Isolation of Mycobacterium bolletii from human omentum after laparoscopic gastric banding

Mycobacterium bolletii infection with band erosion complicating laparoscopic gastric banding is reported. A 33-year-old man developed right upper quadrant pain and an epigastric discharging lesion 4 weeks after revision of gastric banding for morbid obesity. Investigation revealed band erosion with infection of the omentum and the abdominal wall. The band was removed and M. bolleti was isolated and identified after DNA sequence analysis. To the best of our knowledge, this is the first case in which M. bolletii was isolated from a human omentum after complicated gastric banding surgery.     

Acquired Omental Cystic Lymphangioma after Subtotal Gastrectomy: A Case Report

We herein describe a case of cystic lymphangioma in the greater omentum of the remnant stomach, which is thought it to be related with subtotal gastrectomy 10 yr ago for early gastric cancer. A 76-yr-old man was admitted to our department with postprandial abdominal discomfort and bowel habit change. Intraabdominal multilocular cystic mass was detected by ultrasonography and computed tomography. We performed a complete En-bloc tumor resection including spleen and distal pancreas, and histological examination confirmed cystic lymphangioma originated from the greater omentum of the remnant stomach. Although the etiology of omental lymphangioma remains largely unclear, these findings suggested strongly that obstruction of the lymphatic vessels after gastric resection for gastric carcinoma might be the most plausible cause. The surgical extirpation with resection of organs involved appears to be a treatment of choice for such unusual case.     

Rare peritoneal bands and recesses: incidental findings in a cadaveric dissection

Variable arrangement of the visceral peritoneum would result in the formation of unexpected peritoneal bands and associated recesses. These could confound the unsuspecting clinician in both the diagnostic and therapeutic approach to the abdomen. It is thus imperative to be alert to the surprises the peritoneum may throw up and, however rare, abdominal conditions resulting from such aberrations must be kept in mind. Cadaveric dissection of an elderly female revealed a number of peritoneal anomalies. Apart from a cysto-duodenal extension of the lesser omentum, there was a bilaminar, avascular band passing from the inferior surface of the right lobe of liver to both the duodenum and the transverse colon. This anomalous band lay posterior to and distinct from the lesser omentum. The epiploic foramen was thus delimited by two unconventional folds. Further, the distal half of the transverse mesocolon failed to reach the posterior abdominal wall and instead formed an arched continuity with an aberrant mesentery of descending colon. An unusual type of peri-caecal recess was also present.     

Earlobe-like peritoneal appendage near the angle of His: a useful landmark for demarcating the lateral margin of the gastric cardia

The gastric cardia—the small area around the cardiac orifice including the abdominal esophagus—is an important target area for abdominal and thoracic surgeries, especially for laparoscopic procedures. In this study of 28 cadavers, a peritoneal earlobe-like appendage near the angle of His was identified as a useful indicator of the lateral margin of the abdominal esophagus, which is otherwise obscure because the peritoneum continues to the diaphragm without definite demarcation of this margin. This structure, which appears equivalent to the epiploic appendages, was commonly found to be present (in 22/28, 78.6 % of the 28 cadavers) and was 4–21 mm × 6–40 mm × 1–4 mm in size, triangular, round, or leaf-like in shape, contained fat, and was on an imaginary line along which the lesser omentum adheres to the lesser curvature and continues to the diaphragm (18/22, 81.8 %). This indicator is associated with the lesser omentum and is part of the gastrophrenic ligament, and could serve as a useful indicator of the margin of the gastric cardia, thus aiding surgeons performing laparoscopic surgery in this region.     

Biphasic synovial sarcoma of the abdominal wall

Synovial sarcoma arising in the abdominal wall is a rare tumor. We report a case of a 38-year-old man who complained of abdominal pain. Physical examination revealed a firm mobile mass, 25 cm in diameter, in the left lower abdominal wall. The tumor was first thought to be a sarcoma arising from the omentum or mesentery. During surgery, a large tumor was found attached to the inner surface of the abdominal wall and compressing the gastrointestinal tract. On microscopic examination the tumor corresponded to a biphasic synovial sarcoma immunoreactive for cytokeratins (AE1/AE3, 7 and 19), epithelial membrane antigen and carcinoembryonic antigen in the epithelial tumor cells, for E-cadherin especially in their glandular structure, vimentin, CD99, and CD56 in the spindle cell component and for bcl-2 protein. The tumor recurred at the same site, and clinical course progressed to death 3 months after the initial diagnosis.     

