It is quite common to see abnormal peritoneal folds in the abdominal cavity. Some of them might compress or strangulate the viscera and others might determine the direction of the flow of peritoneal fluid, pus or blood. Many unusual clinically important peritoneal folds such as Ladd's band, cysto-gastro-colic fold, omento-cystic fold, and cysto-colic fold have been reported earlier. Knowledge of these folds is important for radiologists, gastroenterologists, and surgeons. We report an unusual cysto-duodeno-colic fold observed during our dissection classes. The fold was seen to compress the duodenum and colon. The fold extended from the descending part of the duodenum and the transverse colon to the gallbladder. It enclosed the entire gallbladder. A case similar to this has not been reported yet. It is important for the gastroenterologists and laparoscopic surgeons to be aware of this fold to avoid misdiagnosis and iatrogenic injuries.
Abdomen ; Abdominal Cavity ; Ascitic Fluid ; Colon ; Colon, Transverse ; Diagnostic Errors ; Duodenum ; Gallbladder ; Omentum ; Peritoneal Cavity ; Peritoneum ; Suppuration ; Surgeons ; Viscera

The retroperitoneal space is that indefinite area in the lumber and iliac region which lies between the peritoneum and the posterior wall of the abdominal cavity. The term retroperitoneal cyst or tumor is usually confined by the pathologist to these arising from the structures situated in the retroperitoneal space. Retroperitoneal cysts are that of non-neoplastic nature and originated from retroperitoneal tumor Because the retroperitoneal space is rather extensive and adjacent organs are easily displaced, many of the cysts grow to a large size before giving any clinical manifestation. Frequently, when the patient is first seen, there is an indefinite abdominal mass the exact nature of which is obscure, and the diagnosis is not made until the time of surgical investigation.
Abdominal Cavity ; Diagnosis ; Humans ; Peritoneum ; Retroperitoneal Space

PURPOSE: To evaluate the CT findings of peritonitis associated with continuous ambulatory peritonealdialysis(CAPD). MATERIALS AND METHODS: We retrospectively analyzed CT scans of 14 symptomatic patients withperitonitis after CAPD. Diffuse abdominal pain was present in 11, fever in two, and abdominal mass with vomitingin one. The mean duration of CAPD ranged from 10 months to 5 years(mean : 3.9 years). On abdominal CT, weevaluated the presence and location of ascites, bowel wall thickening, cocoon formation, the pattern ofenhancement of peritoneal thickening, the presence of calcifications in the peritoneum, and mesenteric and omentalchange. RESULTS: On enhanced CT, multiloculated ascites was observed in all cases(n=14) ; it was located mainlyin the pelvic cavity with small multi-loculated fluid collections in the peritoneal cavity (n=13), including thelesser sac(n=3). In one patient, ascites was located in the space between the greater omentum and anteriorperitoneal surface. CT showed ileus in 12 cases, small bowel wall thickening in 11, and cocoon formation in five.Uneven but smooth thickening of the peritoneum, with contrast enhancement, was seen in eight cases, and in five ofthese, peritoneal thickening was more prominent in the anterior peritoneum. Other findings included reticularopacity in two cases, hematoma of the rectus muscle in one, and umbilical hernia in one. CONCLUSION:Multiloculated fluid collection, ileus, small bowel wall thickening, uneven but smooth peritoneal thickening, andcocoon formation appear to be CT features of CAPD peritonitis.
Abdominal Pain ; Ascites ; Dialysis ; Fever ; Hematoma ; Hernia, Umbilical ; Humans ; Ileus ; Omentum ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritoneum ; Peritonitis* ; Retrospective Studies ; Tomography, X-Ray Computed

