BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by exter...BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by external tumors of the scrotum is rare.The patient had both a greater omentum tumor and an inguinal hernia,and the tumor protruded into the scrotum through the hernia sac,which is even rarer.Moreover,omental tumors are mostly metastatic,and primary omental fibroma is rare.CASE SUMMARY Here,we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months.Preoperative examination and multidisciplinary discu-ssions considered intra-abdominal tumor displacement and inguinal hernia,and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum.Therefore,tumor resection and tension-free inguinal hernia repair were performed.The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking,physical examination,and imaging before surgery.展开更多
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 pa...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.展开更多
BACKGROUND Omental infarction(OI)is a surgical abdominal disease that is not common in adults and is very rare in children.Similar to various acute abdominal pain diseases including appendicitis,diagnosis was previous...BACKGROUND Omental infarction(OI)is a surgical abdominal disease that is not common in adults and is very rare in children.Similar to various acute abdominal pain diseases including appendicitis,diagnosis was previously achieved by diagnostic laparotomy but more recently,ultrasonography or computed tomography(CT)examination has been used.CASE SUMMARY A 6-year-old healthy boy with no specific medical history visited the emergency room with right lower abdominal pain.He underwent abdominal ultrasonography by a radiologist to rule out acute appendicitis.He was discharged with no significant sonographic finding and symptom relief.However,the symptoms persisted for 2 more days and an outpatient visit was made.An outpatient abdominal CT was used to make a diagnosis of OI.After laparoscopic operation,his symptoms resolved.CONCLUSION In children’s acute abdominal pain,imaging studies should be performed for appendicitis and OI.展开更多
BACKGROUND: Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.
BACKGROUND The life-threatening complications following pancreatoduodenectomy(PD),intraabdominal hemorrhage,and postoperative infection,are associated with leaks from the anastomosis of pancreaticoduodenectomy.Althoug...BACKGROUND The life-threatening complications following pancreatoduodenectomy(PD),intraabdominal hemorrhage,and postoperative infection,are associated with leaks from the anastomosis of pancreaticoduodenectomy.Although several methods have attempted to reduce the postoperative pancreatic fistula(POPF)rate after PD,few have been considered effective.The safety and short-term clinical benefits of omental interposition remain controversial.AIM To investigate the safety and feasibility of omental interposition to reduce the POPF rate and related complications in pancreaticoduodenectomy.METHODS In total,196 consecutive patients underwent PD performed by the same surgical team.The patients were divided into two groups:An omental interposition group(127,64.8%)and a non-omental interposition group(69,35.2%).Propensity scorematched(PSM)analyses were performed to compare the severe complication rates and mortality between the two groups.RESULTS Following PSM,the clinically relevant POPF(CR-POPF,10.1%vs 24.6%;P=0.025)and delayed postpancreatectomy hemorrhage(1.4%vs 11.6%;P=0.016)rates were significantly lower in the omental interposition group.The omental interposition technique was associated with a shorter time to resume food intake(7 d vs 8 d;P=0.048)and shorter hospitalization period(16 d vs 21 d;P=0.031).Multivariate analyses showed that a high body mass index,nonapplication of omental interposition,and a main pancreatic duct diameter<3 mm were independent risk factors for CR-POPF.CONCLUSION The application of omental interposition is an effective and safe approach to reduce the CR-POPF rate and related complications after PD.展开更多
BACKGROUND Primary omental tumors are uncommon,and omental fibromas account for 2%of these tumors.Due to the low incidence of omental fibromas and the limited relevant literature,it is challenging for clinicians to ma...BACKGROUND Primary omental tumors are uncommon,and omental fibromas account for 2%of these tumors.Due to the low incidence of omental fibromas and the limited relevant literature,it is challenging for clinicians to make an accurate diagnosis of this condition,especially before surgery.CASE SUMMARY A 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo.A physical examination was performed,and the findings showed that the epididymal mass may have entered the abdominal cavity.Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents,and no masses were found in the left epididymis.A traditional inguinal hernia incision was made.Intraoperative hernia contents were found to be of the greater omentum,and a 2.5 cm-diameter mass was found at the distal end of the greater omentum.The scrotum and epididymis did not exhibit other masses.Then,the mass of the greater omentum was excised.Intraoperative frozen pathological examination suggested a spindle cell tumor.The postoperative pathological examination suggested that the mass was an omental angiofibroma.Postoperatively,the patient recovered well and was discharged.Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities.CONCLUSION Due to the low morbidity rate associated with and latent nature of omental tumors,these tumors are difficult to diagnose preoperatively;thorough medical history taking,detailed physical examinations,and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.展开更多
