Are all primary omental infarcts truly idiopathic?Five case reports

BACKGROUND Idiopathic omental infarction(IOI)is challenging to diagnose due to its low incidence and vague symptoms.Its differential diagnosis also poses difficulties because it can mimic many intra-abdominal organ pathologies.Although hypercoagulability and thrombosis are among the causes of omental infarction,venous thromboembolism scanning is rarely performed as an etiological investigation.CASE SUMMARY The medical records of the 5 cases,who had the diagnosis of IOI by computed tomography,were examined.The majority of the patients were male(n=4,80%)and the mean age was 31 years(range:21-38).The patients had no previous abdominal surgery or a history of any chronic disease.The main complaint of all patients was persistent abdominal pain.Omental infarction was detected in all patients with contrast-enhanced computed tomography.Conservative treatment was initially preferred in all patients,but it failed in 1 patient(20%).After discharge,all patients were referred to the hematology department for thrombophilia screening.Only 1 patient applied for thrombophilia screening and was homozygous for methylenetetrahydrofolate reductase(A1298C mutation)and heterozygous for a factor V Leiden mutation.CONCLUSION IOI should be considered in the differential diagnosis in patients presenting with progressive and/or persistent right side abdominal pain.Investigating risk factors such as hypercoagulability in patients with IOI is also important in preventing future conditions related to venous thromboembolism.

Carcinoembryonic antigen in the diagnosis,treatment,and follow-up of focal liver lesions

In this editorial review,we comment on the article published in the recent issue of the World Journal of Gastrointestinal Surgery.Carcinoembryonic antigen(CEA)is a fetal glycoprotein and can be secreted in very small amounts from healthy adults after birth.CEA is widely used not only for diagnostic tumor markers but also importantly for the management of some gastrointestinal tumors.The most common clinical use is surveillance for the monitoring of colorectal carcinoma.However,CEA can become elevated in several malign or benign characterized pathologies.Serum CEA level may vary depending on the location of the lesion,whether it metastasizes or not,and its histopathological characteristics.It has been determined that cases with high preoperative CEA have a more aggressive course and the risk of metastasis to the lymph tissue and liver increases.In this editorial review,we focused on evaluating the role of CEA in clinical practice with a holistic approach,including the diagnostic and prognostic significance of CEA in patients with focal liver lesions,the role of CEA in follow-up after definitive surgery,and also hepatic resection for metastasis,and the management of all patients with raised CEA.

Imaging features and management of focal liver lesions

Notably,the number of incidentally detected focal liver lesions(FLLs)has increa-sed dramatically in recent years due to the increased use of radiological imaging.The diagnosis of FLLs can be made through a well-documented medical history,physical examination,laboratory tests,and appropriate imaging methods.Although benign FLLs are more common than malignant ones in adults,even in patients with primary malignancy,accurate diagnosis of incidental FLLs is of utmost clinical significance.In clinical practice,FLLs are frequently evaluated non-invasively using ultrasound(US),computed tomography(CT),and magnetic resonance imaging(MRI).Although US is a cost-effective and widely used imaging method,its diagnostic specificity and sensitivity for FLL characterization are limited.FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI.MRI is a problem-solving method with high specificity and sensitivity,commonly used for the evaluation of FLLs that cannot be characterized by US or CT.Recent technical advancements in MRI,along with the use of hepatobiliary-specific MRI contrast agents,have significantly improved the success of FLL characterization and reduced unnece-ssary biopsies.The American College of Radiology(ACR)appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients.ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommend-ations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios.The American College of Gastroenterology(ACG)Clinical Guideline offers evidence-based recommend-ations for both the diagnosis and management of FLL.American Association for the Study of Liver Diseases(AASLD)Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma.In this article,FLLs are reviewed with a comprehensive analysis of ACR Appropri-ateness Criteria,ACG Clinical Guideline,AASLD Practice Guidance,and current medical literature from peer-reviewed journals.The article includes a discussion of imaging methods used for the assessment of FLL,current recommended imaging techniques,innovations in liver imaging,contrast agents,imaging features of common nonmetastatic benign and malignant FLL,as well as current management recommendations.