Paraduodenal hernia is by far the most common form of congenital internal hernia. Chylous ascites is an accumulation of lymphatic fluid in the peritoneal cavity. It develops when the lymphatic system is disrupted due to traumatic injury or obstruction. A 40-year-old, woman showed up to the Emergency Department with severe, colicky abdominal pain. Tenderness and rebound tenderness were observed at the left abdomen. Abdominal CT confirmed a cluster of dilated proximal small bowel loops with ischemic change, without ascites. The patient underwent an emergency surgery to relieve bowel ischemia. As soon as the peritoneum was exposed, 1.5 L of chylous fluid was found. A hernial sac was found along the posterior side of the mesentery of the inferior mesenteric artery. We resected the hernial sac and pulled out the herniated small bowel. On the sixth day after the surgery, she was discharged without any complication.
Abdomen ; Abdominal Pain ; Adult ; Ascites ; Chylous Ascites* ; Emergencies ; Emergency Service, Hospital ; Female ; Hernia* ; Humans ; Ischemia ; Lymphatic System ; Mesenteric Artery, Inferior ; Mesentery ; Peritoneal Cavity ; Peritoneum ; Tomography, X-Ray Computed

PURPOSE: Natural orifice transluminal endoscopic surgery (NOTES) is a new surgical option using endoscopic advancement to the peritoneal cavity through the stomach, colon, vagina, or urinary bladder without an abdominal wall scar (incision). The aim of this study was to assess the feasibility of transgastric gastroscopic intra-abdominal exploration with gastric incision and closure before the NOTES would be done. METHODS: Under general anesthesia of a female dog, one-channel gastroscope was advanced to the stomach and the lumen was irrigated with anti-bacterial solution. The anterior wall of the antrum was incised by about 1 cm with a needle knife; then, the gastroscope was advanced into the peritoneal cavity. An exploration of the entire intra-abdominal cavity was performed. RESULTS: We were able to evaluate the stomach, the greater omentum, the diaphragm, the peritoneum, the urinary bladder, the bowel, the spleen, the liver, the gallbladder, the uterine horn, the uterine body, and the vagina, but could not evaluate the ovary, the kidney, and the pancreas. The observation of the abdominal cavity was followed by the gastric wall closure with a 135o endoclip. The dog was recovered after confirmation of secure closure of the incision site. CONCLUSIONS: Transgastric incision, closure, and abdominal exploration are feasible without an abdominal wall scar, and the NOTES can be one option for future abdominal operations in humans and needs to be further investigated.
Abdominal Cavity ; Abdominal Wall ; Anesthesia, General ; Animals ; Cicatrix ; Colon ; Diaphragm ; Dogs* ; Female* ; Gallbladder ; Gastroscopes ; Horns ; Humans ; Kidney ; Liver ; Natural Orifice Endoscopic Surgery ; Needles ; Omentum ; Ovary ; Pancreas ; Peritoneal Cavity ; Peritoneum ; Spleen ; Stomach ; Urinary Bladder ; Vagina

An inflammatory myofibroblastic tumor (IMT) is a rare tumor in the abdominal cavity. A number of descriptive terms have been used to describe inflammatory tumors with myofibroblastic proliferation. The etiology and the biologic behaviors of IMTs are still unknown. Extensive pathologic examination is important to prevent misdiagnosis, and the need for long- term follow up is emphasized. Recently, we experienced a case of a huge inflammatory myofibroblastic tumor of the abdominal cavity in a young male. The patient had a painless mass in the entire abdomen. The resected specimen revealed a 15X14X12 cm3 mass involving the posterior rectus sheath, mesentery, ascending, and descending colon; and omentum. We present our experience with that along with a review of literature.
Abdomen ; Abdominal Cavity ; Abdominal Wall* ; Colon, Descending ; Diagnostic Errors ; Humans ; Male ; Mesentery ; Myofibroblasts* ; Omentum

Iatrogenic parasitic myomas are rare. The condition is defined by the presence of multiple smooth-muscle tumorous nodules in the peritoneal cavity. This may be attributable to seeding of myoma particles during uterine surgery. The clinical course is usually indolent. The disease is often asymptomatic and is usually discovered only incidentally. A 38-year-old woman who had undergone abdominal myomectomy 7 months prior presented with acute abdominal pain and a huge pelvic mass. We performed exploratory laparotomy. A parasitic mass 17 cm in diameter with a twisted omental pedicle was identified. En bloc excision of the mass and omentum was performed, followed by total abdominal hysterectomy. Histopathological examination of multiple sections revealed features compatible with an infarcted leiomyoma. Thus, we present a very rare case of an iatrogenic, rapidly growing parasitic myoma complicated by omental torsion (which caused the acute abdominal pain). We also offer a literature review.
Abdominal Pain ; Adult ; Female ; Humans ; Hysterectomy ; Laparotomy ; Leiomyoma ; Myoma* ; Omentum ; Peritoneal Cavity

