increase in VEGF expression levels observed in the first set of samples. The increase in VEGF expression in the flap may have been caused by adipocyte hypertrophy resulting from neoangiogenesis.

Co-existing acute appendicitis and segmental infarction: report of a case and review of the literature

Omental infarction is a rare entity in children, especially coexisting with acute appendicitis. We present a case of a 6-year old child presenting with abdominal pain with fever, anorexia, and leukocytosis. The child underwent surgery with preoperative diagnosis of acute appendicitis according to the findings of sonography. The definitive diagnosis of an infarcted segment of right side of the greater omentum and acute appendicitis was made intraoperatively and confirmed pathologically. As the etiology is unknown, we surgeons should be aware of the coincident intraperitoneal pathological condition of acute appendicitis and segmental infarction to avoid further complications

Secondary Omental Infarction Related to Open and Laparoscopic-Assisted Distal Gastrectomy: Report of Two Cases

Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

Use of greater omentum in thoracic onco-surgery.

BACKGROUND: Omentum is well known for its immunocompetence and good blood supply; and therefore, is being used in various complex thoracic procedures. Specially, in situations when staplers, sealants and total parenteral nutrition may not be used because of financial constraints, omentum may prove very helpful in preventing post-operative fatal complications. METHODS: A retrospective review of 61 patients was undertaken. Patients were categorized into two groups. In group I, omentum was sutured to the anastomosis for prophylaxis of leak from gastro-oesophagectomy after radical surgery for cancer of cardia and oesophagus. In group II, it was used for therapeutic purpose, to control diffuse air leak from lung parenchyma after chest wall and invaded lung resection for malignant chest wall tumours (subgroup A) and treatment of post pneumonectomy bronchopleural fistula for NSCLC of right lung (subgroup B). Gastro-oesophagectomy, closure of bronchial stump and suturing of lung parenchyma after wedge resection was done with manual suturing technique only. RESULTS: Group I: There were 57 patients with the diagnosis of cancer of cardia and oesophagus, who underwent radical surgery. Transthoracic approach was used in 96.5% patients, whereas 3.5% patients underwent transhiatal resection. Anastomotic level was located in chest in 68.4% and in neck in 31.6% patients. The leakage rate was 5.4%. Group II: There were three patients in subgroup A, all with lesions located in left side of chest wall. There was one patient in subgroup B. Chest tube was removed after a mean time of 2 days and after 4 days in subgroup A and B, respectively. There was 1 mortality (1.6%) secondary to chylothorax. CONCLUSION: Use of pedicled omentum appears to be a very simple technique to prevent the anastomotic leak after radical surgery for cancer of cardia and oesophagus, and to seal the diffuse parenchymal pulmonary leak after various procedures in thorax.

A Case of Primary Omental Torsion Presenting as an Acute Abdominal Pain / 대한소화기학회지

Torsion of greater omentum is a rare cause of acute abdomen. However, it should be included in the differential diagnoses in addition to acute cholecystitis, acute appendicitis, cecal diverticulitis, and other variable causes of acute abdomen. Diagnosis is usually made at laparotomy for suspected appendicitis. In some cases, computed tomography demonstrates a successful preoperative detection of omental torsion. We report a case of surgically and pathologically proven torsion with subsequent infarction of greater omentum presented as an acute abdominal pain.

Development of blood vessels of the greater omentum in the hepatic lobe after vascular ligation: an experimental model in the rats

PURPOSE: To verify the development of blood vessels between the greater omentum and the liver in the presence of distinct liver blood intake blockages. METHODS: Two hundred and eighty conventional male Wistar rats were used, divided into 5 groups: control (n=35), laparotomy (n=35); hepatic artery ligature (n=70), ligature of the right-hand branch of the portal vein (n=70); and ligature of both blood vessels (n=70). The last three groups were divided into two subgroups each (n=35), according to the presence or absence of the transposition of the greater omentum onto the right hepatic lobe. The postoperative periods were 1, 3, 7, 15, 30, 60 and 90 days. At the end of each period, the greater omentum and right hepatic lobe were collected for histopathological examination. The presence of blood vessels between the referred tissues was verified by the administration of Indian ink as a marker of vascular lumen. RESULTS: Macroscopic and microscopic observation and the dye marker demonstrated the distribution of blood vessels between the greater omentum and liver tissues. CONCLUSION: The greater omentum was capable of developing blood vessels when fixed to the parenchyma of the liver after the suppression of hepatic blood flow.

OBJETIVO: Verificar o desenvolvimento de vasos sanguíneos entre o omento maior e o fígado em presença de diferentes bloqueios do aporte sanguíneo hepático. MÉTODOS: Foram utilizados 280 ratos machos, Wistar, convencional, divididos em 5 grupos: controle (n = 35), com laparotomia (n = 35), com ligadura da artéria hepática própria (n = 70), com ligadura do ramo direito da veia porta (n = 70) e com ligadura de ambos vasos sanguíneos (n = 70). Os três últimos grupos foram divididos em dois subgrupos (n = 35), de acordo com a transposição ou não do omento maior no lobo direito do fígado. Os períodos de pós-operatório foram de 1, 3, 7, 15, 30, 60 e 90 dias. Em cada período foram coletados o omento maior e o lobo direito do fígado para exame histopatológico. Presença de vasos sanguíneos entre os referidos tecidos foi verificada pela administração da tinta nanquim como marcador de lúmen vascular. RESULTADOS: As observações macroscópicas, microscópicas e do marcador tintorial demonstraram a distribuição dos vasos sanguíneos entre o omento maior transposto e o tecido hepático. CONCLUSÃO: O omento maior foi capaz de desenvolver vasos sanguíneos quando fixado junto ao parênquima do fígado, após supressão do fluxo sanguíneo hepático.

