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The Cochrane Database of Systematic... Jan 2019Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen. Life-threatening complications include injury to viscera (e.g. bowel, bladder) or to vasculature (e.g. major abdominal and anterior abdominal wall vessels). No clear consensus has been reached as to the optimal method of laparoscopic entry into the peritoneal cavity.
OBJECTIVES
To evaluate the benefits and risks of different laparoscopic entry techniques in gynaecological and non-gynaecological surgery.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, and trials registers in January 2018. We also checked the references of articles retrieved.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that compared one laparoscopic entry technique versus another. Primary outcomes were major complications including mortality, vascular injury of major vessels and abdominal wall vessels, visceral injury of bladder or bowel, gas embolism, solid organ injury, and failed entry (inability to access the peritoneal cavity). Secondary outcomes were extraperitoneal insufflation, trocar site bleeding, trocar site infection, incisional hernia, omentum injury, and uterine bleeding.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed risk of bias, and extracted data. We expressed findings as Peto odds ratios (Peto ORs) with 95% confidence intervals (CIs). We assessed statistical heterogeneity using the I² statistic. We assessed the overall quality of evidence for the main comparisons using GRADE methods.
MAIN RESULTS
The review included 57 RCTs including four multi-arm trials, with a total of 9865 participants, and evaluated 25 different laparoscopic entry techniques. Most studies selected low-risk patients, and many studies excluded patients with high body mass index (BMI) and previous abdominal surgery. Researchers did not find evidence of differences in major vascular or visceral complications, as would be anticipated given that event rates were very low and sample sizes were far too small to identify plausible differences in rare but serious adverse events.Open-entry versus closed-entryTen RCTs investigating Veress needle entry reported vascular injury as an outcome. There was a total of 1086 participants and 10 events of vascular injury were reported. Four RCTs looking at open entry technique reported vascular injury as an outcome. There was a total of 376 participants and 0 events of vascular injury were reported. This was not a direct comparison. In the direct comparison of Veress needle and Open-entry technique, there was insufficient evidence to determine whether there was a difference in rates of vascular injury (Peto OR 0.14, 95% CI 0.00 to 6.82; 4 RCTs; n = 915; I² = N/A, very low-quality evidence). Evidence was insufficient to show whether there were differences between groups for visceral injury (Peto OR 0.61, 95% CI 0.06 to 6.08; 4 RCTs; n = 915: I² = 0%; very low-quality evidence), or failed entry (Peto OR 0.45, 95% CI 0.14 to 1.42; 3 RCTs; n = 865; I² = 63%; very low-quality evidence). Two studies reported mortality with no events in either group. No studies reported gas embolism or solid organ injury.Direct trocar versus Veress needle entryTrial results show a reduction in failed entry into the abdomen with the use of a direct trocar in comparison with Veress needle entry (OR 0.24, 95% CI 0.17 to 0.34; 8 RCTs; N = 3185; I² = 45%; moderate-quality evidence). Evidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.59, 95% CI 0.18 to 1.96; 6 RCTs; n = 1603; I² = 75%; very low-quality evidence), visceral injury (Peto OR 2.02, 95% CI 0.21 to 19.42; 5 RCTs; n = 1519; I² = 25%; very low-quality evidence), or solid organ injury (Peto OR 0.58, 95% Cl 0.06 to 5.65; 3 RCTs; n = 1079; I² = 61%; very low-quality evidence). Four studies reported mortality with no events in either group. Two studies reported gas embolism, with no events in either group.Direct vision entry versus Veress needle entryEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.39, 95% CI 0.05 to 2.85; 1 RCT; n = 186; very low-quality evidence) or visceral injury (Peto OR 0.15, 95% CI 0.01 to 2.34; 2 RCTs; n = 380; I² = N/A; very low-quality evidence). Trials did not report our other primary outcomes.Direct vision entry versus open entryEvidence was insufficient to show whether there were differences between groups in rates of visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.50; 2 RCTs; n = 392; I² = N/A; very low-quality evidence), solid organ injury (Peto OR 6.16, 95% CI 0.12 to 316.67; 1 RCT; n = 60; very low-quality evidence), or failed entry (Peto OR 0.40, 95% CI 0.04 to 4.09; 1 RCT; n = 60; very low-quality evidence). Two studies reported vascular injury with no events in either arm. Trials did not report our other primary outcomes.Radially expanding (STEP) trocars versus non-expanding trocarsEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.24, 95% Cl 0.05 to 1.21; 2 RCTs; n = 331; I² = 0%; very low-quality evidence), visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.37; 2 RCTs; n = 331; very low-quality evidence), or solid organ injury (Peto OR 1.05, 95% CI 0.07 to 16.91; 1 RCT; n = 244; very low-quality evidence). Trials did not report our other primary outcomes.Other studies compared a wide variety of other laparoscopic entry techniques, but all evidence was of very low quality and evidence was insufficient to support the use of one technique over another.
