Giant peritoneal loose body and its protein composition: a case report.

Peritoneal loose body (PLB) is a kind of lesions located in the abdominal cavity or pelvic cavity, which is rare and difficult to diagnose. The diameter of PLB is mostly 0.5-2.5 cm. Most PLBS are asymptomatic. Here we reported a case of giant PLB in the pelvis and analyzed its structure and protein composition. Surgical exploration revealed a white oval mass (4.5*4*3 cm) in the pelvic cavity. After the mass was removed, the symptoms of hematuria disappeared and the patient was discharged on the second postoperative day. Histochemical staining showed that PLB was mainly composed of collagen and scattered calcification. The protein components of PLB were detected by proteome analysis, and a variety of proteins related to collagen deposition and calcification were identified in PLB.

Computed tomography of a canine omental torsion secondary to a chronic abdominal gossypiboma and concurrent incidental broad ligament torsion.

A 5-year-old female spayed Dogue de Bordeaux was referred for concerns of an abdominal mass and peritoneal effusion. Abdominal radiographs identified a mid-ventral abdominal soft tissue opaque mass containing a radiopaque marker consistent with a gossypiboma. Contrast-enhanced abdominal CT identified two whirl signs associated with the abdominal gossypiboma. Exploratory laparotomy confirmed an omental torsion with encapsulated gossypiboma and concurrent incidental torsion of the remnant of the right broad ligament. Based on a literature review, omental torsions are an unreported complication of gossypibomas in canids.

[Pleuroperitoneal Communication Using Intraoperative Imaging with Indocyanine Green Fluorescence: Report of a Case].

A 46-year-old man was treated with ascites due to idiopathic portal hypertension. Chest X-ray showed a massive pleural effusion on the right side. Also, contrast-enhanced ultrasonography showed that contrast medium was effusing from abdominal cavity into the thoracic cavity via diaphragm. He was diagnosed with pleuroperitoneal communication. Thoracoscopic surgery was performed and thoracoscope revealed ascites with indocyanine green (ICG) drained from multiple cystic area in the central tendon of the diaphragm. After suturing with non-absorbable thread with reinforcement, the whole diaphragm was covered with a polyglycolic acid sheet and fibrin glue. Postoperatively, there was no reaccumulation of pleural effusion. ICG fluorescence intraoperative imaging was an useful method in detecting the pleural holes.

Giant peritoneal loose body - case report.

The article presents the case of a rare, free moving, completely benign intra-abdominal formation called "giant peritoneal loose body". In our case, an expansion of the left hypogastrium with central calcification, in intimate contact with intestinal loops, of rather benign etiology, reminiscent of a mesenteric calcifying fibrous tumor, was accidentally detected on CT angiography. A possible neoplastic process was suspected, and therefore PET/CT was completed, showing that the expansion had moved to the right hypogastrium, and the radiologist evaluated the finding as a possible teratoma not originating from an intestinal loop. Due to the still indeterminate nature of the expansion, an exploratory laparotomy was performed with the discovery of a loose ovoid mass without any vascular supply and unrelated to other structures, which was extracted and sent for histological examination. The result was surprising. According to the pathologist, it was a rare, completely benign intra-abdominal lesion called the "giant peritoneal loose body". This pseudotumor should be considered as a differential diagnosis whenever we accidentally detect an asymptomatic, freely moving intra-abdominal lesion with central necrosis or calcification, in order to avoid unnecessary surgery, because according to available information, only symptomatic ones should be surgically removed.

Giant intraperitoneal non-pancreatic pseudocyst: a case report.