Omentopexy for limb salvage in Buerger's disease: indications, technique and results.

Buerger's disease is a limb-threatening condition occurring in the young and productive age group and its management has always been a challenging problem. A large number of medical and surgical options have been suggested, but the quest for an ideal solution to this problem continues. Omentopexy for Buerger's disease is an attractive option, which is rapidly gaining popularity. We discuss the historical aspects, technical considerations and results of omental transfer for this limb-threatening condition. In doing so, the relevant literature on the subject has been extensively reviewed. In all published series, there has been marked improvement in intermittent claudication and rest pain. Ischaemic ulcers have healed and the progression of gangrene has stopped. If carried out with the complete understanding of the anatomy of the omental vascular arcade, the results of omentopexy are gratifying, thus avoiding amputation and conserving the limb.

Epiplón mayor: su utilización para la reconstrucción de la pared torácica consecutiva a la exéresis de tumores / Greater omentum: your usefull in chest wall reconstruction after resected malignant tumors

Seis pacientes portadores de tumores parietales del tórax resecados, fueron reparados mediante prótesis cubiertas por epiplón mayor traspuesto. El empleo de este tejido fue de elección para casos en que debieron ser ser extirpados músculos contiguos invadidos y por consiguiente hubiera sido necesario colgajos musculares o miocutáneos distantes para una adecuada reconstrucción. En lugar de ellos, hemos elegido el epiplón, el cual además, produjo mejor resultado estético. No hemos observado complicaciones atribuibles al procedimiento

Vascular prostacyclin production in andean women with pregnancy-induced hypertension

Although prostacyclin (PGI2) production in the umbilical artery is known to be reduced in prognancy-induced hypertension (PIH), little information is available about its production in maternal vascular tissues. We measured 6-keto-prostaglandin F 1* generation in the umbiblical and comentum arteries of 24 Andean women divided into three groups: 1) 8 normal pregnant women, 2) 8 cases with clinical evidence of severe PIH, and 3) 8 normotensive non-pregnant women.The normal pregnant group (232 ñ 172 pg mg-1 2h-1) and the non-pregnant control group (237 ñ 146 pg mg-1 2h-1 0 showed similar PGI2 production in the omentum arteries, whereas the PIH group showed lower PGI2 generation (P<0.05) than the normal patients both in the umbilical (697 ñ 377 vs 1528 ñ 291 pg mg-1 2h-1) and omentum (132 ñ 73 vs 232 ñ 172 pg mg-1 2h-1) arteries. PGI2 production was 6.8 times lower in the omentum arteries than in the umbilical arteries. The data confirm and extend the view of the occurrence of reduced PGI2 production in the maternal-fetal vascular tissues of women with severe PIH.

Dimensions of potential arterial grafts for coronary artery bypass grafting in Indians--an autopsy evaluation study.

Total revascularization of the heart using as many arterial grafts as possible is the trend of the day. We have chosen two commonly used arterial grafts to evaluate their efficiency in myocardial revascularization in Indian subjects. An autopsy study was conducted in 25 cases. Both internal mammary arteries with their branches and the right gastroepiploic artery were harvested. These arteries were distended with heated Gelatin, deep frozen and their diameters were measured. In 56% of subjects diameter of internal mammary artery was 1.5 to 2.0 mm (n = 14). However 36% of subjects had diameter above 2.0 mm (n = 9). Musculo-phrenic and superior epigastric arteries had 1.85 and 1.65 mm internal diameters respectively. The mean internal diameter of right gastro-epiploic artery was 2.3 mm. When these diameters were indexed to the body surface area, they were comparable with similar figures from western subjects.

Distribuiçäo arterial no omento maior do homem e sua importância cirúrgica / Arterial distribution in the human omentum mayor and its surgical importance

O estudo dos tipos de distribuiçäo arterial no omento maior foi realizado em 50 preparaçöes de necrópsias, constituídas por blocos de estômago, baço, pâncreas, colo transverso, parte dos colos ascendente e descendente e omento maior. Os vasos do tronco celíaco dessas preparaçöes foram injetados com 80 a 100 ml de suspensäo aquosa de sulfato de bário e metil celulose, para análise radiográfica. Além da presença constante das artérias omentais direita, média e esquerda em cerca de 54% dos casos, foram descritos apenas o arco gastro-omental e a arcada transomental. Em 48% das peças foi encontrado arco anastomótico entre as artérias gastro-omental direta e omental esquerda ou entre as artérias omentais direita e esquerda, situado entre aqueles dois. Consideraçöes sobre aplicaçäo cirúrgica desses dados morfológicos säo feitas, com vista `a crescente utilizaçäo dos autotransplantes pediculados do omento maior nas várias especialidades cirúrgicas