bedah 7 wenny

8/12/2019 bedah 7 wenny

1/34


2/34

farction of the great

omentum and acute

appendicitis: a rare

associationLuigi Battaglia*, Filiberto Belli, Alberto

Vannelli, Giuliano Bonfanti,

Gianfrancesco Gallino, Elia Poiasina,

Mario Rampa, Marco Vitellaro andErmanno Leo

Address: olo!rectal ancer "urger# $nit, %epartment of "urger#, Fonda&ione 'R"

('stituto )a&ionale dei umori(, +ia Vene&ian, ! Milan, -.//, 'tal#

Email: Luigi Battaglia* ! luigi0battaglia1istitutotumori0mi0it2 Filiberto Belli !

luigi0battaglia1istitutotumori0mi0it2

Alberto Vannelli ! luigi0battaglia1istitutotumori0mi0it2 Giuliano Bonfanti !


Gianfrancesco Gallino ! luigi0battaglia1istitutotumori0mi0it2 Elia Poiasina !


Mario Rampa ! luigi0battaglia1istitutotumori0mi0it2 Marco Vitellaro !


Ermanno Leo ! luigi0battaglia1istitutotumori0mi0it

* orresponding aut3or

Published: 29 October 2008Received: 31 August2008

World Journal of Emergency Surgery 2008,3:30

doi:10118!"1#$9%#922%3%30

Acce&ted: 29 October2008

'his article is available (ro): htt&:""wwww*esorg"content"3"1"30

+ 2008 attaglia et al- licensee io.ed Central /td'his is an O&en Access article distributed under the ter)s o( the Creative Co))ons

Attribution /icense htt&:""creativeco))onsorg"licenses"b"20, which &er)its

unrestricted use, distribution, and re&roduction in an )ediu), &rovided the original wor

is &ro&erl cited

Abstract

4dio&athic seg)ental in(arction o( the greater

o)entu) is an unco))on cause o( acute

abdo)en 'he etiolog is still unclear and the

s)&to)s )i)ic acute a&&endicitis 4ts

&resentation si)ultaneousl with acute

a&&endicitis is still )ore in(re5uent 6e

&resent a case o( a $#%ear old wo)an

without signi(icant &revious )edical histor,

ad)itted with an acute abdo)en, in which the

clinical diagnosis was acute a&&endicitis and

in who) an in(arcted seg)ent o( right side o(

the greater o)entu) was also (ound at

la&aroto) As the etiolog is unnown, we

highlighted so)e o( the &ossible theories, and

e)&hasi7e the i)&ortance o( o)ental

in(arction even in the &resence o( acute

a&&endicitis as a coincident intra&eritoneal

&athological condition

Revie4mental 'nfarction, t3e result of

impaired perfusion to t3e greater

omentum, is a rare entit#0 First

described b# Bus3 in 567 89, t3eincidence of idiopat3ic segmental

infarction of t3e greater omentum is

estima

ted to

be

.0

of t3e

total

laparo

tomie

s

perfor

med

foracute

abdo

men

8-90

E+en

t3oug

3

more

t3an

..

cases3a+e

been

report

ed in

t3e

literat

ure,

its

associ

ation

;it3

acute

appendicitis

3as

been

rarel#

docu

mente

d0

More

intere

stingl

#, t3is

case

alsopresen

ted in

a

femal

e

patien

t,

;3ic3

ma


3/34

3e purpose of t3is report is to

describe our first e=peri!ence ;it3 t3is

condition0 E+en t3oug3 t3e etiolog# is

un?!#ear!old ;oman presented to t3e

emergenc# depart!ment complaining

of rig3t lo;er abdominal pain of >5

3ours of duration along ;it3 3ig3

fe+er and nausea ;it3!out +omiting0

3e patient 3ad no rele+ant pre+ious

medi!cal 3istor#0 3e pain started at

t3e rig3t paraumbilical and

Page 1 o(

(page number not for citation purposes)