AUTHORS' CONCLUSIONS
Overall, evidence was insufficient to support the use of one laparoscopic entry technique over another. Researchers noted an advantage of direct trocar entry over Veress needle entry for failed entry. Most evidence was of very low quality; the main limitations were imprecision (due to small sample sizes and very low event rates) and risk of bias associated with poor reporting of study methods.
Topics: Abdominal Wall; Blood Vessels; Female; Gynecologic Surgical Procedures; Humans; Intestines; Intraoperative Complications; Laparoscopy; Male; Peritoneal Cavity; Randomized Controlled Trials as Topic; Urinary Bladder
PubMed: 30657163
DOI: 10.1002/14651858.CD006583.pub5 -
Medicina (Kaunas, Lithuania) Sep 2022: Surgery remains the only possible curative treatment for advanced gastric cancer (AGC). Peritoneal metastases are estimated to occur in approximately 55-60% AGC... (Meta-Analysis)
Meta-Analysis Review
: Surgery remains the only possible curative treatment for advanced gastric cancer (AGC). Peritoneal metastases are estimated to occur in approximately 55-60% AGC patients. Greater omentum is the most common metastatic area in AGC. At present, omentectomy alone or bursectomy are usually carried out during gastric cancer surgery. We performed a meta-analysis in order to evaluate long-term and short-term outcomes among AGC patients, who have undergone radical gastrectomy with or without complete omentectomy (CO). : We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed by use of RevMan (Computer program) Version 5.4. : The eight included studies covered an approximately 20 years long study period (2000-2018). Almost all included studies were retrospective ones and originated from Asian countries. Meta-analysis indicated gastrectomy without CO as significantly associated with longer 3-year (RR: 0.94, 95% CI: 0.90-0.98, = 0.005) and 5-year overall survivals (OS) (RR: 0.93, 95% CI: 0.88-0.98, = 0.007). Moreover, we found longer operative time (MD: 24.00, 95% CI: -0.45-48.45, = 0.05) and higher estimated blood loss (MD: 194.76, 95% CI: 96.40-293.13, = 0.0001) in CO group. : Non-complete omentectomy (NCO) group had a statistically greater rate in 3-year and 5-year OSs than the CO group, while the CO group had significantly longer operative time and higher estimated blood loss than the NCO group. Further randomized, possibly multi-center trials may turn out of paramount importance in confirming our results.
Topics: Gastrectomy; Humans; Laparoscopy; Omentum; Retrospective Studies; Stomach Neoplasms; Treatment Outcome
PubMed: 36143918
DOI: 10.3390/medicina58091241 -
Cureus Nov 2019Lymph node transfer is a surgical treatment that is becoming more prevalent. The lymph nodes from the groin and neck are most frequently used. Iatrogenic lymphedema can... (Review)
Review
Lymph node transfer is a surgical treatment that is becoming more prevalent. The lymph nodes from the groin and neck are most frequently used. Iatrogenic lymphedema can be a consequence of the dissection of the groin nodes; thus, some surgeons prefer to use the neck as a donor site. Literature reporting surgical algorithms for the treatment of lymphedema is scarce. Thus, we conducted a systematic review of vascularized omentum lymph node transfer (VOLT) in patients with lymphedema to provide more information about this increasingly common procedure. We hypothesize that the analyzed studies will show that VOLT has positive outcomes. Two reviewers (G.J.C., D.B.) performed independent searches using the PubMed database without timeframe limitations initially through title and abstract descriptions and then by full-text review. The search was done using the following keywords: Breast cancer lymphedema OR lymphedema AND lymph node transfer OR lymph node flap OR lymph node graft AND omental OR omentum OR gastroepiploic. Eligibility criteria included publications evaluating patients with lymphedema in the upper extremity and lower extremity, who underwent VOLT. Our search yielded 35 potential papers in the literature, but only six studies fulfilled the study eligibility criteria. The total number of patients was 137. Three studies described single VOLT, two studies described double VOLT and one study described two cohort patients, one that was treated with single VOLT and another one that was treated with double VOLT. Postoperative reduction of arm circumference, arm volume, and symptoms of the upper extremity were reported in all patients. Nonetheless, in one study, seven patients did not notice any extremity circumference reduction during the follow-up period and four patients noticed an increase in arm volume. Flap loss was reported by two authors in a total of two patients. Overall, patients experienced successful lymphedema treatment with VOLT. All authors presented results with reduced circumferential size of the affected upper and lower limbs, as well as reduction of the infectious intercurrences, such as cellulitis, with a small incidence of associated complications.