We report a case of surgically proved left-sided torsion of the greater omentum that caused secondary by untreated inguinal hernia. Case A 36-year-old man presented to our hospital with abdominal pain. He had been dia...We report a case of surgically proved left-sided torsion of the greater omentum that caused secondary by untreated inguinal hernia. Case A 36-year-old man presented to our hospital with abdominal pain. He had been diagnosed with a left inguinal hernia, but he had not received any treatments. Contrast-enhanced computed tomography (CT) of the abdomen showed a large fat density mass below the Sigmoid colon and left inguinal hernia with incarcerated fat. Exploratory laparotomy revealed torsion of the greater omentum with small bloody ascites. The greater omentum was twisted into one and a half circles and entered into a left inguinal hernia. An omentectomy with a repair of left inguinal hernia was performed. A resected omentum was submitted for pathological examination, which showed hemorrhagic infarction. Omental torsion is a rare cause of acute abdominal pain but should be included in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.展开更多
In this report,a patient had a previous diagnosis of cholangiocarcinoma with an extended cholecystectomy. Three years later,he was evaluated for recurrent ascites. The patient had several large volume paracentesis, wi...In this report,a patient had a previous diagnosis of cholangiocarcinoma with an extended cholecystectomy. Three years later,he was evaluated for recurrent ascites. The patient had several large volume paracentesis, without evidence of malignant cells.Subsequently, endoscopic ultrasound(EUS)with fine needle aspiration (FNA)of both lymph and omental nodules was utilized.While the lymph nodes were negative for malignancy, the omental nodule was interrogated with multiple antibodies and was found to be positive for neoplasia. EUS with FNA can safely be used in patients with cirrhosis to spare the patient invasive evaluation such as exploratory laparotomy(ex-lap)for diagnosis and staging of cholangiocarcinoma.展开更多
Background: The perforation of peptic ulcer is a common and serious life threatening surgical emergency. Up-till now no consensus was reached regarding the best practice in management of perforated peptic ulcer. The a...Background: The perforation of peptic ulcer is a common and serious life threatening surgical emergency. Up-till now no consensus was reached regarding the best practice in management of perforated peptic ulcer. The aim of this study is to evaluate and compare between both management strategies of perforated peptic ulcer;performing simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors versus performing definitive repair of perforated peptic ulcer (closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy to discover a proper management strategy of perforated peptic ulcer. Patients and Methods: In the current study we included 30 patients which were divided into 2 groups: group 1 included 15 patients where we managed them by simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors and group 2 included 15 patients where we performed closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy. Results: We found that younger patient underwent vagotomy and gastro-jejunostomy technique (p Conclusions: Peptic ulcer perforation could be safely managed by primary closure and covering by omentum in addition to medical treatment of H. pylori infection and inhibition of acid secretion especially in old patients with comorbid condition who presented late or with shock.展开更多
Background: Omental cysts are the least common variety of intraabdominal cystic lesions encountered in children. They are often identified incidentally, although they may also cause acute abdominal pain. Case Report: ...Background: Omental cysts are the least common variety of intraabdominal cystic lesions encountered in children. They are often identified incidentally, although they may also cause acute abdominal pain. Case Report: We describe here two girls with omental cysts with very unusual clinical presentations. Conclusion: The majority of omental cysts are discovered incidentally. Overall results in pediatric patients are favourable. Optimal surgical management mandates complete excision.展开更多