INTRODUCTION: Non-pancreatic pseudocysts are rare lesions that typically form from the omentum and mesentery. These cysts have a thick fibrotic wall made up of fibrous tissue and may show signs of calcifications and inflammatory changes. The fluid inside them can vary, ranging from hemorrhage and pus to serous or sometimes chylous content. In most cases, these cysts appear as a result of trauma, surgery, or infection. CASE PRESENTATION: A 35-year-old male patient from Ethiopia presented with swelling in his lower abdomen that had been present for 2 years. Initially, the swelling was small but gradually increased in size. The patient experienced frequent urination but no pain or difficulty during urination, urgency, intermittent urination, or blood in the urine. The swelling was initially painless but became painful 2 months prior to his presentation. Abdominal computed tomography scans revealed a well-defined, lobulated peritoneal lesion measuring 16 × 12 × 10 cm, consisting primarily of fluid-filled cysts with a thick, enhancing wall and septa. Additionally, there was a large, heterogeneous enhancing soft tissue component measuring 8 × 6 cm. As a result, the cystic mass was surgically removed in its entirety with partial removal of the bladder wall, and the patient was discharged in an improved condition. CONCLUSION: Primary non-pancreatic pseudocysts are extremely rare lesions that must be differentiated from other possible causes of cystic lesions within the peritoneal or retroperitoneal regions. Surgeons should be aware of the potential occurrence of these lesions, which may have an unknown origin.

Laparoscopically treated bowel obstruction secondary to a lesser omental hernia resulting from a previous laparoscopic total colectomy for ulcerative colitis: A report of two cases.

Lesser omental hernias are rare; however, they should be considered in symptomatic bowel obstruction subsequent to a subtotal or total colectomy. This report describes two cases of recurrent bowel obstruction secondary to lesser omental hernias after laparoscopic total colectomies for ulcerative colitis. Initially, these patients had been treated conservatively; however, due to symptom recurrence, surgical intervention was decided on. In both cases, laparoscopic surgery revealed lesser omental hernias. The small bowel, which had entered from the dorsal aspect of the stomach, was returned to the original position, and the lesser omentum was closed. The patients were discharged uneventfully, with no recurrent bowel obstruction during the follow-up period. These cases highlight the importance of including internal hernias in the differential diagnosis relative to recurrent bowel obstruction, in patient subpopulations with a prior history of a subtotal or total colectomy. Confirmation by computed tomography is preferable.

[Uroperitoneum in a heifer]. / Uroperitoneum bei einem weiblichen Jungrind.

Uroperitoneum is a rarely documented finding in heifers. More frequently uroperitoneum is described in male youngstock suffering from obstructive urolithiasis, or abscesses of the urachus. This report describes a case of uroperitoneum most likely as a result of a traumatic rupture of the urinary bladder in an 8.5 months old heifer. The animal was presented with a severely dilated abdomen and an undulating wave was evident upon palpation. The heifer exhibited physiologic urination. Additionally, left displacement of the abomasum was evident. In consequence to findings of the ultrasonographic examination and abdominocentesis, diagnostic laparotomy was performed. Urine was evacuated from the abdominal cavity in fractions and the damaged cranial pole of the urinary bladder was excised followed by the suture of the urinary bladder. The abomasum was replaced in its physiologic position and an omentopexy was performed. The heifer was discharged from hospital and was still in the herd 5 years after discharge.

Unusual case of retroperitoneal hematoma and duodenal ulcerative bleeding after nephrectomy: Case report.

RATIONALE: Retroperitoneal hematomas are relatively common in patients undergoing nephrectomy. Herein, we report an unusual case involving a giant retroperitoneal hematoma and subsequent duodenal ulcerative bleeding following a radical nephrectomy. PATIENT CONCERNS: A 77-year-old woman was admitted to our hospital for lower back pain, and she had severe right hydronephrosis and a urinary tract infection. DIAGNOSES: The patient was diagnosed and confirmed as high-grade urothelial carcinoma. INTERVENTIONS: After ineffective conservative treatments, a right radical nephrectomy and ureteral stump resection were performed. The patient received proton pump inhibitors to prevent stress ulcer formation and bleeding. On the first day post-surgery, she had normal gastrointestinal (GI) endoscopy findings. On the second day post-surgery, abdominal computed tomography revealed a retroperitoneal hematoma. Notably, 14 days post-surgery, massive GI bleeding occurred, and GI endoscopy identified an almost perforated ulcer in the bulbar and descending duodenum. OUTCOMES: The patient died on day 15 after surgery. LESSONS: Duodenal ulceration and bleeding might occur following a retroperitoneal hematoma in patients treated with nephrectomy. Timely intervention may prevent duodenal ulcers and complications, and thus could be a promising life-saving intercession.