PubMed: 31807393
DOI: 10.7759/cureus.6227 -
The Cochrane Database of Systematic... Oct 2014Oesophagectomy followed by oesophagogastrostomy is the preferred treatment for early-stage oesophageal cancer. It carries the risk of anastomotic leakage after... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oesophagectomy followed by oesophagogastrostomy is the preferred treatment for early-stage oesophageal cancer. It carries the risk of anastomotic leakage after oesophagogastric anastomosis, which causes considerable morbidity and mortality and is one of the most dangerous complications. Omentoplasty has been recommended by some researchers to prevent anastomotic leaks associated with oesophagogastrostomy. However, the value of omentoplasty for oesophagogastrostomy after oesophagectomy has not been systematically reviewed.
OBJECTIVES
To assess the effects of omentoplasty for oesophagogastrostomy after oesophagectomy in patients with oesophageal cancer.
SEARCH METHODS
A comprehensive search to identify eligible studies for inclusion was conducted using the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PubMed and other reliable resources.
SELECTION CRITERIA
Randomised controlled trials comparing omentoplasty versus no omentoplasty for oesophagogastrostomy after oesophagectomy in patients with oesophageal cancer were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Two review authors (Yong Yuan and Xiaoxi Zeng) independently assessed the quality of included studies and extracted data; disagreements were resolved through arbitration by another review author. Results of dichotomous outcomes were expressed as risk ratios (RRs) with 95% confidence intervals (CIs), and continuous outcomes were expressed as mean differences (MDs) with 95% CIs. Meta-analysis was performed when available data were sufficiently similar. Subgroup analysis was carried out on the basis of different approaches to surgery.
MAIN RESULTS
Three randomised controlled trials (633 participants) were included in this updated review. No significant differences in hospital mortality were noted between the study group (with omentoplasty) and the control group (without omentoplasty) (RR 1.28, 95% CI 0.49 to 3.39). None of the included studies reported differences in long-term survival between the two groups. The incidence of postoperative anastomotic leakage was significantly less among study participants treated with omentoplasty than among those treated without (RR 0.25, 95% CI 0.11 to 0.55), but the additional benefit was seen in the subgroup analysis only for participants undergoing a transhiatal oesophagogastrectomy (THE) procedure (RR 0.23, 95% CI 0.07 to 0.79); transthoracic oesophagogastrectomy (TTE) (RR 0.19, 95% CI 0.03 to 1.03); or three-field oesophagectomy (RR 0.33, 95% CI 0.09 to 1.19 ). Omentoplasty did not significantly improve other surgery-related complications, such as anastomotic stricture (RR 0.91, 95% CI 0.33 to 2.57). However, participants treated with omentoplasty could reduce the duration of hospitalisation compared with that seen in the control group (MD -2.13, 95% CI -3.57 to -0.69).
AUTHORS' CONCLUSIONS
Omentoplasty may provide additional benefit in decreasing the incidence of anastomotic leakage after oesophagectomy and oesophagogastrostomy for patients with oesophageal cancer without increasing or decreasing other complications, especially among those treated with THE. It also has the potential to reduce the duration of hospital stay after operation. Further randomised controlled trials are needed to investigate the influences of omentoplasty on the incidence of anastomotic leakage and anastomotic stricture, long-term survival, duration of hospital stay and quality of life after oesophagectomy and oesophagogastrostomy when different surgical approaches are used.
