RESUMEN
A woman in her 30s presented to emergency with complaints of acute lower abdominal pain for 3 days, not associated with any menstrual, bowel or urinary symptoms. Examination revealed an abdominopelvic mass corresponding to an 18-week gravid uterus with diffuse tenderness and guarding over her lower abdomen. The patient was a follow-up case of subserosal fibroid uterus, chronic kidney disease stage 4 and rheumatic heart disease on anticoagulants. Fibroid degeneration or torsion was suspected. Ultrasound revealed a large posterior wall subserosal fibroid with free fluid in the pelvis. As findings did not suggest degeneration or pedunculated fibroid, noncontrast CT was done, which showed a similar mass with a pedicle arising from the uterine fundus with free fluid with no other evident cause of acute abdomen. The patient was taken up for emergency laparotomy. Intraoperatively, it was found to be a case of subserosal fibroid with greater omentum adhered to it and twisted around its axis about eight times. This case is being reported to highlight a rare cause of acute abdomen.
Asunto(s)
Abdomen Agudo , Leiomioma , Epiplón , Anomalía Torsional , Neoplasias Uterinas , Humanos , Abdomen Agudo/etiología , Femenino , Leiomioma/complicaciones , Leiomioma/cirugía , Leiomioma/diagnóstico por imagen , Epiplón/cirugía , Epiplón/patología , Anomalía Torsional/cirugía , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/complicaciones , Anomalía Torsional/diagnóstico , Adulto , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/cirugía , Neoplasias Uterinas/diagnóstico por imagen , Laparotomía/métodos , Tomografía Computarizada por Rayos X , Enfermedades Peritoneales/cirugía , Enfermedades Peritoneales/complicaciones , Enfermedades Peritoneales/diagnóstico por imagen , UltrasonografíaRESUMEN
Disease spread in the abdomen and pelvis generally occurs in a predictable pattern in relation to anatomic landmarks and fascial planes. Anatomically, the abdominopelvic cavity is subdivided into several smaller spaces or compartments by key ligaments and fascial planes. The abdominal cavity has been traditionally divided into peritoneal, retroperitoneal, and pelvic extraperitoneal spaces. Recently, more clinically relevant classifications have evolved. Many pathologic conditions affect the abdominal cavity, including traumatic, inflammatory, infectious, and neoplastic processes. These abnormalities can extend beyond their sites of origin through various pathways. Identifying the origin of a disease process is the first step in formulating a differential diagnosis and ultimately reaching a final diagnosis. Pathologic conditions differ in terms of pathways of disease spread. For example, simple fluid tracks along fascial planes, respecting anatomic boundaries, while fluid from acute necrotizing pancreatitis can destroy fascial planes, resulting in transfascial spread without regard for anatomic landmarks. Furthermore, neoplastic processes can spread through multiple pathways, with a propensity for spread to noncontiguous sites. When the origin of a disease process is not readily apparent, recognizing the spread pattern can allow the radiologist to work backward and ultimately arrive at the site or source of pathogenesis. As such, a cohesive understanding of the peritoneal anatomy, the typical organ or site of origin for a disease process, and the corresponding pattern of disease spread is critical not only for initial diagnosis but also for establishing a road map for staging, anticipating further disease spread, guiding search patterns and report checklists, determining prognosis, and tailoring appropriate follow-up imaging studies. ©RSNA, 2024 Supplemental material is available for this article.
Asunto(s)
Enfermedades Peritoneales , Peritoneo , Humanos , Peritoneo/diagnóstico por imagen , Peritoneo/patología , Peritoneo/anatomía & histología , Enfermedades Peritoneales/diagnóstico por imagen , Diagnóstico DiferencialRESUMEN
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.
Asunto(s)
Verde de Indocianina , Humanos , Masculino , Persona de Mediana Edad , Fluorescencia , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , ToracoscopíaRESUMEN
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.