A 61-year-old man presenting with abdominal pain and fever refractory to antibiotics underwent diagnostic laparoscopy and non-mass-forming isolated omental panniculitis was identified. He presented with left-upper-qua...A 61-year-old man presenting with abdominal pain and fever refractory to antibiotics underwent diagnostic laparoscopy and non-mass-forming isolated omental panniculitis was identified. He presented with left-upper-quadrant abdominal pain. Laboratory data and the CT findings suggested intraabdominal bacterial disease in the splenic flexure, which we treated with antibiotics and fasting. He clinically improved once, but later relapsed with abdominal pain migration to the left-lower-quadrant. CT re-examination revealed no inflammation in the splenic flexure, but attenuation of adipose tissue in the greater omentum. We partially extracted the greater omentum during diagnostic laparoscopy and diagnosed omental panniculitis and administered steroids. He improved and was discharged three days after starting oral prednisone and is recurrence-free with a close follow-up. The characteristic CT feature of omentum panniculitis is a high-density fatty mass, but we noted only an attenuation of adipose tissue in the greater omentum. Diagnositic laparoscopy is useful for diagnosing this condition.展开更多
Prostate cancer is the most common type of male malignancy in the world and approximately 10-20%of prostate cancer shows a metastatic disease at initial diagnosis commonly to the bones,vertebrae,ribs,long bones,and sk...Prostate cancer is the most common type of male malignancy in the world and approximately 10-20%of prostate cancer shows a metastatic disease at initial diagnosis commonly to the bones,vertebrae,ribs,long bones,and skull.However,prostate cancer metastasis to the omentum with malignant ascites is extremely uncommon.In this study,we report such a case,which also highlights a repeatedly negative ascetic fluid cytology even with multiple omental metastatic nodules.The purpose of this case report is to provide awareness to physicians for this rare occurrence.展开更多
Hepatocellular carcinoma (HCC) is one of the most common primary cancers in the world. Surgery is the gold standard for treatment of patients with HCC. Recurrence and metastasis are the major obstacles to further im...Hepatocellular carcinoma (HCC) is one of the most common primary cancers in the world. Surgery is the gold standard for treatment of patients with HCC. Recurrence and metastasis are the major obstacles to further improve the prognosis of HCC. Most recurrences are intrahepatic. However, 30% of the recurrences are extrahepatic. The role of resection in intrahepatic recurrences is widely accepted. The role of resection in extrahepatic HCC recurrence and metastasis is not well established. 18F fluorodeoxyglucose (18F-FDG) positron emission tomography/computer tomography (PET/CT) is useful in detecting distant metastasis from a variety of malignancies and shows superior accuracy to conventional imaging modalities in identification of intrahepatic and extrahepatic metastasis. We present one patient with one new isolated omental lymph node metastasis, who had a history of huge HCC resected six years ago. The metastatic focus was identified with 18 F-FDG PET/CT and resected. The follow-up revealed good prognosis with a long-term survival potential after resection of the omental lymphatic metastasis.展开更多
Hepatic epithelioid hemangioendothelioma(HEH)is a rare neoplasm of vascular origin with variable malignant potential.Because most patients with this condition have multiple bilobar lesions,liver transplantation is the...Hepatic epithelioid hemangioendothelioma(HEH)is a rare neoplasm of vascular origin with variable malignant potential.Because most patients with this condition have multiple bilobar lesions,liver transplantation is the standard treatment,and hepatectomy is much less frequently indicated.We describe a case of a 35-yearold woman with unresectable multiple bilobar HEH successfully treated by combination treatment with hepatectomy and carbon-ion radiotherapy.This case is very meaningful since it demonstrated the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.展开更多
Background:?Perforated peptic ulcer is a common surgical emergency. The classic treatment is the mid-line laparotomy. However, laparoscopic treatment has been shown to be reliable. Few studies have evaluated its overa...Background:?Perforated peptic ulcer is a common surgical emergency. The classic treatment is the mid-line laparotomy. However, laparoscopic treatment has been shown to be reliable. Few studies have evaluated its overall utility. The aim of this study is to assess the efficacy of laparoscopic repair of perforated duodenal ulcer.?Patients and Methods:?This study included 50 patients presented by perforated peptic ulcer between July 2009 and August 2014. They were submitted to laparoscopic omental patch repair with thorough peritoneal wash. Patients’ demographics, diagnostic techniques, management and outcome were evaluated. Results:?The mean age was 38.6 years with male to female ratio being 1.6:1. The perforation was diagnosed by plain X-ray abdomen in erect position in 43 patients and by abdominal CT scan in 7 patients. The laparoscopic repair of the perforation was successful in 48 patients while in 2 patients mid-line laparotomy was needed for proper control of the severe intra-abdominal sepsis. Post-operatively, all patients tolerated soft diet on the 3rd?post-operative day and full diet on the 4th?post-operative day. The mean duration of hospital stay was 4.5 days. Two patients developed post-operative intra-abdominal collection that was treated by ultrasound guided drainage, three patients developed umbilical port site wound infection while only two patients developed leakage, one of them reoperated after failed conservative surgery. No mortality was encountered in the study. Conclusion:?Laparoscopic repair of perforated peptic ulcer is a safe and reliable technique with accepted morbidity and mortality rates with all the advantages of the minimally invasive surgery.展开更多