Topics: Anastomosis, Surgical; Anastomotic Leak; Esophageal Neoplasms; Esophagectomy; Esophagostomy; Esophagus; Gastrostomy; Humans; Length of Stay; Omentum; Randomized Controlled Trials as Topic; Stomach
PubMed: 25274134
DOI: 10.1002/14651858.CD008446.pub3 -
European Journal of Cardio-thoracic... Dec 2020Preclinical in vivo studies using omental tissue as a biomaterial for myocardial regeneration are promising and have not previously been collated. We aimed to evaluate...
OBJECTIVES
Preclinical in vivo studies using omental tissue as a biomaterial for myocardial regeneration are promising and have not previously been collated. We aimed to evaluate the effects of the omentum as a support for bioengineered tissue therapy for cardiac regeneration in vivo.
METHODS
A systematic scoping review was performed. Only English-language studies that used bioengineered cardio-regenerative tissue, omentum and ischaemic cardiomyopathy in vivo models were included.
RESULTS
We initially screened 1926 studies of which 17 were included in the final qualitative analysis. Among these, 11 were methodologically comparable and 6 were non-comparable. The use of the omentum improved the engraftment of bioengineered tissue by improving cell retention and reducing infarct size. Vascularization was also improved by the induction of angiogenesis in the transplanted tissue. Omentum-supported bioengineered grafts were associated with enhanced host reverse remodelling and improved haemodynamic measurements.
CONCLUSIONS
The omentum is a promising support for myocardial regenerative bioengineering in vivo. Future studies would benefit from more homogenous methodologies and reporting of outcomes to allow for direct comparison.
Topics: Cardiomyopathies; Heart; Humans; Myocardial Ischemia; Omentum; Regeneration
PubMed: 32808023
DOI: 10.1093/ejcts/ezaa205 -
Cancers Apr 2023Medical use of (non-)thermal plasmas is an emerging field in gynaecology. However, data on plasma energy dispersion remain limited. This systematic review presents an... (Review)
Review
Medical use of (non-)thermal plasmas is an emerging field in gynaecology. However, data on plasma energy dispersion remain limited. This systematic review presents an overview of plasma devices, fields of effective application, and impact of use factors and device settings on tissues in the female pelvis, including the uterus, ovaries, cervix, vagina, vulva, colon, omentum, mesenterium, and peritoneum. A search of the literature was performed on 4 January 2023 in the Medline Ovid, Embase, Cochrane, Web of Science, and Google Scholar databases. Devices were classified as plasma-assisted electrosurgery (ES) using electrothermal energy, neutral argon plasma (NAP) using kinetic particle energy, or cold atmospheric plasma (CAP) using non-thermal biochemical reactions. In total, 8958 articles were identified, of which 310 were scanned, and 14 were included due to containing quantitative data on depths or volumes of tissues reached. Plasma-assisted ES devices produce a thermal effects depth of <2.4 mm. In turn, NAP effects remained superficial, <1.0 mm. So far, the depth and uniformity of CAP effects are insufficiently understood. These data are crucial to achieve complete treatment, reduce recurrence, and limit damage to healthy tissues (e.g., prevent perforations or preserve parenchyma). Upcoming and potentially high-gain applications are discussed, and deficits in current evidence are identified.
PubMed: 37190314
DOI: 10.3390/cancers15082386 -
International Journal of Surgery... Dec 2021Omentectomy has been traditionally a part of standard radical gastrectomy. Its clinical benefit for locally advanced gastric cancer (LAGC) remains controversial. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Omentectomy has been traditionally a part of standard radical gastrectomy. Its clinical benefit for locally advanced gastric cancer (LAGC) remains controversial. This study aimed at evaluating the impact of gastrectomy with omentum preservation (GOP) on survival, recurrence, surgical outcomes and postoperative complications by comparing with gastrectomy with omentum resection (GOR).
METHODS
Original studies comparing GOP with GOR in LAGC were searched. Meta-analysis was performed using RevMan 5.4.