Asunto(s)
Tomografía Computarizada por Rayos X , Humanos , Masculino , Adulto , Quistes/diagnóstico por imagen , Quistes/cirugía , Quistes/patología , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , Enfermedades Peritoneales/patología , Enfermedades Peritoneales/diagnóstico , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Enfermedades de los Perros , Cuerpos Extraños , Epiplón , Tomografía Computarizada por Rayos X , Anomalía Torsional , Perros , Animales , Femenino , Anomalía Torsional/veterinaria , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugía , Anomalía Torsional/etiología , Enfermedades de los Perros/etiología , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/cirugía , Enfermedades de los Perros/diagnóstico , Epiplón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/veterinaria , Cuerpos Extraños/veterinaria , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Enfermedades Peritoneales/veterinaria , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/etiología , Enfermedades Peritoneales/cirugía , Ligamento Ancho/diagnóstico por imagen , Tapones Quirúrgicos de Gaza/efectos adversos , Tapones Quirúrgicos de Gaza/veterinariaRESUMEN
BACKGROUND: Peritoneal cystic echinococcosis happens usually after traumatic rupture or after surgical treatment. Primary peritoneal cystic echinococcosis is a very rare case that constitutes a diagnostic and therapeutic challenge. CASE REPORT: A 30-year-old Tunisian man was admitted for hypogastric pain since 4 months. He has a 10 cm hypogastric mass. Biological-tests were normal. A computed tomography Scan showed a cystic mass on the pelvis measuring 13 × 17 cm without echinococcosis cyst in the liver. The patient was operated and we found a cystic mass of 17 cm located on the Douglas cul-de-sac that suggest a pelvic hydatid cyst. We have performed an aspiration of the cyst confirms the diagnosis followed by injection of hypertonic solution, extarction of the germinal layer and a maximal reduction of the pericyst. The postoperative course was uneventful. CONCLUSION: Trough our case, we try to focus on the diagnosis and therapeutic options of this rare entity that we should think of in front of a patient with isolated peritoneal cyst especially in endemic country.
Asunto(s)
Quistes , Equinococosis , Enfermedades Peritoneales , Masculino , Humanos , Adulto , Peritoneo/diagnóstico por imagen , Peritoneo/cirugía , Equinococosis/diagnóstico por imagen , Equinococosis/cirugía , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , Dolor Abdominal/etiología , Quistes/complicacionesRESUMEN
We present a report of two adult females who presented to the surgery clinic at different time frames in our hospital with a swelling in the inguinal region. The swelling was painful for one of our patients. The first patient was evaluated with a contrast-enhanced CT and an MRI, while the second patient underwent a ultrasonography and an MRI. Imaging revealed the structure to be cystic in nature and confirmed the diagnosis as a hydrocele of the canal of Nuck in both patients. Our second patient was also found to have concomitant endometriosis, with internal septations seen in the hydrocele. Aspiration revealed altered blood with haemosiderin deposition, which established a diagnosis of endometriosis of the canal of Nuck. The first patient underwent excision, while the second patient refused a surgical approach and opted for medical management for endometriosis.