Dealing with hepatic artery traumas:A clinical literature review

BACKGROUND The hepatic artery(HA)is one of the most threatened vascular structures during hepatopancreatobiliary(HPB)surgeries and interventional procedures.It can be affected by many clinical pictures,especially tumors,due to its anatomical position and neighborhood.AIM To reveal the evolution and recent developments in the management of HA traumas in the light of the literature.METHODS In this article,100 years of MEDLINE(PubMed)literature and articles including cases and series of HA injuries were reviewed,and the types of injury occurrence,treatment,and related complications and their management were compiled.RESULTS The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies,among the most common operations.HA anatomy shows anomalies in approximately 15%-25%of the cases,further increasing this risk.The incidence of HA injury is not precisely known.Approaches that have evolved in recent years in managing patients with HA injury(laceration,transection,ligation,resection)with severe morbidity and mortality risk are reviewed in light of the current literature.CONCLUSION In conclusion,complications and deaths due to HA injury are less common today.The risk of complications increases in patients with hemodynamic instability,jaundice,cholangitis,and sepsis.Revealing the variations in the preoperative radiological evaluation will reduce the risks.In cases where HA injury is detected,arterial flow continuity should be tried to maintain with primary anastomosis,arterial transpositions,or grafts.In cases where bile duct injury develops,patients should be directed to HPB surgery centers,considering the possibility of accompanying HA injury.Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies?A systematic review

BACKGROUND The omentum is an organ that is easily sacrificed during abdominal surgery.The scope of omentectomy and whether a routine omentectomy should be performed are still unknown.AIM To review the literature in order to determine the physiological functions of the omentum and the roles it plays in pathological events in order to reveal the necessity for removal and preservation of the omentum.METHODS A clinical review of the English language literature based on the MEDLINE(PubMed)database was conducted using the keywords:“abdomen”,“gastrointestinal”,“tumor”,“inflammation”,“omental flap”,“metastasis”,“omentum”,and“omentectomy”.In addition,reports were also identified by systematically reviewing all references in retrieved papers.RESULTS The omentum functions as a natural barrier in areas where pathological processes occur in the abdominal cavity.The omentum limits and controls inflammatory and infectious pathologies that occur in the abdomen.It also aids in treatment due to its cellular functions including lymphatic drainage and phagocytosis.It shows similar behavior in tumors,but it cannot cope with increasing tumor burden.The stage of the disease changes due to the tumor mass it tries to control.Therefore,it is considered an indicator of poor prognosis.Due to this feature,the omentum is one of the first organs to be sacrificed during surgical procedures.However,there are many unknowns regarding the role and efficacy of the omentum in cancer.CONCLUSION The omentum is a unique organ that limits and controls inflammatory processes,foreign masses,and lesions that develop in the abdominal cavity.Omental flaps can be used in all anatomical areas,including the thorax,abdomen,pelvis,and extremities.The omentum is an organ that deserves the title of the abdominal policeman.It is generally accepted that the omentum should be removed in cases where there is tumor invasion.However,the positive or negative contribution of omental resection in the treatment of abdominal pathologies should be questioned.

Role of contrast-enhanced serial/spot abdominal X-rays in perioperative follow-up of patients undergoing abdominal surgery:An observational clinical study

BACKGROUND Many imaging methods such as ultrasonography,computed tomography(CT),magnetic resonance imaging,and endoscopy are used to identify the problems or complications that occur in the perioperative period and to determine the appropriate therapeutic approach.Specialists at surgical clinics and intensive care units sometimes need diagnostic procedures that can give quick results or reveal unexpected results.In particular,rapid on-site evaluation of patients followed under intensive care conditions has several advantages.AIM To determine the problems developing in patients in the perioperative period by contrast-enhanced abdominal X-ray(CE-AXR),revealing their current status or defining the effectiveness of CE-AXR.METHODS The files of the patients who underwent hepatopancreatobiliary or upper gastrointestinal surgery,whose CE-AXR film was taken,were reviewed retrospectively.Abdominal X-ray radiographs taken after ingestion of a watersoluble contrast agent(iohexol,300 mg,50 cc vial)and its application in a drain,nasogastric tube,or stent were evaluated.The contribution of the data obtained in patients who underwent CE-AXR to the diagnosis,follow-up,and treatment processes and the effectiveness of the application were investigated.RESULTS CE-AXR was applied to 131 patients in our clinic,most of whom underwent hepatopancreatobiliary or upper gastrointestinal surgery.It was determined that the data obtained from CE-AXR films taken in 98(74.8%)of the patients contributed to the diagnosis,treatment,and follow-up expectations and positively affected the clinical processes.CONCLUSION CE-AXR is a simple procedure that can be applied anywhere,especially in intensive care patients and at bedside,with a portable X-ray device.The simplicity of the procedure,less radiation exposure for the patients,less time wastage,reduction in the CT and endoscopy procedure burden and costs,quick results,rapid assessment of the situation,and enabling the monitoring of processes with repetitive procedures are important advantages.X-rays taken will be useful in terms of being a reference value during the follow-up period of the patient and determining the situation in medicolegal processes.