1/4. Idiopathic segmental infarction of the greater omentum successfully treated by laparoscopy: report of case.Idiopathic or spontaneous segmental infarction of the greater omentum (ISIGO) is a rare cause of acute right-sided abdominal pain. The symptoms simulate acute appendicitis in 66% of cases and cholecystitis in 22%. Progressive peritonitis usually dictates laparotomy, and an accurate diagnosis is rarely made before surgery. The etiology of the hemorrhagic necrosis is unknown, but predisposing factors such as anatomic variations in the blood supply to the right free omental end, obesity, trauma, overeating, coughing, and a sudden change in position may play a role in the pathogenesis. We present herein the case of a 37-year-old man in whom ISIGO, precipitated by obesity and overeating, was successfully diagnosed and treated by laparoscopy. Resection of the necrotic part of the greater omentum is the therapy of choice, and ensures fast recovery and pain control. Serohemorrhagic ascites is a common finding in ISIGO, and careful exploration of the whole abdominal cavity should be performed. The laparoscopic approach allows both exploration and surgical intervention.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
2/4. Omental infarction as a delayed complication of abdominal surgery.Omental infarction, an uncommon cause of acute abdominal pain, is the result of compromised perfusion to the greater omentum. Although its etiology remains uncertain, predisposing factors include obesity [Surg. Today 30 (2000) 451], strenuous activity [N. Z. Med. J. 111 (1998) 211], trauma, and idiopathic omental torsion. Often confused with acute appendicitis or cholecystitis on clinical grounds [Surg. Today 30 (2000) 451], its diagnosis has traditionally been one of exclusion, based on intraoperative and pathologic findings. This diagnosis can be made radiologically based on the characteristic findings of an inflammatory mass containing fat and fluid. We describe a case of right lower quadrant omental infarction temporally related to bowel surgery.- - - - - - - - - - ranking = 0.5keywords = obesity (Clic here for more details about this article) |
3/4. Small bowel obstruction by the silicone tube of the gastric band.A wide range of operations are used today for morbid obesity. Adjustable gastric banding (AGB) is one of the most widespread. Numerous complications after AGB are known, namely gastric perforation, band slippage, penetration of the band into stomach, port disconnection, port-site infection, etc. The authors present a case of small bowel obstruction caused by the intra-abdominal silicone tube of the gastric band in a woman with AGB performed 9 years before, with a very good result and considerable weight loss. She was operated as an emergency, and part of the terminal ileum was found incarcerated around and between the silicone tube and the anterior abdominal wall. Bowel resection for intestinal necrosis, with terminal ileostomy, was performed, followed 1 month later by an end-to-end ileo-ileal anastomosis. The patient recovered without sequelae.- - - - - - - - - - ranking = 0.5keywords = obesity (Clic here for more details about this article) |
4/4. The excluded small-bowel segment. A source of complications after small-bowel bypass.Two cases of obstruction of the bypassed small intestine after jejunoileal shunt for obesity are presented. These cases illustrate the possible failure of radiologic visualization of the obstructed bowel since no gas traverses this bowel, as well as two of the possible causes-internal herniation and volvulus. A third cause, intussusception of the blind loop into the colon, has been reported. Obstruction of the bypassed bowel demands surgical intervention and could lead to perforation and peritonitis if untreated. Its prevention involves the closure of all mesenteric defects at the original operation. Surgeons should be aware of the possibility of these conditions in any patient who has had a small-bowel bypass operation.- - - - - - - - - - ranking = 0.5keywords = obesity (Clic here for more details about this article) |