Primary Omental Torsion in Children in the Laparoscopy Era: What Have we Learned so far?

BACKGROUND/AIM: Primary omental torsion is uncommon, mimicking appendicitis and other acute abdominal pathologies. It often escapes diagnosis on imaging investigation or conventional open laparotomy. This study aimed to evaluate the effect of laparoscopy on the various parameters of this entity, including incidence, diagnosis, and treatment. MATERIALS AND METHODS: A systematic review was performed, including PubMed and Scopus databases, without a time limit, following the PRISMA principles. A total of 16 articles from January 2000 to December 2023, corresponding to 56 children with primary omental torsion, complied with the research criteria. RESULTS: Primary omental torsion was associated with obesity. Symptoms were right abdomen oriented, often compared to those of acute appendicitis. Preoperative ultrasound displayed low diagnostic accuracy, whereas computerized tomography diagnosed only two thirds of cases. In all patients, the vermiform appendix was normal. CONCLUSION: Laparoscopy affected both diagnosis and treatment of primary omental torsion in children. Easy peritoneal cavity access rendered possible the diagnosis of cases previously discharged as abdominal pain of unknown etiology. Combined with the increased pediatric obesity, it also affected primary omental torsion incidence. The recent pathogenetic theories may be better supported today, as laparoscopy provides a detailed view in situ, and facilitates harvesting of fat tissue from the omentum for molecular investigation. The diagnostic efficiency of laparoscopy is superior to ultrasonography and computerized tomography. Finally, the removal of the ischemic omentum is technically easier compared to the open laparotomy alternative with all the technical difficulties of traction of a vulnerable hemorrhagic tissue through a small incision.

An indocyanine green fluorescence-guided operation for diagnosing and treating pleuroperitoneal communication.

Pleuroperitoneal communication occurs when ascites moves from the abdominal cavity to the pleural cavity via a diaphragmatic fistula. Managing large pleural fluid volumes is challenging, often requiring an operation. Identifying small diaphragmatic fistulas during the operation can be problematic, but ensuring their detection improves outcomes. This video tutorial presents a recent empirical case in which we successfully identified and closed a pleuroperitoneal contact using a thoracoscopic surgical procedure aided by indocyanine green fluorescence imaging. The patient, a 66-year-old woman, was hospitalized due to acute dyspnoea from a right thoracic pleural effusion during hepatic ascites treatment for cirrhosis. Because ascites decreased with pleural fluid drainage, surgical intervention was considered due to suspicion of a pleuroperitoneal connection. During the operation, indocyanine green was injected intraperitoneally, and near-infrared fluorescence-guided thoracoscopy pinpointed the location of the diaphragmatic fistula. The fistula was sutured and reinforced with a polyglycolic acid sheet and fibrin glue. Detecting the fistula intraoperatively is crucial to prevent recurrence, and the indocyanine green fluorescence method is a safe and effective technique for detecting small fistulas.

Management of uroperitoneum through combination of conservative and surgical treatments in two colts.

Background: Ruptures of the urinary bladder and urachus are the most frequent cause of uroperitoneum in foals. Surgical correction is often the first treatment choice, however, nonsurgical methods, such as urine removal via urinary catheters and abdominal drains, have been successfully performed in foals. Case Description: Two foals were referred to the Equine Perinatology Unit for suspicion of uroperitoneum. The diagnosis was confirmed by hematobiochemical and ultrasound examinations, thus cystorrhaphy and cystoplasty were attempted. Surgeons found a lesion in the dorsocranial margin of the bladder (Case 1) and a tear in the pelvic urethra (Case 2); in the first case, the defect was routinely repaired, while the last lesion was impossible to repair due to its localization. A urinary catheter was left in place in both cases. Uroperitoneum recurred 72 hours after the surgery in both foals: a second surgical correction was not recommended due to the localization of the tears and conservative treatment, with the placement of a 32F chest tube in the most ventral part of the abdomen, was preferred. Abdominal drains were removed 5-7 days after surgery, while urinary catheters were left in place for up to 7-8 days. Colts' conditions improved during hospitalizations. Two months after bladder surgery, Case 1 was euthanized due to multiple adhesions between the small intestine and the abdominal wall. Case 2 was still alive one year postoperatively. Conclusion: Although it cannot be considered the first choice for the treatment of uroperitoneum in the foal, nonsurgical treatment was successful in both cases in the short-term follow-up. However, the prognosis should be cautious due to the risk of long-term complications. Conservative management may be used to manage bladder/urethral tears that cannot be solved by surgery.