BACKGROUND/AIMS: Preoperative diagnosis of peritoneal metastasis is extremely important to select the appropriate treatment strategy and predict the prognosis for patients with gastrointestinal cancer. However, imaging techniques have a limited capacity for detecting peritoneal metastasis. We therefore evaluated the feasibility of percutaneous ultrathin flexible peritoneoscopy in an animal model. MATERIALS AND METHODS: Percutanous ultrathin flexible peritoneoscopy was performed on two mini-pigs under general anesthesia. We punctured the abdominal wall at the anti-Mcburney and umbilical regions using a 16-gauge angiocatheter. Guidewire was inserted through the angiocatheter and we then enlarged the puncture using a biliary dilation catheter and a 6- to 8-mm balloon dilator catheter. After track formation, we inserted a 4.9-mm ultrathin endoscope into the abdominal cavity. The peritoneal cavity was examined, and peritoneal and liver biopsy was performed. The puncture was closed with a single suture. After the procedure, we monitored the general condition of the pigs for 2 weeks. RESULTS: Percutaneous ultrathin flexible peritoneoscopy was successfully performed regardless of the puncture site location. Peritoneal and liver biopsy was also successfully executed. The mean procedure time was 20 minutes. Formation of the abdominal track was not easily accomplished with standard endoscopic equipment. Nevertheless, none of the abdominal organs were injured. The post-procedure course was uneventful. Minor scarring was observed at the incision site 2 weeks after the procedure. CONCLUSIONS: Percutanous ultrathin flexible peritoneoscopy is a relatively simple and technically feasible method. However, dedicated accessories for fascial dilation should be developed to ensure the safety of human patients undergoing this procedure.
Abdominal Cavity ; Abdominal Wall ; Anesthesia, General ; Animals ; Biopsy ; Catheters ; Cicatrix ; Endoscopes ; Feasibility Studies ; Gastrointestinal Neoplasms ; Laparoscopy ; Liver ; Neoplasm Metastasis ; Peritoneal Cavity ; Peritoneum ; Prognosis ; Punctures ; Sutures ; Swine

We introduce a case of middle colic artery rupture due to medial degeneration which progressed to hemoperitoneum. Visceral artery aneurysm is an uncommon form of vascular disease that has a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrahge. The case involved a 58-year old man with abdominal pain who admitted to our hospital with a diagnosis of hemoperitoneum due to bleeding of omentum. At surgery, a large amount of hematoma was found in lesser sac which was removed totally. The bleeding focus was middle colic artery. Histological examination showed medial degeneration of unknown origin. The postoperative course was uneventful, and the patient discharged with good condition.
Abdominal Pain ; Aneurysm* ; Arteries* ; Colic ; Diagnosis ; Hematoma ; Hemoperitoneum* ; Hemorrhage ; Humans ; Middle Aged ; Omentum ; Peritoneal Cavity ; Rupture* ; Vascular Diseases ; Viscera

Natural orifice translumenal endoscopic surgery (NOTES) involves the intentional perforation of the viscera with an endoscope to access the abdominal cavity and perform an intraabdominal operation. In a brief time period, NOTES has been shown to be feasible in laboratory animal and human studies. Easy access to the peritoneal cavity and complete gastric closure should be secured before NOTES can be recommended as an acceptable alternative in clinical practice. The concept of submucosal endoscopy has been introduced as a solution to overcome these two primary barriers to human NOTES application. Its offset entry/exit access method effectively prevents contamination and allows the rapid closure of the entry site with a simple mucosal apposition. In addition, it could be used as an endoscopic working space for various submucosal conditions. Herein, the detailed procedures, laboratory results and human application of the submucosal endoscopy will be reviewed.
Abdominal Cavity ; Animals, Laboratory ; Endoscopes ; Endoscopy ; Humans ; Peritoneal Cavity ; Viscera