RESUMO
INTRODUCTION: Omental torsion is a rare cause of acute abdominal pain caused by twisting of the omentum along its long axis, thus compromising its vascularity. Its presentation is non-specific and can mimic other common pathologies, making its pre-operative diagnosis challenging. PRESENTATION OF CASE: A 44-year-old female presented for periumbilical abdominal pain. Her laboratory results showed no leukocytosis and CRP was within normal range. CT scan of the abdomen and pelvis with oral and IV contrast showed a well demarcated pericecal mass at the right side, mostly suggestive of transmesenteric internal herniation with strangulation. The patient eventually required laparoscopic surgical intervention. DISCUSSION: The acute abdominal manifestations in patients with omental torsion are due to the development of edema and necrotic tissue distal of the torsion after the arterial supply and venous drainage have been obstructed. Rotation around the right gastroepiploic artery is considered to be the most common cause of omental torsion. Primary torsion is considered to be idiopathic, while secondary torsion occurs due to an identifiable predisposing pathology such as omental cysts, hernias, adhesions, or intra-abdominal tumors. Since symptoms of omental torsion are non-specific, it is crucial to consider the differential diagnosis and rule out other causes of acute abdomen. Surgical intervention is the mainstay treatment when there is uncertainty in the diagnosis, or when the patient's clinical, radiological, and laboratory findings worsen with conservative treatment. CONCLUSION: Early surgical intervention in cases of omental torsion reduces the incidence of formation of abscesses, adhesions, and omental necrosis. In cases of non-operative candidates, conservative treatment is the best option; therefore, the choice of treatment of omental torsion should be considered on a case-by-case basis.
RESUMO
INTRODUCTION: Leiomyosarcoma is a malignant neoplasm that is derived from smooth muscle cells in walls of small blood vessels or branch of the inferior vena cava, the uterus and the gastrointestinal tract. Different treatment options are present for the treatment of LMS. However, due to the rarity of LMS, the optimal treatment option is still to be discussed and determined. PRESENTATION OF CASE: A 51-year-old male patient, previously healthy, presented for perianal pain. Biopsy of the mass found showed spindle cell tumors with mild atypia, dense cellularity, and pelvic MRI with contrast showed a well-circumscribed mass of the anus, developed between the layers of the external sphincter with possible invasion of the internal sphincter consistent with Leiomyosarcoma Grade I. Wide excision was performed. Close follow-up should be done every 3 to 6 months for the first 2 to 3 years, every 6 to 12 months for the following 3 years, and annually afterwards. DISCUSSION: The symptoms of LMS include rectal bleeding with rectal and/or abdominal pain, weight loss, constipation, altered bowel motion and protruding mass. Treatment options include wide local excision, abdominoperineal resection, low anterior resection, bloc resection and pelvic exenteration. Patients who underwent wide local excision show a higher local recurrence rate as compared to patients who underwent radical resection. Distant metastasis is higher in patients who underwent radical resection. CONCLUSION: The treatment options of anal LMS are controversial. At present, very few cases have been reported, thus no universally accepted standard of surgical treatment has been established.