Inguinal hernia leading to omental torsion: Role of CT in differentiating from other clinical mimics - a case report and literature review.

Omental torsion is a very rare cause of acute abdomen. Clinically, it mimics other common pathologies such as acute appendicitis, acute diverticulitis and acute cholecystitis. It is therefore no surprise, that it was rarely diagnosed pre operatively before the advent and easy availability of modern imaging techniques. CT scan, in particular, can diagnose omental torsion with confidence pre operatively. This can make conservative treatment possible in cases of primary omental torsion and guide regarding the appropriate treatment in cases of secondary torsion. We present a case of a young male patient who presented to Emergency department with symptoms of acute abdomen. Clinical and laboratory findings were non-specific for any specific cause of acute abdomen. CT scan, however, showed omental fat stranding with whirlpool sign representing omental torsion which was seen to be secondary to left inguinal hernia. Patient was operated in emergency and necrotic omentum was resected and hernia repaired. Post-operative recovery was uneventful.

Osificación heterotópica mesentérica precoz posabdomen abierto y su manejo quirúrgico: presentación de un caso / Mesenteric heterotopic ossification after open abdomen and its surgical management: presentation of a case

OBJETIVO: Reportar el caso de un paciente con antecedente de múltiples cirugías por peritonitis y abdomen abierto, con hallazgo intraoperatorio de osificación heterotópica en el mesenterio. CASO CLÍNICO: Paciente masculino de 59 años, con antecedente de apendicectomía complicada hace 12 meses, que en esa oportunidad requirió manejo de abdomen abierto, colectomía derecha e ileostomía terminal. Un año posapendicectomía reingresa para reconstitución de tránsito con hallazgo intraoperatorio de masa calcificada en mesenterio, de 15 x 10 x 6 cm, cuyo estudio histológico informa osificación heterotópica mesentérica. Esta entidad es de baja frecuencia, asociada al antecedente de trauma y cirugía abdominal, y se ha descrito como causa de morbimortalidad. El manejo quirúrgico resectivo es factible por equipos con experiencia. CONCLUSIÓN: Se describe un caso con antecedente de abdomen abierto, con posterior hallazgo de osificación heterotópica mesentérica. Este caso clínico es representativo por sus factores de riesgos clásicos y manejo empleado para su resolución.

OBJECTIVE: Report the case of a patient with a history of multiple surgeries due to peritonitis and open abdomen, with intraoperative finding of mesenetrioc heterotopic ossification. CLINICAL CASE: A 59-year-old male patient with a history of complicated appendectomy 12 months ago, which requires the management of an open abdomen, right colectomy and terminal ileostomy. One year after appendectomy, is readmitted for transit reconstitution. Intraoperative finding were calcified mass in mesentery, of 15 x 10 x 6 cm, whose histological study reports mesenteric heterotopic ossification. This entity has low frequency, and is associated with a history of trauma and abdominal surgery, is described as a cause of morbidity and mortality. Resective surgical management is feasible for experienced teams. CONCLUSION: A case with antecedent of open abdomen is described, with later finding of mesenteric heterotopic ossification. This clinical case is representative for its classic risk factors and management used for its resolution.

Comunicación pleuroperitoneal en paciente con diálisis peritoneal: un caso de interés para el cirujano / Pleuroperitoneal communication in a patient with peritoneal dialysis: An interesting case for the surgeo

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Retalho autólogo de grande omento como estrutura cirúrgica de reparo extraperitoneal. Estudo experimental comparativo, pareado e controlado de suas propriedades adaptativas / The autologous greater omental flap as a structure for extraperitoneal surgical repair: a comparative, paired, and controlled experimental study of its adaptive properties

