Malignant tumor,of the gastrointestinal stromal tumor type,in the greater omentum

We report herein a rare case of gastrointestinal stromal tumor (GIST) type, arising from the greater omentum. A 65-year-old man who had a large abdominal tumor was referred to our hospital. Ultrasonography (US) and computed tomography (CT) scans showed a mass occupying almost the entire abdomen anterior to the bowel loops. Abdominal angiography showed that the main feeding artery of the tumor was the right gastroepiploic artery. The preoperative diagnosis was suspected gastric leiomyosarcoma. Laparotomy revealed a large mass arising from the greater omentum, and the tumor seemed to be completely excised. Histopathological and immunohistochemical studies indicated the tumor had the same characteristics as GIST. Twelve months after the operation, the tumor recurred in the peritoneal cavity at the site of the stomach, and was associated with multiple liver metastases. The patient died of hypovolemic shock. Necropsy revealed that rupture of one of the metastatic liver tumors had resulted in a massive intraperitoneal hemorrhage.     

Actinomycosis of the greater omentum

A case of histologically proven actinomycosis of the greater omentum is reported. Computed tomography (CT) showed a mass at the greater omentum near the left flank area; it was hypervascular on angiograms and was supplied by the omental artery originating from the splenic artery. Sonography showed that the echogenecity of the lesion was complex. Actinomycosis of the greater omentum, although rare, should be included in the differential diagnosis of omental mass.     

Use of the greater omentum in colorectal surgery

INTRODUCTION: Complications related to impaired healing remain a major challenge in colorectal surgery. This review examines the potentially protective role of the greater omentum in colorectal operations. METHODS: Review of all reports concerning applications of the greater omentum in colorectal surgery identified through MEDLINE (1966-1997) and other sources. RESULTS: Clinical case studies indicate that an interposition flap of omentum is beneficial in the management of complex rectal fistulas. Pelvic omentoplasty or an omental hammock appears to reduce the incidence of radiation enteropathy in patients receiving pelvic radiotherapy after rectal resection. However, recent research demonstrates that omental wrapping does not "protect" colonic or rectal anastomoses. Nor is there convincing evidence that pelvic omentoplasty promotes primary perineal healing after abdominoperineal resection for cancer, although it may reduce the incidence of perineal wound breakdown. CONCLUSIONS: Previous assumptions concerning the omentum are now being rigorously investigated with the aim of defining its true value in colorectal applications. This must be encouraged, especially where use of the omentum increases the magnitude or duration of operations significantly.     

Extragastrointestinal stromal tumor of the greater omentum: case report and review of the literature

Primary neoplasms of the greater omentum are rare. We report a case of omental tumors occurring in 58-year-old Japanese man. Ultrasonography showed multiple solid tumors in the abdomen and angiography identified the greater omentum as the precise location. The tumors were completely resected with the major part of the greater omentum and analyzed histologically, immunohistochemically, and genetically. Positive reactivity for CD117 (c-kit, a transmembrane tyrosine kinase receptor) and CD34, and the absence of TLS/FUS-CHOP rearrangement confirmed that the tumors were extragastrointestinal counterparts of a gastrointestinal stromal tumor. Although the higher mitotic activity measured by the Ki-67 labeling ratio suggests the malignant potential of this tumor, there was no recurrence at the 20-month follow-up.     

Gastric involvement by omental cakes: radiographic findings

Six cases of malignancy (3 ovarian, 1 endometrial, 1 cecal, and 1 breast) were collected in which upper gastrointestinal (UGI) examinations revealed mass effect, nodularity, flattening, and/or spiculated mucosal folds on the greater curvature of the stomach due to contiguous spread of tumor from the greater omentum. Carcinoma of the transverse colon invading the stomach via the gastrocolic ligament may produce identical radiographic findings. In 3 cases, however, barium enema (BE) examinations revealed simultaneous involvement of the transverse colon by omental tumor as well as other evidence of intraperitoneal seeding. When a UGI examination suggests gastric involvement by omental metastases or so-called omental "cakes," a BE should be performed to demonstrate associated colonic involvement and to rule out a carcinoma of the transverse colon as the cause of these radiographic findings.     

Torsion of the greater omentum with inguinal hernia.

Torsion of the greater omentum is an uncommon cause of acute abdomen, often diagnosed only intraoperatively. We report a 30-year-old man with torsion of the greater omentum in association with inguinal hernia, diagnosed on CT scan and managed conservatively.     