Pelvic ependymoma arising from the small bowel

A 37-year-old woman underwent resection of an abdominal tumour which was adherent to the wall of the ileum. The diagnosis of an ependymoma was supported by evidence of typical perivascular pseudorosettes which stained positive for glial fibrillary acidic protein and contained abundant intermediate filaments within the elongated processes by electron microscopy. Flow cytometric study showed a diploid population of tumour cells. This is the first case of an ependymoma arising from the small bowel without any connection to the genital tract, the omentum or with the sacroccygeal area. As is the case with other unusual and ectopic localisations of ependymomas, prognosis of this tumour is difficult to evaluate.     

大网膜恶性肿瘤的超声诊断价值

目的探讨大网膜恶性肿瘤的超声表现特点。方法经手术及穿刺活检证实为大网膜恶性肿瘤的32例患者,其中男性13例,女性19例,年龄29～88岁,平均年龄53.7岁。回顾性分析术前全腹超声检查,并与病理组织检查结果进行对照。结果大网膜呈大片或结节状增厚,呈实性或囊实混合性回声。32例病例中,28例腹腔内常可发现腹腔局限性或大量腹水,占87.50%(28/32)。24例超声发现的大网膜恶性肿瘤中,17例有彩色血流信号,占70.83%。32例大网膜恶性肿瘤中,8例超声检查同时发现网膜外转移,占25.00%。结论超声对大网膜恶性肿瘤具有较高的诊断价值,但超声声像图表现复杂多变,判断性质需结合临床和其他影像学检查。     

Mesothelial cells from tunica vaginalis, a practical source for mesothelial transplantation

Transplantation of mesothelial cells is used to repair peritoneum that is damaged by surgery, peritonitis, and peritoneal dialysis. The largest obstacle for clinical application of mesothelial cell transplantation is the lack of a reliable source of mesothelial cells. So far, they are isolated from omentum, mesentery, parietal wall and ascites. Procedures used to obtain mesothelial cells from the omentum or mesentery are invasive, however, especially in pre-operative situations. Sufficient amounts of ascites for aspiration can not be obtained under physiological conditions. We have developed a novel method of isolating mesothelial cells from the tunica vaginalis. The tunica vaginalis originates from the peritoneum and descends into the scrotum along with the testis during fetal development. This region provides a source of mesothelial cells that is convenient to approach and free from abdominal complications. Transplantation of autologous mesothelial cells that were isolated from tunica vaginalis was effective in preventing post-operative adhesions. In this review, we summarize mesothelial cell transplantation trials and describe the method of isolating mesothelial cells form the tunica vaginalis. Mesothelial cell transplantation might be widely accepted for clinical use in the near future.     

Abdominal wall and thigh abscess resulting from the penetration of ascending colon cancer

An unusual case is described in which an abdominal wall and thigh abscess was an initial symptom of ascending colon cancer. A 76-year-old woman was referred to our hospital for investigation of fever and abdominal and thigh swelling. Computed tomography revealed a right abdominal wall, retroperitoneal, psoas and thigh abscess formation suspected to be caused by colon perforation. Due to the patient's poor general condition, local drainage of the abscess was performed on the following day of hospitalization. Histological examination of necrotic tissues removed form the retroperitoneal cavity demonstrated adenocarcinoma of the colon. The patient subsequently underwent right hemicolectomy with lymph nodal dissection after 19 days of the drainage procedure and was transferred to another hospital on the 49th day following the second surgery.     

A case of gallstone ileus with an unusual impaction site and spontaneous evacuation

Gallstone ileus is an unusual cause of colonic obstruction. The formation of a fistula between the gall bladder and the bowel wall may allow a gallstone to enter the intestinal tract. Plain abdominal films, abdominal ultrasound and abdominal computed tomography aid in the diagnosis. Although surgery is the treatment of choice in cases of colonic gallstone ileus, colonoscopic removal of the impacted stone should be attempted. We describe the case of an 85-year-old man who presented with symptoms and signs of large bowel obstruction. Diagnostic evaluation revealed a large gallstone impacted in the sigmoid colon, which is a rather unusual impaction site. Despite our efforts we could not extract the stone endoscopically, mainly due to its large size. Yet, despite its large size, the stone was spontaneously evacuated a few hours later.     

Effect of implantation site on hepatocytes heterotopically transplanted on biodegradable polymer scaffolds

We investigated the engraftment of heterotopically transplanted hepatocytes in three sites: the subcutaneous space, the small intestinal mesentery, and the omentum to determine the optimal location for tissue-engineered liver constructs. Hepatocytes were isolated from inbred Lewis rats and placed on polymer constructs. Cell-polymer constructs were implanted into the subcutaneous space of the abdominal wall, the small intestinal mesentery, and the omentum of Lewis rats. One group of rats had undergone previous portacaval shunt. Animals were killed 2 or 4 weeks after implantation and the constructs were analyzed for engraftment, using computer-assisted morphometric analysis. Engraftment was greatest in the omentum with less engraftment in the mesentery. There was minimal engraftment in the subcutaneous space in all specimens. Prior portacaval shunt increased engraftment in the mesentery and the omentum, but not the subcutaneous space. The omentum is the most favorable bed for engraftment of hepatocyte-polymer tissue-engineered constructs and the addition of a portacaval shunt increases survival of transplanted hepatocytes in the omentum and mesentery.     