RESULTS
Seven studies involving 1879 patients were analyzed. Compared with GOR, GOP achieved significantly better overall survival (HR = 0.75 [0.60, 0.95], P = 0.01), with similar relapse-free survival (HR = 0.84 [0.68, 1.03], P = 0.10). The two groups had similar total recurrence rate (OR = 0.86 [0.68, 1.08], P = 0.19) and no significant differences in rates of peritoneal, hematogenous, locoregional or distant lymph node recurrences. GOP had significantly less blood loss (MD = -83 [-139, -28] ml, P = 0.003) and tended to have shorter operation time (MD = -28 [-58, 2] min, P = 0.06), with similar harvested number of lymph nodes (MD = -0.4 [-2.6, 1.8], P = 0.70). The incidences of total all grade and major complications were similar in GOP and GOR (all grade: 31.8% vs. 30.3%, OR = 1.08 [0.79, 1.46], P = 0.64; major: 9.2% vs. 10.1%, OR = 1.14 [0.55, 2.34], P = 0.73). There were no significant differences in incidences of complication or postoperative mortality.
CONCLUSIONS
Omentum preservation did not affect curability or survival in LAGC. These findings require validation in randomized controlled trials with large sample sizes.
Topics: Gastrectomy; Humans; Laparoscopy; Neoplasm Recurrence, Local; Omentum; Stomach Neoplasms
PubMed: 34763112
DOI: 10.1016/j.ijsu.2021.106176 -
Frontiers in Oncology 2021Complete omentectomy is considered to be essential in the radical gastrectomy for gastric cancer (GC), but its clinical benefit remains unclear. This study aims to...
BACKGROUND
Complete omentectomy is considered to be essential in the radical gastrectomy for gastric cancer (GC), but its clinical benefit remains unclear. This study aims to evaluate the efficacy of omentum-preserving gastrectomy (OPG) for patients with GC.
METHODS
Studies comparing the surgical and oncological outcomes of OPG and gastrectomy with complete omentectomy (GCO) for GC up to March 2021 were systematically searched from PubMed, Web of Science, Embase, and Cochrane Library. A pooled analysis was performed for the available data regarding the baseline features, surgical and oncological outcomes. The RevMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted.
RESULTS
Nine studies with a total of 3335 patients (1372 in the OPG group and 1963 in the GCO group) undergoing gastrectomy were included. In the pooled analysis, the baseline data in two groups were all comparable (p > 0.05). However, the OPG group was associated with shorter operative time (MD = -18.67, 95% CI = -31.42 to -5.91, P = 0.004) and less intraoperative blood loss (MD = -38.09, 95% CI = -53.78 to -22.41, P < 0.00001) than the GCO group. However, the number of dissected lymph nodes (MD = 2.16, 95% CI = -0.61 to 4.93, P = 0.13), postoperative complications (OR = 0.92, 95% CI = 0.74 to 1.15, p = 0.47), overall recurrence rate (OR = 0.83, 95% CI = 0.66 to 1.06, p = 0.14), peritoneal recurrence rate (OR = 0.91, 95% CI = 0.65 to 1.29, p = 0.60), 3-year relapse-free survival (RFS) rate (OR = 1.40, 95% CI = 0.86 to 2.27, p = 0.18), and 5-year RFS rate (OR = 1.21, 95% CI = 0.95 to 1.55, p = 0.12) of the two groups were comparable.
CONCLUSIONS
OPG might be an oncologically safe procedure with better surgical outcomes for patients with GC than GCO. However, high-quality randomized controlled trials are needed to confirm this benefit.
PubMed: 34540677
DOI: 10.3389/fonc.2021.710814 -
Medicine Jan 2017Hepatoblastoma is a rare malignancy. Approximately 100 cases are diagnosed yearly in the United States. The highest incidence occurs in infants and in children younger... (Review)
Review
RATIONALE
Hepatoblastoma is a rare malignancy. Approximately 100 cases are diagnosed yearly in the United States. The highest incidence occurs in infants and in children younger than 5 years. Cases involving patients older than 5 years are very rare. We describe the case of a patient who was diagnosed with hepatoblastoma at an atypical age of presentation for this type of malignancy. We also performed Ovid MEDLINE search for hepatoblastoma and epidemiology reports occurring in children between the ages of 5 and 18 years. In this article we review the epidemiology and summarize case reports published between 1997 and 2012 of patients with hepatoblastoma, who were older than 5 years.