We report a diagnosis of diabetes type 2 suggested by diffuse omental infiltration seen on computed tomography which resolved following treatment. There have been reports of increased macrophage infiltration in the om...We report a diagnosis of diabetes type 2 suggested by diffuse omental infiltration seen on computed tomography which resolved following treatment. There have been reports of increased macrophage infiltration in the omental fat of diabetic patients which we believe is identifiable by CT. To our knowledge, the diagnosis of diabetes with CT has not yet been reported. Diabetes type 2 is commonly a clinical diagnosis. However, undiagnosed diabetic patients may present with nonspecific manifestations and CT may be ordered as part of the initial evaluation. We present a case in which diabetes type 2 was suggested by diffuse omental infiltration.展开更多
文摘BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by external tumors of the scrotum is rare.The patient had both a greater omentum tumor and an inguinal hernia,and the tumor protruded into the scrotum through the hernia sac,which is even rarer.Moreover,omental tumors are mostly metastatic,and primary omental fibroma is rare.CASE SUMMARY Here,we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months.Preoperative examination and multidisciplinary discu-ssions considered intra-abdominal tumor displacement and inguinal hernia,and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum.Therefore,tumor resection and tension-free inguinal hernia repair were performed.The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking,physical examination,and imaging before surgery.
文摘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.
文摘BACKGROUND Omental infarction(OI)is a surgical abdominal disease that is not common in adults and is very rare in children.Similar to various acute abdominal pain diseases including appendicitis,diagnosis was previously achieved by diagnostic laparotomy but more recently,ultrasonography or computed tomography(CT)examination has been used.CASE SUMMARY A 6-year-old healthy boy with no specific medical history visited the emergency room with right lower abdominal pain.He underwent abdominal ultrasonography by a radiologist to rule out acute appendicitis.He was discharged with no significant sonographic finding and symptom relief.However,the symptoms persisted for 2 more days and an outpatient visit was made.An outpatient abdominal CT was used to make a diagnosis of OI.After laparoscopic operation,his symptoms resolved.CONCLUSION In children’s acute abdominal pain,imaging studies should be performed for appendicitis and OI.
文摘BACKGROUND: Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.
基金Supported by the Shanghai Science and Technology Commission of Shanghai Municipality,No.20Y11908600the Shanghai Shenkang Hospital Development Center,No.SHDC2020CR5008Shanghai Municipal Health Commission,No.20194Y0195。
文摘BACKGROUND The life-threatening complications following pancreatoduodenectomy(PD),intraabdominal hemorrhage,and postoperative infection,are associated with leaks from the anastomosis of pancreaticoduodenectomy.Although several methods have attempted to reduce the postoperative pancreatic fistula(POPF)rate after PD,few have been considered effective.The safety and short-term clinical benefits of omental interposition remain controversial.AIM To investigate the safety and feasibility of omental interposition to reduce the POPF rate and related complications in pancreaticoduodenectomy.METHODS In total,196 consecutive patients underwent PD performed by the same surgical team.The patients were divided into two groups:An omental interposition group(127,64.8%)and a non-omental interposition group(69,35.2%).Propensity scorematched(PSM)analyses were performed to compare the severe complication rates and mortality between the two groups.RESULTS Following PSM,the clinically relevant POPF(CR-POPF,10.1%vs 24.6%;P=0.025)and delayed postpancreatectomy hemorrhage(1.4%vs 11.6%;P=0.016)rates were significantly lower in the omental interposition group.The omental interposition technique was associated with a shorter time to resume food intake(7 d vs 8 d;P=0.048)and shorter hospitalization period(16 d vs 21 d;P=0.031).Multivariate analyses showed that a high body mass index,nonapplication of omental interposition,and a main pancreatic duct diameter<3 mm were independent risk factors for CR-POPF.CONCLUSION The application of omental interposition is an effective and safe approach to reduce the CR-POPF rate and related complications after PD.
基金Supported by Science and Technology Fund of Tianjin Health and Family Planning Commission,No.16KG103Tianjin Health Science and Technology Project,No.ZC20162.