Asunto(s)
Quistes , Endometriosis , Enfermedades Peritoneales , Masculino , Femenino , Adulto , Humanos , Endometriosis/complicaciones , Endometriosis/diagnóstico por imagen , Endometriosis/cirugía , Enfermedades Peritoneales/complicaciones , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , Quistes/diagnóstico por imagen , Quistes/cirugía , Conducto Inguinal/cirugía , IngleRESUMEN
La torta omental describe la presencia de material infiltrativo en la grasa epiploica. El carcinoma de ovario es el proceso maligno clásicamente relacionado con las tortas omentales; sin embargo, las neoplasias malignas que pueden desarrollarlo son múltiples. Igualmente, procesos agudos o crónicos de índole inflamatoria e infecciosa pueden llevar a esta situación. De hecho, si bien la presencia de torta omental siempre implica descartar malignidad, en la edad pediátrica son más frecuentes estas otras etiologías. La clínica de la infiltración epiploica suele ser muy inespecífica, independientemente de la etiología. Los casos descritos suelen debutar con dolor abdominal mal localizado de días o semanas de evolución. La torta omental, en esencia, es un signo radiológico; por tanto, su diagnóstico implica la realización de una o varias pruebas de imagen. El gold standard es la tomografía computarizada (TC). La ecografía es una buena alternativa en niños. Si la causa de la torta omental es incierta, es necesario el examen anatomopatológico de una muestra de tejido peritoneal. Finalmente, el tratamiento en casos de omental cake depende de la etiología. En general, la presencia de este signo radiológico en el seno de una enfermedad neoplásica implica peores resultados. En cambio, en procesos infecciosos es posible un tratamiento dirigido con erradicación del patógeno implicado, consiguiendo una evolución clínica favorable (AU)
Omental cake describes the presence of infiltrative material in the epiploic fat. Ovarian carcinoma is the malignant process classically associated with omental cakes; however, there are multiple malignant neoplasms that can lead to its development. Similarly, acute or chronic inflammatory and infectious processes can lead to this condition. In fact, while the presence of omental cake always implies the need to rule out malignancy, these other etiologies are more common in the pediatric age group. The clinical presentation of epiploic infiltration is usually nonspecific, regardless of the etiology. Described cases often present with poorly localized abdominal pain that has been present for days or weeks. Omental cake, essentially, is a radiological sign; therefore, its diagnosis involves performing one or more imaging tests. The gold standard is computed tomography (CT). Ultrasound is a good alternative to CT as an initial test, especially in children, where neoplastic causes of omental cake are rare. If the cause of omental cake is uncertain, a histopathological examination of a peritoneal tissue sample is necessary. Finally, the treatment for omental cake depends on the etiology. In general, the presence of this radiological sign within a neoplastic disease implies worse outcomes. Conversely, in infectious processes, targeted treatment aiming to eradicate the implicated pathogen can lead to a favorable clinical course. (AU)
Asunto(s)
Humanos , Femenino , Adolescente , Epiplón/microbiología , Enfermedades Peritoneales/diagnóstico por imagen , Campylobacter jejuni , Infecciones por Campylobacter/diagnóstico por imagenRESUMEN
BACKGROUND: Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain. METHODS: The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature. RESULTS: The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings. CONCLUSION: POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient's clinical condition.
Asunto(s)
Abdomen Agudo , Colitis Isquémica , Enfermedades Peritoneales , Humanos , Abdomen Agudo/etiología , Abdomen Agudo/diagnóstico , Estudios Retrospectivos , Dolor Abdominal/etiología , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/diagnóstico por imagen , Necrosis , Diagnóstico DiferencialRESUMEN
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.
Asunto(s)
Abdomen Agudo , Hernia Inguinal , Enfermedades Peritoneales , Humanos , Masculino , Abdomen Agudo/diagnóstico por imagen , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Hernia Inguinal/diagnóstico por imagen , Hernia Inguinal/cirugía , Hernia Inguinal/complicaciones , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugía , Anomalía Torsional/complicaciones , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , Epiplón/diagnóstico por imagen , Epiplón/cirugía , Epiplón/patología , Tomografía Computarizada por Rayos XRESUMEN
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.
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Calcinosis , Enfermedades Peritoneales , Humanos , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Laparotomía , Calcinosis/diagnóstico por imagen , Calcinosis/cirugía , Calcinosis/patologíaAsunto(s)
Equinococosis , Echinococcus , Hiperemia , Enfermedades Peritoneales , Animales , Humanos , Hiperemia/complicaciones , Equinococosis/complicaciones , Equinococosis/diagnóstico por imagen , Enfermedades Peritoneales/complicaciones , Enfermedades Peritoneales/diagnóstico por imagen , Pelvis/diagnóstico por imagenRESUMEN
Omental torsion is a rare cause of abdominal emergency. Due to its clinical presentation and according to its localisation it is seldom diagnosed preoperatively as it imitates other more common diagnoses leading to surgical revision quite precisely. In this case report the authors present omental torsion with partial omental necrotisation in the right upper quadrant, imitating acute cholecystitis. The condition was managed by laparoscopic resection with a good clinical course postoperatively.