4/34


5/34


6/34

ad3esions,

resected and

remo+ed0

Fur!t3er

inspection

s3o;ed no

ot3er

abnormalities

0 3ere!fore,

a partial

omental

resection and

a base!apical

appendectom

# ;ere

performed0

!igure "

Macroscopicalappearance oftheinfarctedarea ofthegreateromentu

m foundduringlaparoto

my foracuteappendicitis#ote thechange incolor andede)a o(theo)ental

(atarrows

Page 2 o(

(page number notfor citation

purposes)


7/34

WorldJournal ofEmergencySurgery2008,3:30

istopat3olo

gical

e=amination

confirmed

t3e diagnosis

of omental

infarction

and

p3legmonous

acute

appendici!tis0

3e

3istological

e=amination

re+ealed a

reddis3

infarc!tion of

t3e fatt#

tissue of t3e

greater

omentum0

3e

omentum

contained

scattered

3emorr3ages

and t3e +es!

sels ;ere

mar


8/34


9/34

also present

at

e=ploration0

Among t3e

publis3ed

cases, our

patient 3as a

more at#pi!cal

presentation

t3at t3ose

pre+iousl#

reported0 As

described

earlier, most

aut3ors

suggest acute

appendicitis

!igure $

Micrographshoingthehistological resultsof the

infarctedomentum#ote the

areas o((atnecrosisandli5ue(ac%tivechanges'here arealsoscattered

acutein(la))ator cells

Page 3 o(

(page number notfor citation

purposes)


10/34

World Journal of Emergency

Surgery 2008,3:30

htt&:""wwww*esorg"content"3"1"30

%able ": &lassification of theinfarctions of the greateromentum#

Omental infarction without

torsion:

Pri)ar 4dio&athic in(arctiono( the greater o)entu)

econdar: hernia,h&ercoagulabil, &athologvascular, &olglobulia

Omental infarction with

torsion:

Pri)ar

econdar: adherences,csts, tu)or

aspreoperati+e

diagnosis,

but t3e

appendi= is

usuall# found

to be

macroscopica

ll# normal

eit3er at

e=ploration

or at

3istopat3olog

ical anal#sis8>90

3e e=act

etiolog# and

pat3ogenesis

of t3is

condition is

un


11/34

+enous

engorgement

after 3ea+#

meals or

+enous

elongation

pro!duced b#

e=cessi+e

;eig3t of t3e

greateromentum as

a cause, since

t3e 3ig3er

pre+alence of

t3e s#ndrome

in t3e obese

population

8790

linicall#,

most patients

present ;it3acute or

subacute

abdominal

pain0 3e

pain ma# be

to t3e left or

rig3t side of

t3e midline

based on t3e

side of

omental

in+ol+ement0

Pain ma#locali&e to

t3e upper or

lo;er

@uadrant of

t3e abdomen,

simulating

acute

appendicitis

D77 or

c3ole!c#stitis

890 'n female

patients, t3e

entit# canalso mimic

g#necologic

problems0

ca


12/34

t3e infarcted

omentum,

and it is t3e

usual

treatment

;3en t3e

diagnosis is

not

establis3ed

preoperati+el#0 Eit3er b#

open surger#

or

laparoscop#,

t3e rationale

for e=cision

rests on t3e

t3eo!retical

possibilit# of

ad3esions

forming

about t3e

infarct,;3ic3 could

obstruct

nearb# bo;el

loops0

'diopat3ic

segmental

infarction of

t3e rig3t

sided greater

omentum

s3ould be

considered

e+en in t3e

presence of

acute

appendicitis

or ot3er intra

abdominal

pat3ologies

since it ma#occur and

mimic t3e

basic

pat3ologic

condi!tion as

an associated

disease0

Furt3ermore,

e+en ;3en

ot3er +iscera

are found to

be normal at

e=ploration,t3e omentum

s3ould be

inspected for

infarction,

especiall# if

free

serosanguine

ous

peritoneal

fluid is

present0

3e p3#sicalfindings are

+ariable but

usuall# t3ere

is ten!derness

in t3e rig3t

side of t3e

abdomen,

predominantl

# at t3e rig3t

lo;er

@uadrant0

P3#sical

e=aminationusuall#

elicits

locali&ed

tenderness

;it3 or

;it3out a

palpable

(mass(0

emperature

is usuall#

normal or

slig3tl#

raised04ccasionall#,

t3e B

count ma# be

ele+ated03erefore,

clinicall#,

omental

infarction is

difficult to be

distin!

guis3ed from

appendicitis,

c3olec#stitis,

or adne=al

prob!lems0

"ince it is

rarel#

diagnosed

before

surger#, t3e

imaging fea!

tures of

omental

resection

3a+e been

seldom

described in

t3eradiological

literature0


13/34

omputed

tomograp3#

andCor

ultrasound

can be

e=tremel#

3elpful in

establis3ing

t3e diagnosis0

Bot3 ma#s3o; a ;ell

circumscribe

d, o+oid or

&onclusion't is possible

t3at

infarction of

un


14/34

g

Page $ o(

(page number not for citation purposes)


15/34

World Journal of Emergency

Surgery 2008,3:30

htt&:""wwww*esorg"content"3"1"30

i

m

ag

e

s

0

A

c

o

p

#

of

t

3

e

;

r

i

t

t

e

n

c

o

n

s

e

n

t

i

s

a

+

a

i

l

a

b

l

e

f

o

r

r

e


16/34

+

i

e

;

b

#

t

3e

E

d

i

t

o

r

!

i

n

!

3

i

e

f

o

f

t

3

i

s

o

u

r

n

a

l

0

(

&ompeting interests3e aut3ors declare t3at t3e#

3a+e no competing interests0

Authors' contributionsL

B

;

r

o

t

e

t

3e


17/34


18/34

e

r

a

t

i

+

e

a

nd

p

o

s

t

o

p

e

r

a

t

i+

e

p

a

t

i

e

n

t

m

an

a

g

e

m

e

n

t

,

A

V

p

a

r

t

i

c

i

p

a

t

e

d

i

n


19/34

m

a

n

u

s

c

r

i

pt

d

e

s

i

g

n

a

n

d

c

o

o

r

d

i

n

a

t

i

o

n

,

G

B

p

a

r

t

i

c

i

p

at

e

d

i

n

l

i

t

e

r

at

u


20/34

r

e

r

e

+

i

e

;

in

g

a

n

d

p

a

t

i

e

nt

f

o

l

l

o

;

!

u

p

,

G

G

p

a

r

t

i

c

i

p

a

te

d

i

n

l

i

t

e

r

a

tu

r


21/34


22/34


23/34

!

p

a

t

e

d

i

n

l

i

t

e

r

a

t

u

r

e

r

e+

i

e

;

i

n

g

,

F

B

pa

r

t

i

c

i

p

a

t

e

d

in

l

i

t

e

r

a

t

u

r

e

r

e


24/34

+

i

e

;

i

n

g

,

EL

i

s

t

3

e

3

i

ef

o

f

t

3

e

"

u

r

gi

c

a

l

$

n

i

t

a

n

d

p

a

r

t

i

c

i

!

p

a

t

ed


25/34

i

n

m

a

n

u

s

c

ri

p

t

d

e

s

i

g

n

0

Ac(noledgements'his stud was &artiall su&&ortedb grants o( the 4talian Association(or

Cancer Research A4RC ; .ilanAuthors than the secretar, .rsAceto

Roberta, (or assistance in&re&aring the )anuscri&t

References

H ush P: A case ofhaemorrhage into thegreater omentum#The Lancet 189!,")*:28!

-H arciaP

bedah 7 wenny

Documents