Observation of the upside-down stomach esophageal hiatal hernia in a cadaver

In the course of a cadaveric dissection in 2006, an upside-down stomach esophageal hiatal hernia was observed in a 91-year-old Japanese woman with kyphosis who had died of brain infarction. There are 31 clinical reports of upside-down stomach esophageal hiatal hernia, but the vascular system was not analyzed in any of these cases. In this specimen, most of the stomach except the pyloric region passed through the esophageal hiatus (approximately 40 mm in diameter) with the greater omentum and into the hernial sac located dorsal to the heart in the thoracic cavity. The greater omentum was raised on the ventral region in the hernial sac and spread toward the upper abdomen through the esophageal hiatus from the sac, without any adhesion in the abdominal cavity. The tail of the pancreas and the spleen were located near the esophageal hiatus. No abnormality was observed in the heart or lungs. The celiac trunk and its main branches were normal, but the left and right gastric arteries, the short gastric artery and the left gastroepiploic artery passed into the hernial sac through the esophageal hiatus. This specimen was classified as the sliding type of esophageal hiatal hernia. We consider the excessive kyphosis of the vertebral column to likely be associated with the formation of such a highly advanced hernia.     

The effect of anterior abdominal wall scars on the vascular anatomy of the abdominal wall: A cadaveric and clinical study with clinical implications

The anterior abdominal wall integument is frequently used in a range of reconstructive flaps. These tissues are supplied by the deep and superficial inferior epigastric arteries (DIEA and SIEAs) and the deep and superficial superior epigastric arteries (DSEA and SSEAs). Previous abdominal wall surgery alters this vascular anatomy and may influence flap design. One hundred and sixty‐eight patients underwent abdominal wall computed tomographic angiography (CTA) for preoperative imaging. Fifty‐eight of these patients had undergone previous abdominal surgery, and were assessed for scar pattern and relationship to the course and distribution of all major axial vessels and perforators. Two cadaveric abdominal wall specimens with midline abdominal scars underwent contrast injection of the DIEAs and DSEAs, with subsequent CTA. The course and distribution of all cutaneous vessels were assessed. In all clinical and cadaveric cases, the vasculature of the abdominal wall had been altered by previous surgery. In the clinical cases, vascular architecture was universally altered in the region of the scar, often modifying the filling patterns of the abdominal wall and occasionally precluding the use of an abdominal wall flap. In both cadaveric specimens, regions of non‐filling were evident upon contrast injection, highlighting the angiosomes not supplied by the DIEA or DSEA. Previous abdominal wall surgery necessarily alters the vascular architecture of the abdominal wall, and may alter the source vessels supplying cutaneous tissues. CTA was useful in identifying and delineating these changes, and may be used as a preoperative tool in this role. Clin. Anat. 22:815–822, 2009. © 2009 Wiley‐Liss, Inc.     

蝶筛窦外侧壁应用解剖

观察５７具成人尸头标本蝶、筛窦外侧壁，以及同视神经管和颈内动脉的毗邻关系。眶板前下宽，后上窄，平均厚度为０．２ｍｍ。９３．８６％的视神经管内壁与蝶、筛窦外侧壁毗邻，且视神经管内蝶、筛窦内突出形成隆起的找率和程度同蝶、筛窦气代程度呈正相关。     

Primary liposarcoma of the omentum: a case report and review of the literature

A case of round cell liposarcoma of omentum in a 45-year-old man is reported. The patient presented with abdominal pain, swelling and fever of 4-month duration. Abdominal ultrasonography and computed tomogram confirmed the presence of an abdominal mass, but the omental origin of the tumour was revealed only on laparotomy. In addition to the main tumour mass, multiple nodules were present in the omentum. The tumour was excised with omentum. Histopathology of the tumour revealed a round cell liposarcoma. The patient expired 9 months after operation. Eight other cases of liposarcoma of omentum reported in English literature are reviewed.     

Intraabdominal zygomycosis caused by Syncephalastrum racemosum infection successfully treated with partial surgical debridement and high-dose amphotericin B lipid complex

Invasive zygomycosis rarely complicates trauma. We describe the first recorded case of invasive infection of the anterior abdominal wall and omentum with the zygomycete Syncephalastrum racemosum, which was successfully treated with partial surgical debridement and amphotericin B lipid complex.     