文摘BACKGROUND Primary omental tumors are uncommon,and omental fibromas account for 2%of these tumors.Due to the low incidence of omental fibromas and the limited relevant literature,it is challenging for clinicians to make an accurate diagnosis of this condition,especially before surgery.CASE SUMMARY A 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo.A physical examination was performed,and the findings showed that the epididymal mass may have entered the abdominal cavity.Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents,and no masses were found in the left epididymis.A traditional inguinal hernia incision was made.Intraoperative hernia contents were found to be of the greater omentum,and a 2.5 cm-diameter mass was found at the distal end of the greater omentum.The scrotum and epididymis did not exhibit other masses.Then,the mass of the greater omentum was excised.Intraoperative frozen pathological examination suggested a spindle cell tumor.The postoperative pathological examination suggested that the mass was an omental angiofibroma.Postoperatively,the patient recovered well and was discharged.Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities.CONCLUSION Due to the low morbidity rate associated with and latent nature of omental tumors,these tumors are difficult to diagnose preoperatively;thorough medical history taking,detailed physical examinations,and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.
文摘We report a case of surgically proved left-sided torsion of the greater omentum that caused secondary by untreated inguinal hernia. Case A 36-year-old man presented to our hospital with abdominal pain. He had been diagnosed with a left inguinal hernia, but he had not received any treatments. Contrast-enhanced computed tomography (CT) of the abdomen showed a large fat density mass below the Sigmoid colon and left inguinal hernia with incarcerated fat. Exploratory laparotomy revealed torsion of the greater omentum with small bloody ascites. The greater omentum was twisted into one and a half circles and entered into a left inguinal hernia. An omentectomy with a repair of left inguinal hernia was performed. A resected omentum was submitted for pathological examination, which showed hemorrhagic infarction. Omental torsion is a rare cause of acute abdominal pain but should be included in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.
文摘In this report,a patient had a previous diagnosis of cholangiocarcinoma with an extended cholecystectomy. Three years later,he was evaluated for recurrent ascites. The patient had several large volume paracentesis, without evidence of malignant cells.Subsequently, endoscopic ultrasound(EUS)with fine needle aspiration (FNA)of both lymph and omental nodules was utilized.While the lymph nodes were negative for malignancy, the omental nodule was interrogated with multiple antibodies and was found to be positive for neoplasia. EUS with FNA can safely be used in patients with cirrhosis to spare the patient invasive evaluation such as exploratory laparotomy(ex-lap)for diagnosis and staging of cholangiocarcinoma.
文摘Background: The perforation of peptic ulcer is a common and serious life threatening surgical emergency. Up-till now no consensus was reached regarding the best practice in management of perforated peptic ulcer. The aim of this study is to evaluate and compare between both management strategies of perforated peptic ulcer;performing simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors versus performing definitive repair of perforated peptic ulcer (closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy to discover a proper management strategy of perforated peptic ulcer. Patients and Methods: In the current study we included 30 patients which were divided into 2 groups: group 1 included 15 patients where we managed them by simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors and group 2 included 15 patients where we performed closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy. Results: We found that younger patient underwent vagotomy and gastro-jejunostomy technique (p Conclusions: Peptic ulcer perforation could be safely managed by primary closure and covering by omentum in addition to medical treatment of H. pylori infection and inhibition of acid secretion especially in old patients with comorbid condition who presented late or with shock.
文摘Background: Omental cysts are the least common variety of intraabdominal cystic lesions encountered in children. They are often identified incidentally, although they may also cause acute abdominal pain. Case Report: We describe here two girls with omental cysts with very unusual clinical presentations. Conclusion: The majority of omental cysts are discovered incidentally. Overall results in pediatric patients are favourable. Optimal surgical management mandates complete excision.
文摘A 61-year-old man presenting with abdominal pain and fever refractory to antibiotics underwent diagnostic laparoscopy and non-mass-forming isolated omental panniculitis was identified. He presented with left-upper-quadrant abdominal pain. Laboratory data and the CT findings suggested intraabdominal bacterial disease in the splenic flexure, which we treated with antibiotics and fasting. He clinically improved once, but later relapsed with abdominal pain migration to the left-lower-quadrant. CT re-examination revealed no inflammation in the splenic flexure, but attenuation of adipose tissue in the greater omentum. We partially extracted the greater omentum during diagnostic laparoscopy and diagnosed omental panniculitis and administered steroids. He improved and was discharged three days after starting oral prednisone and is recurrence-free with a close follow-up. The characteristic CT feature of omentum panniculitis is a high-density fatty mass, but we noted only an attenuation of adipose tissue in the greater omentum. Diagnositic laparoscopy is useful for diagnosing this condition.
