The successful report of total mesorectal excision (TME)/complete mesocolic excision (CME) has encouraged people to apply this concept beyond colorectal surgery. However, the negative results of the JCOG1001 trial denied the effect of complete resection of the "mesogastrium" including the greater omentum on the oncological survival of gastric cancer patients. People even believe that the mesentery is unique in the intestine, because they have a vague understanding of the structure of the mesentery. The discovery of proximal segment of the dorsal mesogastrium (PSDM) proved that the greater omentum is not the mesogastrium, and further revised the structure (definition) of the mesentery and revealed its container characteristics, i.e. the mesentery is an envelope-like structure, which is formed by the primary fascia (and serosa) that enclose the tissue/organ/system and its feeding structures, leading to and suspended on the posterior wall of the body. Breakdown of this structure leads to the simultaneous reduction of surgical and oncological effects of surgery. People quickly realized the universality of this structure and causality which cannot be matched by the existing theories of organ anatomy and vascular anatomy, so a new theory and surgical map- membrane anatomy began to form, which led to radical surgery upgraded from histological en bloc resection to anatomic en bloc resection.
Humans ; Fascia/anatomy & histology* ; Laparoscopy ; Lymph Node Excision/methods* ; Mesentery/surgery* ; Mesocolon/surgery* ; Omentum ; Serous Membrane ; Clinical Trials as Topic

The great omentum is an intraperitoneal organ and plays an important role in protecting the environment of the peritoneal cavity. Several specialized innate immune cells including B1 cells and resident macrophages are found in the omentum, which may be attributed to the unique niche and its special stromal cells. However, it is not clear how these omental innate immune cells contribute to the peritoneal immunity. This review attempts to summarize the latest research on the omental innate immunity and discuss its involvement in the immune response of the peritoneal cavity.
Immunity, Innate ; Macrophages ; Omentum ; Peritoneal Cavity ; Stromal Cells

An inflammatory myofibroblastic tumor (IMT) is a solid tumor of unknown etiology frequently affecting children and young adults and commonly affecting the lung or orbital region. We present a case involving a 41-year-old man who had an IMT combined with Mycobacterium tuberculosis infection in the retroperitoneum. He presented with only pain in the right lower abdomen without accompanying symptoms; a retroperitoneal mass was found on computed tomography. The tumor had invaded the end of the ileum and was attached to the omentum, so mass excision could not be performed. The tumor was completely excised surgically and had histological features diagnostic of an IMT. Histologic findings of the omentum were positive for Ziehl-Nielsen staining for acid-fast bacilli and for a positive polymerase chain reaction for M. tuberculosis. The patient had no apparent immune disorder. These findings made this case exceptional because IMTs, which are mostly due to atypical mycobacteria, have been found mainly in immunocompromised patients.
Abdomen ; Adult ; Child ; Humans ; Ileum ; Immune System Diseases ; Immunocompromised Host ; Inflammation ; Lung ; Mycobacterium tuberculosis ; Myofibroblasts ; Nontuberculous Mycobacteria ; Omentum ; Orbit ; Polymerase Chain Reaction ; Tuberculosis ; Young Adult

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arising from the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasingly detected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advanced technique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a number of methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem is appropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge, this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic option in patients with gastric GISTs.
Endoscopy ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Omentum ; Stomach

omentum covers the transverse colon from the anterior side in adults, but people might believe the morphology stable once established during fetal life. Sections from 49 midterm and 17 late-stage human fetuses, of gestational ages (GA) 8–15 and 30–38 weeks, respectively, showed complete fusion between the greater omentum and transverse mesocolon after physiological herniation at GA 8–9 weeks; the transverse colon attaching to the anterior aspect of the gastric antrum and pylorus at GA 10–15 weeks; the colon pushing the pylorus or superior portion of the duodenum upward (at GA 10–15 weeks and 30–38 weeks); and the greater omentum without covering the greater portion of the jejunum and ileum but shifted leftward (at GA 30–38 weeks). These subsequent topographical variations of the transverse colon with the stomach and duodenum included the colon tightly fusing with the stomach by a fibrous tissue and; the greater omentum and/or the mesocolon wedged between the stomach and transverse colon. Therefore, in combination, the colon was partly separated from the greater omentum. Moreover, at GA 30–38 weeks, the duodenum consistently showed a horizontal loop in contrast to the usual C-loop in the frontal plane. Consequently, after a complete fusion occurred once between the greater omentum and transverse mesocolon, the topographical change of the upper abdominal viscera seemed to modify, change or even break the initial fusion of the peritoneum. A logical lamination of the peritoneum seemed not to simply connect with the surgical application.]]>
Adult ; Colon ; Colon, Transverse ; Duodenum ; Fetus ; Gestational Age ; Humans ; Ileum ; Jejunum ; Logic ; Mesocolon ; Omentum ; Peritoneum ; Pyloric Antrum ; Pylorus ; Stomach ; Viscera