Inguinal canal development: The muscular wall and the role of the gubernaculum

The inguinal canal is an anatomically complex region. Although much has been written about the gubernaculum and the descent of the testis, little is known about the development of the abdominal wall itself. We dissected this inguinal canal in 75 fetuses between 10 and 25 weeks of gestation, 42 males and 33 females. We identified the anterior body‐wall muscular layers, located the gonads and uterus, and observed the formation of the scrotum. The gubernaculum was dissected, from the deep to the superficial ends and its distal attachments were determined. We proved that the muscular‐fibrous layers of the wall were well‐differentiated and observed how the inguinal canal enlarged with embryological development. In only one of the cases, an abnormal testis was found located in the scrotum. The upper end of the gubernaculum inserted into the inferior pole of the testis or the lateral angle of the uterus, according to gender. The lower end was attached by one or multiple tails, mainly on the pubic bone. This fact explained the clinical findings of ectopic testis. Observations of the abdominal wall and its relationship with the gubernaculum assisted us in explaining the development of the inguinal region, the formation of the inguinal canal, and the presence of the gubernaculum, in both genders. We intend to explain how the deep inguinal ring moves upwards, bringing the gubernaculum along with it, and thus determines the final form of the inguinal canal. Clin. Anat. 22:614–618, 2009. © 2009 Wiley‐Liss, Inc.     

The insertion of the lesser and greater gastric omenta and its significance for the T classification of gastric carcinomas (UICC)

The problem of T classification of proximal gastric carcinomas is becoming increasingly important due to a rise in the incidence of these tumors. The aim of this study was to examine the gastric insertion of the lesser and greater omenta and its role in the T classification of gastric carcinomas. The stomach and greater and lesser omenta were removed from 76 fixed cadavers and 12 measurements each were done in defined localizations. The lesser omentum extended to the gastric wall in 98% of the cases. This junction as well as the omental thickness and thus the retroperitoneal part are especially pronounced in the cardiac region. According to the current UICC classification, even advanced tumors extending into the gastric wall can be classified T2 as long as they do not penetrate the visceral peritoneum. This results in « understaging » and a seemingly poorer prognosis for cardiac carcinomas. Our study results support the recommendation of Hermanek and Wittekind [5] to subdivide the T2 stage of gastric carcinomas on the basis of infiltration depth.     

Effect of autologous omental free graft on wound healing process in experimental cervical oesophagus incision in dog: short-term preliminary histopathological study

This study was designed to evaluate the role of free autologous greater omentum graft in enhancing the healing process in cervical oesophagus surgical wounds. The study was carried out on eight male adult dogs, assigned equally into either an experimental or control group. All dogs underwent cervical oesophagotomy and laparotomy operations simultaneously. A 3-cm linear full thickness incision was made on the cervical oesophagus and then sutured. A small piece of omentum was obtained from the abdominal cavity and secured on the oesophageal suture line in the experiment group. In the control group, the suture line was left without a graft and the isolated omentum disposed. During this study, the dogs were examined clinically and euthanized on day?14. The surgical site on the oesophagus was assessed macroscopically, and then histopathologic samples were taken from the repaired tissue of the oesophageal wall. The samples were stained by haematoxylin–eosin and Masson’s trichrome. The results demonstrated that there were no significant differences based on clinical and macroscopic examination between the two groups. The microscopic study revealed that cellularity, angiogenesis and granulation tissue formation in the wound bed in the experimental group was significantly more than in the control group. The application of autologous free omental graft can influence cervical oesophagus wound healing through augmentation of angiogenesis, cell infiltration and granulation tissue formation.     

Potential fascial dome made by the upper leaf of the phreno-esophageal membrane

We describe the configuration and size of the artificial fascial dome created in 57 cadavers. This dome protrudes into the thoracic cavity from the esophageal hiatus. This dome was a potential space realized by finger dissection (i.e., a specific but common surgical procedure during surgery of the upper part of the stomach). The vagus nerves penetrated the top of the dome and ran down along the esophagus. The height of the ventral wall of the dome ranged from 10-60 mm, while the dorsal wall was 10-40 mm longer than the ventral one since the dorsal wall attached to the lower, dorsal limb of the esophageal hiatus. Accordingly, the dorsal wall separated the "thoracic" aorta from the "abdominal" esophagus. We considered that the upper leaf of the phreno-esophageal membrane forms the fascial dome, although the lower leaf of the membrane was not identified in this study. According to the results, we proposed a schematic representation of the phreno-esophageal membrane.