Introdução: O grande omento vem sendo utilizado como estrutura de reparo desde o século XIX e a partir do século XX tem sido descrito, em meio extraperitoneal, para o tratamento de diversas afecções em várias especialidades cirúrgicas. Apesar de amplamente estudado a partir da década de 1960, não há descrição de estudos comparativos sobre o seu retalho em meio extra peritoneal. O objetivo do presente estudo foi analisar as características adaptativas do grande omento em meio extra peritoneal para identificar a real aplicabilidade cirúrgica desta estrutura. Métodos: Estudo experimental comparativo, pareado e controlado de 20 amostras teciduais de ratos (Rattus norvegicus) fêmeas obesas, irmãs da linhagem Sprague- Dawley. De cada animal foram analisados e comparados, macroscopicamente e microscopicamente, através das técnicas de Hematoxilina-eosina (HE) amostras de: (1) omento sem manipulação, (2) omento manipulado intraperitoneal, (3) omento manipulado extraperitoneal e (4) tecido adiposo subcutâneo. Resultados: omento extraperitoneal, macroscopicamente, apresentou uma coloração amarelado mais intenso, semelhante à gordura subcutânea adjacente, com alto grau de contração se comparado ao omento intraperitoneal de controle. Pela técnica de HE, foi identificado alto grau de fibrose e tamanho médio dos adipócitos semelhante ao omento de controle e inferior ao do subcutâneo (p<0,001). Conclusão: O omento extraperitoneal não se mostra capaz de promover regeneração tecidual, uma vez que não foi observado metaplasia à histologia do retalho translocado. Entretanto, pode servir para a correção de pequenas deformidades, para o tratamento de áreas isquêmicas, como estrutura carreadora para a reconstrução cirúrgica e como plataforma germinadora para o desenvolvimento de novos órgãos.

Introduction: The greater omentum was initially used in the repair of gastrointestinal defects in the 19th century; during the 20th century, it has been used extraperitoneally in the treatment of various disorders, in several surgical specialties. Despite the fact that the greater omentum was studies in detail in the 1960s, there are no reported comparative studies concerning the use of omental flaps extraperitoneally. The present study analyzed the adaptive features of the greater omentum in the extraperitoneal space, with the aim of identifying its surgical applicability. Methods: A paired, controlled comparative study was conducted using 20 tissue samples from 5 obese female Sprague-Dawley rats (Rattus norvegicus). The following specimens from each animal were analyzed and compared, macroscopically and microscopically, using the hematoxylin-eosin (HE) technique: (1) omentum without manipulation; (2) intraperitoneally manipulated omentum; (3) extraperitoneally manipulated omentum; and (4) subcutaneous adipose tissue. Results: Macroscopically, the extraperitoneal omentum exhibited a more intense yellowish color and a higher degree of contraction than the control (intraperitoneal) omentum. The extraperitoneal omentum was similar in color to the adjacent subcutaneous adipose tissue. HE staining revealed a high degree of fibrosis and an average adipocyte size, similar to that in the control omentum, but lower than that in subcutaneous adipose tissue (p< 0.001). Conclusion: The results of this study indicate that the extraperitoneal omentum was not able to promote tissue regeneration, as metaplasia of the translocated flap was not observed in the histological analysis. However, this structure may be used to correct small deformities, in the treatment of ischemic areas, as a carrier structure for surgical reconstruction and as a germination platform for the development of new organs.

Torsión omental como causa de abdomen agudo pediátrico / Omental torsion a rare cause of acute abdomen in children

INTRODUCCIÓN: La torsión omental constituye una causa infrecuente de dolor abdominal del niño, con una frecuencia relativa estimada de un caso por cada 200 cirugías realizadas por sospecha de apendicitis. Se sugiere que la incidencia de esta patología estaría en aumento paralelo a la obesidad infantil, y al mayor conocimiento diagnóstico con imagenología. PRESENTACIÓN DE CASOS: Cinco pacientes fueron tratados en el Hospital Luis Calvo Mackenna con diagnóstico postoperatorio de torsión o infarto omental entre enero de 2006 y enero de 2011.Todos se presentaron con dolor abdominal agudo en el cuadrante inferior derecho acompañado de otros síntomas fuertemente sugerentes de una apendicitis aguda. En ninguno de los 5 casos se obtuvo diagnóstico imagenológico de urgencias, por lo que recibieron manejo exclusivamente quirúrgico (omentectomía con o sin apendicectomía, vía minilaparotomía o laparoscopía), con resultados satisfactorios. El estudio histopatológico demostró congestión, hemorragia y/o necrosis omental, e inflamación periférica apendicular. DISCUSIÓN: Con un mayor acceso a imágenes y conocimiento de esta patología por el equipo médico, se hace posible realizar el diagnóstico de forma preoperatoria, lo que es decisivo para posibilitar diferentes alternativas terapéuticas y puede evitar la cirugía restringiéndola a casos seleccionados.