文摘Prostate cancer is the most common type of male malignancy in the world and approximately 10-20%of prostate cancer shows a metastatic disease at initial diagnosis commonly to the bones,vertebrae,ribs,long bones,and skull.However,prostate cancer metastasis to the omentum with malignant ascites is extremely uncommon.In this study,we report such a case,which also highlights a repeatedly negative ascetic fluid cytology even with multiple omental metastatic nodules.The purpose of this case report is to provide awareness to physicians for this rare occurrence.
文摘Hepatocellular carcinoma (HCC) is one of the most common primary cancers in the world. Surgery is the gold standard for treatment of patients with HCC. Recurrence and metastasis are the major obstacles to further improve the prognosis of HCC. Most recurrences are intrahepatic. However, 30% of the recurrences are extrahepatic. The role of resection in intrahepatic recurrences is widely accepted. The role of resection in extrahepatic HCC recurrence and metastasis is not well established. 18F fluorodeoxyglucose (18F-FDG) positron emission tomography/computer tomography (PET/CT) is useful in detecting distant metastasis from a variety of malignancies and shows superior accuracy to conventional imaging modalities in identification of intrahepatic and extrahepatic metastasis. We present one patient with one new isolated omental lymph node metastasis, who had a history of huge HCC resected six years ago. The metastatic focus was identified with 18 F-FDG PET/CT and resected. The follow-up revealed good prognosis with a long-term survival potential after resection of the omental lymphatic metastasis.
文摘Hepatic epithelioid hemangioendothelioma(HEH)is a rare neoplasm of vascular origin with variable malignant potential.Because most patients with this condition have multiple bilobar lesions,liver transplantation is the standard treatment,and hepatectomy is much less frequently indicated.We describe a case of a 35-yearold woman with unresectable multiple bilobar HEH successfully treated by combination treatment with hepatectomy and carbon-ion radiotherapy.This case is very meaningful since it demonstrated the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.
文摘Background:?Perforated peptic ulcer is a common surgical emergency. The classic treatment is the mid-line laparotomy. However, laparoscopic treatment has been shown to be reliable. Few studies have evaluated its overall utility. The aim of this study is to assess the efficacy of laparoscopic repair of perforated duodenal ulcer.?Patients and Methods:?This study included 50 patients presented by perforated peptic ulcer between July 2009 and August 2014. They were submitted to laparoscopic omental patch repair with thorough peritoneal wash. Patients’ demographics, diagnostic techniques, management and outcome were evaluated. Results:?The mean age was 38.6 years with male to female ratio being 1.6:1. The perforation was diagnosed by plain X-ray abdomen in erect position in 43 patients and by abdominal CT scan in 7 patients. The laparoscopic repair of the perforation was successful in 48 patients while in 2 patients mid-line laparotomy was needed for proper control of the severe intra-abdominal sepsis. Post-operatively, all patients tolerated soft diet on the 3rd?post-operative day and full diet on the 4th?post-operative day. The mean duration of hospital stay was 4.5 days. Two patients developed post-operative intra-abdominal collection that was treated by ultrasound guided drainage, three patients developed umbilical port site wound infection while only two patients developed leakage, one of them reoperated after failed conservative surgery. No mortality was encountered in the study. Conclusion:?Laparoscopic repair of perforated peptic ulcer is a safe and reliable technique with accepted morbidity and mortality rates with all the advantages of the minimally invasive surgery.
文摘We report a diagnosis of diabetes type 2 suggested by diffuse omental infiltration seen on computed tomography which resolved following treatment. There have been reports of increased macrophage infiltration in the omental fat of diabetic patients which we believe is identifiable by CT. To our knowledge, the diagnosis of diabetes with CT has not yet been reported. Diabetes type 2 is commonly a clinical diagnosis. However, undiagnosed diabetic patients may present with nonspecific manifestations and CT may be ordered as part of the initial evaluation. We present a case in which diabetes type 2 was suggested by diffuse omental infiltration.