A case of postirradiation angiosarcoma of the greater omentum with hemorrhage

Angiosarcoma, one of the least common sarcomas, occurs most commonly in the skin and soft tissues, and postirradiation angiosarcoma of the greater omentum is extremely rare. Only one reported case of postirradiation angiosarcoma involved the greater omentum. We describe the case of 74-year-old female with a history of cervical cancer treated with abdominal irradiation 5 years before. On admission, she had nausea, vomiting anorexia, and fatigue. She underwent an abdominal computed tomography scan that revealed an irregularly shaped tumor bounded by transverse colon. The patient died on the 34th hospital day. Autopsy revealed that the tumor was composed of anastomosing irregular vascular channels of variable calibers, involving the adipose tissue of the omentum. Histological studies suggested angiosarcoma. The definitive diagnosis was postirradiation angiosarcoma of the greater omentum, which is an extremely rare condition with an overall dismal prognosis.     

Prevention of enteric erosion by vascular prostheses

Aortoenteric fistula is an uncommon but disastrous complication of aortic reconstruction with a prosthetic graft. Prevention of enteric erosion when using a vascular prosthesis must be a foremost consideration. For these occasions, greater omentum may be used to cover the graft. However, when use of the greater omentum is not possible, the interposition of a prosthetic patch is a means of preventing duodenal erosion. We review the usual procedures for reperitonealization and report on an original method of using a prosthetic patch to prevent erosion.     

Primary Torsion of the Greater Omentum Mimicking Duodenal Ulcer

The diagnosis of primary torsion of the omentum is a diagnostic enigma and is made almost exclusively at laparotomy. The difficulty is enhanced when the patient has a chronic problem mimicking a specific entity, e.g. peptic ulcer disease. The case presented is an example of this situation. The patient's history and acute presentation were compatible with chronic peptic ulcer disease with acute perforation. At laparotomy, the findings of torsion of the right lower omentum with infarction, along with marked scarring of the remainder of the greater omentum explained the clinical picture. Torsion of the greater omentum, therefore, must be added to the list of differential diagnoses when one is considering peptic ulcer disease.     

直肠癌根治术中带蒂大网膜移植的价值

目的研究带蒂大网膜移植填塞骶前腔对直肠癌根治术后会阴部伤口的治疗效果．方法按直肠癌根治术（Ｍｉｌｅｓ术）常规先行直肠癌腹会阴联合切除，然后行网膜剪裁及腹膜后隧道成形．根据大网膜入盆时的途径可分为左、中、右３个入路，左路经降结肠旁沟腹膜后隧道入盆，本组６例；中路为结肠后经脊柱左侧腹膜后隧道入盆，本组３５例．右路经升结肠旁沟腹膜后隧道入盆腔，本组９例；以中路法最好，有隧道短，成形容易，隧道位于腹部切口下，显露清楚，操作方便的优点．结果１９８８０１／１９９７０５在直肠癌根治切除术后，５０例带蒂大网膜移植填塞骶前腔组，会阴部伤口Ⅰ期愈合率明显高于１９８８年以前３５例单纯Ⅰ期缝合双腔引流管负压吸引组（６２９％）；术后住院天数和患者医药费用均减少１／３．结论带蒂大网膜移植填塞骶前腔对促进会阴部伤口Ⅰ期愈合效果良好，具有广泛临床实用价值．     

CT平扫对结核性腹膜炎的诊断价值

目的 探讨结核性腹膜炎的CT平扫表现特征。方法 回顾性分析46例有CT扫描资料的结核性腹膜炎患者,其中经手术病理证实6例,腹腔穿刺证实2例,腹腔镜检证实4例,试验性治疗诊断34例。观察内容包括结核性腹膜炎累及壁腹膜、大网膜、肠系膜及腹膜后间隙的CT表现特征。结果 （1）壁腹膜增厚33例,其中均匀、光滑增厚27例,局部不规则增厚6例;（2）腹腔积液31例,其中20例为少量积液;（3）大网膜增厚26例,表现为污迹样增厚22例,饼状增厚2例;（4）肠系膜受累32例,其中9例合并小结节影：（5）淋巴结增大16例;（6）肠壁增厚1例,肠间距增宽2例。结论 结核性腹膜炎CT平扫的主要表现有少量腹腔积液、均匀性腹膜增厚、大网膜污迹样增厚,以及肠系膜、肠管受累与腹腔淋巴结增大,CT平扫能为结核性腹膜炎的诊断提供重要信息。     

Idiopathic abdominal cocoon syndrome with unilateral abdominal cryptorchidism and greater omentum hypoplasia in a young case of small bowel obstruction

Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.     

Left-sided omental torsion with inguinal hernia

We report a case of surgically proved left-sided torsionof the greater omentum that caused secondary byuntreated inguinal hernia.Case A 36-year-old manpresented to our hospital with abdominal pain.Hehad been diagnosed with a left inguinal hernia,but hehad not received any treatments.Contrast-enhancedcomputed tomography(CT)of the abdomen showeda large fat density mass below the Sigmoid colon andleft inguinal hernia with incarcerated fat.Exploratorylaparotomy revealed torsion of the greater omentumwith small bloody ascites.The greater omentum wastwisted into one and a half circles and entered into a leftinguinal hernia.An omentectomy with a repair of leftinguinal hernia was performed.A resected omentum wassubmitted for pathological examination,which showedhemorrhagic infarction.Omental torsion is a rare causeof acute abdominal pain but should be included in thedifferential diagnoses of acute abdomen,especially inpatients with untreated inguinal hernia.     