PATIENT CONCERNS AND DIAGNOSIS
Our patient is an 11 year old boy with stage IV hepatoblastoma with lung and omental metastases at diagnosis.
INTERVENTIONS
The patient received 7 cycles of chemotherapy following the treatment plan of COG protocol AHEP 0731, off study. He also had tumor resection and omentectomy and achieved complete remission.
OUTCOMES
He later had disease recurrence and after undergoing treatment with different modalities, ultimately died of his disease. Review of SEER program data shows that the incidence of hepatoblastoma in children above the age of 5 years is too infrequent to be calculated. Literature review revealed 13 cases of patients diagnosed at age older than 5 years. Most cases were published due to unusual associations and/or complications. There are no obvious unifying characteristics for these cases, although there may be a slight male preponderance and many patients in this selected series presented with elevated Alpha-fetoprotein.
LESSONS
The reported case is rare, given the very low incidence of hepatoblastoma outside of infancy. A systematic review of characteristics and outcomes for patients older than 5 years who are enrolled in cooperative group hepatoblastoma trials may reveal important information about the epidemiology and tumor biology in this rare patient population.
Topics: Age of Onset; Child; Fatal Outcome; Hepatoblastoma; Humans; Incidence; Liver Neoplasms; Lung Neoplasms; Male; Omentum; Peritoneal Neoplasms; Recurrence
PubMed: 28079820
DOI: 10.1097/MD.0000000000005858 -
BMC Surgery May 2018Spontaneous rupture of omental vessels is an infrequent medical condition possibly causing severe intra-abdominal hemorrhage. Omental bleeding results from trauma... (Review)
Review
BACKGROUND
Spontaneous rupture of omental vessels is an infrequent medical condition possibly causing severe intra-abdominal hemorrhage. Omental bleeding results from trauma associated injury and irritation, neoplasia, arterial aneurysm rupture, and anticoagulant treatment. Idiopathic omental bleeding rarely causes acute abdominal bleeding which has been reported to occur in previous studies. Here we reported a case with idiopathic omental hemorrhage due to vascular malformation. A systematic review of literature is provided.
CASE PRESENTATION
A 58-year-old Han Chinese man arrived at the emergency department with left upper quadrant abdominal pain for 1 day. He had no significant previous medical history. There was no history of fever, vomiting, nausea, or anorexia. He was a non-smoker and did not consume alcohol. On physical examination, blood pressure was 118/72 mmHg, for a temperature of 37.7 °C; heart and respiratory rates of 130 per/min and 20 per/min were obtained, respectively. Abdomen assessment showed only mild tenderness in the left upper quadrant. Complete blood count (CBC) showed white cell and platelet counts of 16.69 × 10/L and 196 × 10/L, respectively. The haemoglobin value was 13.5 g/L at admission. Abdominal Computer Tomography (CT) was performed that showed peritoneal fluid appeared around the liver. Fresh blood was confirmed in the abdominocentesis. A hemoperitoneum was confirmed by abdominal enhanced CT, which presented a structural disorder in the left upper abdomen. The subject immediately underwent exploratory laparotomy. A massive hemoperitoneum originating from omental vessels was observed. The omental were partially removed. There was no evidence of malignancy or aneurysm upon palpation. Pathological assessment of the extracted tissue pointed to vascular malformation. The patient subsequently had an uneventful recovery; hospital discharge occurred at 7 days post-operation. Previous reports assessing idiopathic omental bleeding were systematically reviewed, summarizing published cases. A total of 12 hits were found in PubMed for idiopathic omental bleeding.
CONCLUSION
Idiopathic omental bleeding is a rare condition that requires emergency treatment. Treatment strategies include surgical intervention and transcatheter arterial embolization (TAE). The surgical option is suitable in subjects with persistent hypotension and those with unconfirmed diagnosis.
Topics: Abdominal Pain; Embolization, Therapeutic; Emergency Service, Hospital; Hemoperitoneum; Humans; Laparotomy; Male; Middle Aged; Omentum; Rupture, Spontaneous; Tomography, X-Ray Computed; Vomiting
PubMed: 29848342
DOI: 10.1186/s12893-018-0364-9