STUDY DESIGN: Retrospective case analyses.PURPOSE: To investigate the causes, diagnosis, and management of esophageal perforation, depending on the time of diagnosis.OVERVIEW OF LITERATURE: To date, few studies have addressed these issues.METHODS: A total of seven patients were included in this study. The patients were classified into three groups based on esophageal perforation diagnosis time: intraoperative (diagnosed during surgery), perioperative (diagnosed within 30 days postoperatively), and delayed (diagnosed >30 days postoperatively) groups.RESULTS: In the intraoperative group (N=2), infectious spondylitis was the main cause of esophageal perforation. Anterior plate and screw removal, followed by posterior instrumentation, was performed. The injured esophagus was managed by omentum flap repair in one patient and primary repair in one patient. In the perioperative group (N=2), revision surgery for infection and metal failure were the main causes of esophageal perforation. In both cases, food residue was drained on the third postoperative day. The injured esophagus was managed conservatively. In the delayed group (N=3), chronic irritation caused by metal failure was the main cause of esophageal perforation. In all patients, there was no associated infection. The anterior instrumentation was removed, and the two patients were treated by primary repair, and one patient was treated using sternocleidomastoid muscle flap. One patient in intraoperative group died of sepsis.CONCLUSIONS: The main cause of intraoperative esophageal perforation was esophageal adhesions because of infectious spondylitis. However, perioperative and delayed esophageal perforations were caused by chronic irritation because of metal failure. Anterior plate and screw removal was necessary, and posterior instrumentation and fusion may be considered, depending on the fusion status.
Diagnosis ; Esophageal Perforation ; Esophagus ; Humans ; Omentum ; Retrospective Studies ; Sepsis ; Spine ; Spondylitis

Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive malignancy common in young male patient. Typical imaging features of DSRCT include multiple soft tissue masses in the peritoneal cavity, omentum, or mesentery without an organ of origin. This report presents a rare manifestation of DSRCT revealing a solitary large retroperitoneal mass with hepatic metastasis and malignant portal vein thrombosis in 70-year-old women together with the review of literature. The tumor showed a hemorrhagic and necrotic mass with peripheral portion of T2 hypo-intensity and delayed enhancement that indicated desmoplastic stroma with dense cellularity.
Aged ; Desmoplastic Small Round Cell Tumor ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Mesentery ; Neoplasm Metastasis ; Omentum ; Peritoneal Cavity ; Portal Vein ; Venous Thrombosis

Sarcomatoid mesothelioma is not very common, mesothelioma is directly attributable to occupational asbestos exposure, with 90% of cases showing a history of exposure. A 66-year-old male was admitted with an abdominal pain that persisted for 3 weeks. He had no abdominal mass. Computed tomography showed soft tissue thickening in perihepatic space and nodularities in omentum and peritoneum with ascites. There was no absolute diagnosis evidence in ascites analysis. Although the pathology of ascites was free for malignancy, the patient underwent omentum biopsy for definitive diagnosis. In laproscopic exploration, there was omental cake, peritoneal nodular seeding. It was suspected cancer carcinomatosis. Immunohistochemical findings suggested that it was sarcomatoid masothelioma. This is the rare case of a peritoneal sarcomatoid mesothelioma, without any exposure to asbestos.
Abdominal Pain ; Aged ; Asbestos ; Ascites ; Biopsy ; Carcinoma ; Diagnosis ; Humans ; Male ; Mesothelioma ; Omentum ; Pathology ; Peritoneum ; Sarcoma

Benign multicystic peritoneal mesothelioma (BMPM) is rare and difficult to diagnose before surgery. We report a case of BMPM incidentally discovered during laparoendoscopic single site surgery (LESS) for treatment of a pelvic mass. A 47-year-old Korean menopaused woman presented to our outpatient clinic with a pelvic mass. She had a history of right ovary cystectomy with adhesiolysis at a local hospital in 2010. Imaging study of the pelvis revealed a multilocular cystic mass. LESS was performed and multiple grapelike clusters of cysts were seen in the uterus, cul-de-sac, both adnexa, pelvic wall, and omentum. The appendix was grossly free. Frozen biopsy confirmed BMPM. Excision of multiple cyst clusters of cysts, resection of the uterus with both adnexa, appendectomy, omentectomy, and adhesiolysis were performed with LESS. She is well for 2 years with no recurrence. BMPM should be included in the differential diagnosis when small multichamber cystic mass is found on ultrasonography.
Ambulatory Care Facilities ; Appendectomy ; Appendix ; Biopsy ; Cystectomy ; Diagnosis, Differential ; Female ; Humans ; Mesothelioma ; Middle Aged ; Omentum ; Ovary ; Pelvis ; Recurrence ; Ultrasonography ; Uterus

Bochdalek hernia (BH) is defined as herniated abdominal contents appearing throughout the posterolateral segment of the diaphragm. It is usually observed during the prenatal or newborn period. Here, we report a case of an adult patient with herniated omentum and colon due to BH that was discovered during a colonoscopy. A 41-year-old woman was referred to our hospital with severe left chest and abdominal pain that began during a colonoscopy. Her chest radiography showed colonic shadow filling in the lower half of the left thoracic cavity. A computed tomography scan revealed an approximately 6-cm-sized left posterolateral diaphragmatic defect and a herniated omentum in the colon. The patient underwent thoracoscopic surgery, during which, the diaphragmatic defect was closed and herniated omentum was repaired. The patient was discharged without further complications. To the best of our knowledge, this case is the first report of BH in an adult found during a routine colonoscopy screening.
Abdominal Pain ; Adult ; Colon ; Colonoscopy* ; Diaphragm ; Female ; Hernia* ; Hernia, Diaphragmatic ; Humans ; Infant, Newborn ; Mass Screening* ; Omentum ; Radiography ; Thoracic Cavity ; Thoracoscopy ; Thorax