Fixation of the greater omentum for prevention of delayed gastric emptying after left-sided hepatectomy: a randomized controlled trial

BACKGROUND/AIMS: We performed a randomized trial to evaluate whether fixation of the greater omentum to the peritoneum prevents delayed gastric emptying and other complications after left-sided hepatectomy. METHODOLOGY: Patients undergoing left lateral segmentectomy or left hepatectomy were randomly assigned to a fixation group (n=24) and a non-fixation group (n=25). In the fixation group, the greater omentum was sutured to the peritoneum to prevent the stomach from contacting the cut surface of the liver. RESULTS: Delayed gastric emptying developed in 4 of the patients in the non-fixation group (16%) versus none of the patients in the fixation group. According to univariate analysis, fixation significantly lowered the risk of delayed gastric emptying (p<0.05). The overall morbidity was higher in the non-fixation group (20.0%) than in the fixation patients (8.3%) without significance. CONCLUSIONS: Fixation of the greater omentum to the peritoneum decreased the occurrence of delayed gastric emptying following left-sided hepatectomy.     

Hepatic metastatic miliaria from a malignant melanoma: 2 case reports

Malignant melanoma of uveal or cutaneous origins are diseases which may run a fulminant metastatic course immediately or after a prolonged disease-free period. The liver is the most common initial site of metastatic involvement. Nevertheless, hepatic metastatic miliaria spread is rare. In these cases, morphological studies are normal and only biological abnormalities including icteric cholestasis and hepatocellular insufficiency may suggest this diagnosis. We report two cases of hepatic metastatic miliaria from malignant melanoma diagnosed by percutaneous liver biopsy.     

Esophageal mucosal metastasis from adenocarcinoma of the distal stomach

Dissemination of gastric cancer may usually occur by direct spread through the perigastric tissues to adjacent organ, lymphatic spread, and hematogenous spread. We report a rare case of gastric cancer with mucosal metastastic lesion on the upper esophagus that was diagnosed by endoscopy and endosonography. A biopsy of the esophageal mass was performed and the pathologic findings with immunohistochemical stain for Mucin-5AC are proved to be identical to that of gastric adenocarcinoma, suggesting metastasis from main lesion of the gastric cancer. The lesion could not be explained by lymphatic or hematogenous spread,and its metastasis mechanism is considered to be different from previous studies. We suggest that the gastroesophageal reflux of cancer cells could be one of the possible metastatic pathways for metastasis of esophagus from an adenocarcinoma of the stomach.     

Detection of human antinuclear antibodies on rodent omenta

Detection of antinuclear antibodies in the sera of patients by immunofluorescence using mouse or rabbit omentum is recommended, because artifacts stemming from cryostat sectioning and thawing the tissue are eliminated and the advantage of tissue-bound evenly spread cells is preserved. Moreover, the technique is sensitive and permits reading on easily recognizable cell types.     

Myoangiogenesis after cell patch cardiomyoplasty and omentopexy in a patient with ischemic cardiomyopathy

We describe a procedure to promote angiogenesis and impregnation of skeletal myoblast into infarcted myocardium. At the completion of coronary artery bypass surgery, the midline sternotomy incision was extended to open the abdomen, and the greater omentum was tailored to reach the myocardium. Four pieces of autologous rectus muscle were applied to the infarcted left ventricle. This implantation was reinforced by the greater omentum. Incisions were closed in the usual manner. Postoperatively, the patient showed significant improvements in left ventricular ejection fraction (from 0.15 to 0.40) and in exercise tolerance (from 3 METs to 6 METs, or 100%). Computed tomographic angiography and positron emission tomography demonstrated improved myocardial viability and vascularity in the ischemic segments of the left ventricle. Omentopexy and cell patch cardiomyoplasty in conjunction with coronary artery bypass surgery may stimulate myogenesis and angiogenesis in avascular, dyskinetic scar tissue of left ventricle; in this preliminary study, this procedure appeared to improve the functional capacity of the left ventricle.     

Intraabdominal Variceal Bleeding

A patient with known liver cirrhosis, but no previous variceal bleeding, presented with sudden abdominal pain and distention, hypotension, and bloody ascitic fluid. At exploration, he was found to be bleeding from varices in the gastrohepatic omentum and perisplenic area. Pathology of the liver showed cirrhosis and metastatic undifferentiated carcinoma.