Asunto(s)
Abdomen Agudo , Enfermedades Peritoneales , Abdomen Agudo/etiología , Humanos , Epiplón/cirugía , Dolor/complicaciones , Enfermedades Peritoneales/complicaciones , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , Anomalía Torsional/complicaciones , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugíaRESUMEN
BACKGROUND: Torsion of the greater omentum is an uncommon cause of acute abdominal pain. Omental torsion can be divided into primary and secondary. Owing to its nonspecific abdominal pain, preoperative diagnosis is difficult. Ultrasound sonography and abdominal computed tomography scans do not have a major role in preoperative diagnosis. The definite diagnosis is usually made during operation. CASE PRESENTATION: A 7-year-old Persian boy was referred with right lower quadrant pain associated with nausea and vomiting. Laboratory blood tests and urinalysis were requested that revealed normal values. Ultrasonography was performed, revealing inflammatory changes with mild free fluid collection in the interloop. The patient underwent an open appendectomy, confirming a normal appendix with omental torsion. Two days later, he was discharged home without postoperative complications. CONCLUSIONS: In patients with acute abdomen, particularly those with acute appendicitis symptoms, omental torsion should be considered in the differential diagnosis.
Asunto(s)
Abdomen Agudo , Apendicitis , Enfermedades Peritoneales , Abdomen Agudo/etiología , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Enfermedad Aguda , Apendicitis/diagnóstico por imagen , Apendicitis/cirugía , Niño , Diagnóstico Diferencial , Humanos , Masculino , Epiplón/cirugía , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugíaRESUMEN
OBJECTIVE: Primary omental torsion (POT) is a rare condition in children often misdiagnosed because of a lack of clinical manifestations. Here we present insights gained from the treatment of pediatric POT cases at a single center over 8 years and summarize some influencing factors found in diagnosis and treatment, in order to reduce the misdiagnosis of POT in children in the future. METHODS: Demographic and clinical data of 17 children with POT treated in Shanghai Children's Hospital, Shanghai Jiaotong University from June 2012 to December 2020 were reviewed. RESULTS: The mean age of the 17 pediatric patients was 7.65 ± 2.12 years (range: 4-12 years), sixteen were male. The average time from the pain onset to operation was 73.82 ± 47.21 h (range: 21-144 h). In 5 cases, the ultrasound scan revealed a low-intensity inflammatory mass in the abdominal cavity. Only 1 of the 17 patients had normal body mass index, while others were overweight or obese. The mean computed tomography (CT) value of the mass in the lower right abdomen was - 58.74 ± 10.32 HU (range: - 70 to - 46 HU), which is close to that of its own abdominal wall fat [- 46.29 ± 9.45 HU (range: - 62 to - 32 HU)]. The location of the mass was located in front of the right colon in ten cases, except for two cases near the ligamentum teres. Five patients had whirl sign on CT images and 8 patients had pelvic fluid. Five cases were diagnosed as acute appendicitis and 12 were diagnosed as POT, the preoperative diagnosis was correct in 70.59% of cases. All 17 patients were treated with laparoscopic omentectomy. The average duration of hospitalization was 5.53 ± 1.12 days (range: 4-8 days). All cases were followed up. 1 case relapsed 8 months post operation, while the remaining cases had no complications. CONCLUSION: POT is rare in children with acute abdominal pain, which is more common in obese boys. The fatty mass in front of colon and between rectus abdominis sheath in CT image is specific, which is helpful for diagnosis of POT. Laparoscopy is an effective method for the treatment of POT in children.