INTRODUCTION: Omental torsion is a rare cause of abdominal pain in children, with an estimated incidence of one for every 200 appendectomies performed. A rise in that number has been projected, parallel to a higher prevalence of childhood obesity and a higher accuracy in diagnostic imaging. CASE REPORT: Five patients had a postoperative diagnosis of omental torsion in Hospital Luis Calvo Mackenna between January of 2006 and January 2011. All of them started an acute abdominal pain in right iliac fossa and general symptoms that resembled acute appendicitis. None of them had a correct diagnosis by emergency imaging; thereby a surgical resolution – open or laparoscopic omentectomy with or without appendectomy - was indicated with good outcomes. Histopathological study showed congestion, hemorrhage and/or omental necrosis, and periappendicular inflammation. DISCUSSION: With more readily available imaging studies and a higher index of suspicion, a preoperative diagnosis of omental torsion could be achieved, potentially avoiding unnecessary surgery.

Torsión primaria de epiplón: caso clínico / Primary omental torsion: report of one case

We report a 40 years old female consulting in the emergency room for abdominal pain and a mass in the left lower quadrant. An abdominal CAT sean showed an omental torsion. The patient was operated, excising the involved omentum. The postoperative period was uneventful and the patient was discharged three days after admission.

El objetivo de este trabajo es presentar el caso clínico de una paciente con torsión de epiplón manejado en nuestra institución. Se trata de una paciente de sexo femenino de 40 años de edad, que se presenta al servicio de urgencias por clínica de dolor abdominal de una semana de evolución asociado a masa abdominal en flanco izquierdo, en quien se realiza tomografía que revela cambios compatibles con torsión de epiplón por lo cual es llevada a cirugía realizándose resección de todo el omento.

Comparative study between parietal peritoneum suture and nonsuture in midline laparotomies in rats / Estudo comparativo entre sutura e não sutura do peritônio parietal nas laparotomias medianas em ratos

PURPOSE: Compare the parietal peritoneum suture and nonsuture in midline laparotomies in rats, as for the formation of adhesions. METHODS: 40 adult albino Wistar rats (20 males and 20 females) underwent a surgery, weighing between 350 and 400 grams. After anesthesia, a midline laparotomy was performed, followed by cavity closure with and without peritoneum suture. After 40 days, the rats underwent a new surgery in order to verify the peritoneum and check if there were any adhesions, and the rats were then sacrificed. RESULTS: Statistical analysis showed there was no significant difference between the adhesions occurring or not with peritoneal suture or nonsuture, including in relation to the rats' gender. CONCLUSION: Closing the peritoneum or not does not interfere with the formation of adhesions after midline laparotomies in rats from both genders.

OBJETIVO: Comparar a sutura e não sutura do peritônio parietal nas laparotomias medianas em ratos, quanto à formação de aderências. MÉTODOS: Foram operados 40 ratos albinos Wistar (20 machos e 20 fêmeas), adultos, pesando entre 350 e 400 gramas. Após a anestesia, foi realizada laparotomia mediana seguida de fechamento da cavidade com sutura do peritônio e sem sutura do peritônio. Após 40 dias, os animais foram re-operados para a inspeção do peritônio e a constatação da presença ou não de aderências e, em seguida, sacrificados. RESULTADOS: A análise estatística demonstrou que não houve diferença significativa entre a ocorrência ou não de aderências com sutura e não sutura do peritônio, nem com relação ao sexo dos animais operados. CONCLUSÃO: O fechamento ou não do peritônio não interfere na formação de aderências após laparotomias medianas em ratos de ambos os sexos.