Asunto(s)
Epiplón , Enfermedades Peritoneales , Niño , Preescolar , China , Humanos , Masculino , Epiplón/diagnóstico por imagen , Epiplón/cirugía , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , Estudios Retrospectivos , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugíaRESUMEN
PURPOSE: To evaluate the relationship between gastrointestinal (GI) symptoms and transvaginal ultrasound (TVUS) findings suggestive of endometriosis. MATERIALS AND METHODS: A prospective design. Women referred for a diagnostic ultrasound due to suspicion of endometriosis completed a Rome III and Pelvic Floor Distress Inventory (PFDI-20) questionnaire for clinical, GI symptoms, before undergoing TVUS.âEndometriosis was diagnosed in the presence of endometriomas and/or deeply infiltrative endometriotic (DIE) lesions. Association between lesion sites and GI symptoms was evaluated by univariate and multivariate analysis. RESULTS: The study included 241 women who presented with: dysmenorrhea (89.6â%), dyspareunia (76.3â%), chronic pelvic pain (77.2â%), dyschezia (66â%), hematochezia (15.4â%), subfertility (24.5â%). GI symptoms were present in 25.3-76.8â% and 5.4-55.6â% of Rome III and PFDI-20 questionnaire responses, respectively. TVUS findings were endometriomas (23.2â%), peritoneal adhesions (46.5â%), uterosacral ligament (26.7â%), retrocervical (11.2â%), rectosigmoid (11.2â%), intestinal (4.6â%), and bladder (0.8â%) involvement, and pouch of Douglas (POD) obliteration (15.4â%). There was a high prevalence of peritoneal adhesions, uterosacral ligament involvement, and rectosigmoid and intestinal nodules on TVUS in women with GI symptoms, up to Chi2â=â9.639 (pâ=â0.013) on univariate and Chi2â=â8.102 (pâ=â0.005) on multivariate analysis. CONCLUSION: We observed an almost 10-fold increase in DIE lesions in women with GI symptoms. We suggest that the presence of GI symptoms should prompt a referral for endometriosis evaluation and performance of a dedicated TVUS before invasive gastrointestinal procedures.
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Endometriosis , Enfermedades Peritoneales , Endometriosis/diagnóstico por imagen , Endometriosis/patología , Femenino , Humanos , Enfermedades Peritoneales/diagnóstico por imagen , Proyectos Piloto , Derivación y Consulta , Sensibilidad y Especificidad , Ultrasonografía/métodosRESUMEN
We report two cases of lesser omentum infarction with suggestive findings in esophagogastroduodenoscopy (EGD). Both patients were admitted to our hospital who presented with upper abdominal pain accompanied by signs of peritoneal irritation. EGD was performed to rule out gastroduodenal ulcer. No mucosal erythema and ulceration were observed, but we observed two signs suggesting lesser omentum infarction. First, EGD showed a submucosal tumor-like mass at the angular region of the lesser curvature of the stomach in both patients. Second, one of the patients exhibited great tenderness at the site of the tumor when this was depressed by biopsy forceps. We diagnosed the two patients with lesser omentum infarction from the results of abdominal computed tomography, abdominal ultrasonography, and EGD. Conservative management was applied;the patients received analgesic drugs and gradually became asymptomatic. Lesser omentum infarction presents with abdominal pain and sometimes signs of peritoneal irritation, and almost all cases can be successfully managed with conservative treatment. Diagnosing the disease carefully and precisely is essential. We report suggestive findings in EGD, which can assist in the diagnosis of lesser omentum infarction.
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Epiplón , Enfermedades Peritoneales , Endoscopía del Sistema Digestivo , Humanos , Infarto/diagnóstico por imagen , Mesenterio , Epiplón/diagnóstico por imagen , Enfermedades Peritoneales/diagnóstico por imagenRESUMEN
Primary torsion of large omentum is a rare cause of abdominal pain. The knowledge of this disease is essential for surgeons. It plays an important role in differential diagnosis of acute abdomen. The authors present two cases of primary omental torsion. They describe the diagnostic and therapeutic process. Diagnosis of omental torsion is difficult. Frequently, it presents with abdominal pain and imitates other acute abdominal diseases such as acute appendicitis in most cases. It is difficult to diagnose before surgical revision is approached. Laboratory and paraclinical examinations may not provide any clear findings. Laparoscopic revision is the method of choice, with confirmation of the diagnosis and laparoscopic resection of the ischemic part of omentum.