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Hassanesfahani M, Tian J, Keating L, Khan N, Louis MA, Malhotra R. Omental infarction following robotic-assisted laparoscopic inguinal hernia repair. J Surg Case Rep 2024; 2024:rjae343. [PMID: 38784200 PMCID: PMC11115987 DOI: 10.1093/jscr/rjae343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Omental infarction (OI) is a rare condition with an overall incidence of less than 0.3%. It can occur spontaneously or can be secondary to trauma, surgery, and inflammation. While previously a diagnosis of exclusion, due to development in imaging technology, OI can now be identified based on CT findings. OI symptoms can mimic an acute abdomen, prompting potentially unnecessary surgical exploration. Treatment options range from conservative management to interventional radiology or surgical resection of the infarcted omentum. We are presenting the first case of OI following robotic-assisted inguinal hernia repair. This case highlights the importance of considering OI in differential diagnoses for patients presenting with acute abdominal pain, the utility of imaging workup in identifying OI, and guidance for conservative treatment approaches to reduce unnecessary surgical intervention.
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Affiliation(s)
- Maryam Hassanesfahani
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Jane Tian
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Luke Keating
- Medisys Health Network, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Noman Khan
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Martine A Louis
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Rajinder Malhotra
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
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Gazzilli M, Bertoli M, Villanacci A, Albano D, Cerudelli E, Bertagna F, Giubbini R. A rare case of omental infarction after adrenalectomy detected by 18F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2021; 40:121-122. [PMID: 33674233 DOI: 10.1016/j.remn.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/19/2020] [Accepted: 03/01/2020] [Indexed: 10/22/2022]
Affiliation(s)
- M Gazzilli
- Medicina Nuclear, Università di Brescia and Spedali Civili Brescia, Brescia, Italia.
| | - M Bertoli
- Medicina Nuclear, Università di Brescia and Spedali Civili Brescia, Brescia, Italia
| | - A Villanacci
- Departamento de Radiología, Università di Brescia and Spedali Civili Brescia, Brescia, Italia
| | - D Albano
- Medicina Nuclear, Università di Brescia and Spedali Civili Brescia, Brescia, Italia
| | - E Cerudelli
- Medicina Nuclear, Università di Brescia and Spedali Civili Brescia, Brescia, Italia
| | - F Bertagna
- Medicina Nuclear, Università di Brescia and Spedali Civili Brescia, Brescia, Italia
| | - R Giubbini
- Medicina Nuclear, Università di Brescia and Spedali Civili Brescia, Brescia, Italia
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3
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A rare case of omental infarction after adrenalectomy detected by 18F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remnie.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hafezi-Nejad N, Fishman EK, Zaheer A. Imaging of post-operative pancreas and complications after pancreatic adenocarcinoma resection. Abdom Radiol (NY) 2018; 43:476-488. [PMID: 29094173 DOI: 10.1007/s00261-017-1378-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pancreatic ductal adenocarcinoma is one of the leading causes of cancer-related deaths. With surgical resection being the only definitive treatment, improvements in technique has led to an increase in number of candidates undergoing resection by inclusion of borderline resectable disease patients to the clearly resectable group. Post-operative complications associated with pancreaticoduodenectomy and distal pancreatectomy include delayed gastric emptying, anastomotic failures, fistula formation, strictures, abscess, infarction, etc. The utility of dual-phase CT with multiplanar reconstruction and 3D rendering is increasingly recognized as a tool for the assessment of complications associated with vascular resection and reconstruction such as hemorrhage, pseudoaneurysm, vascular thrombosis, and ischemia. Prompt recognition of the complications and distinction from benign post-operative findings such as hepatic steatosis and mesenteric fat necrosis on imaging plays a key role in helping decrease the morbidity and mortality associated with surgery. We discuss, with case examples, some of such common and uncommon findings on imaging to familiarize the abdominal radiologists evaluating post-operative imaging in both acute and chronic post-operative settings.
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Affiliation(s)
- Nima Hafezi-Nejad
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Atif Zaheer
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 North Wolfe Street, Hal B164, Baltimore, MD, 21287, USA.
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Gomez Portilla A, Onaindia E, Larrañaga M, López de Heredia E, Echenagusía V. Periprosthetic seroma with false-positive FDG PET-CT reactive nodes mistaken for metastases in a patient previously treated of metastasic melanoma. Potential source of diagnostic errors. Int J Surg Case Rep 2017; 38:66-68. [PMID: 28738238 PMCID: PMC5524308 DOI: 10.1016/j.ijscr.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION FDG PET/CT is believed to be crucial in oncology, but its limited specificity represents a challenge. Prosthetic meshes used for repair abdominal defects may lead to false-positives FDG PET/CT uptake, over staging malignancies and inducing inappropriate treatments. A false-positive FDG PET/CT uptake mimicking metastatic disease during the follow-up of a previously treated metastatic melanoma patient is presented.
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Affiliation(s)
- Alberto Gomez Portilla
- Department of General Surgery and Digestive Diseases, University Hospital of Araba, Spain; University of the Basque Country, UPV, Spain.
| | - Eleder Onaindia
- Department of Surgery, University of the Basque Country, UPV, Spain.
| | - Maitane Larrañaga
- Department of General Surgery and Digestive Diseases, University Hospital of Araba, Spain.
| | - Eduardo López de Heredia
- Department of General Surgery and Digestive Diseases, University Hospital of Araba, Spain; University of the Basque Country, UPV, Spain.
| | - Victor Echenagusía
- Department of General Surgery and Digestive Diseases, University Hospital of Araba, Spain.
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Javed AA, Bagante F, Hruban RH, Weiss MJ, Makary MA, Hirose K, Cameron JL, Wolfgang CL, Fishman EK. Postoperative Omental Infarct After Distal Pancreatectomy: Appearance, Etiology Management, and Review of Literature. J Gastrointest Surg 2015; 19:2028-37. [PMID: 26302877 DOI: 10.1007/s11605-015-2920-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/10/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The clinico-radiological characteristics and the natural history of postoperative omental infarct (OI) in patients who underwent distal pancreatectomy (DP) and splenectomy have not been defined. MATERIALS AND METHODS Twelve patients who underwent DP over a period of 2 years and were postoperatively diagnosed with OI based on computed tomography (CT) findings were identified. RESULTS A total of 12 patients were diagnosed with an OI based on their postoperative imaging. Seven (58.3 %) patients had previously undergone laparoscopic DP, one (8.3 %) had undergone a robotic DP, and in one (8.3 %), a laparoscopic DP was converted to an open procedure. The remaining three (25.1 %) were treated with open DP. In five (41.6 %) patients, the diagnosis of OI was made during routine follow-up. One patient underwent surgical resection of OI, and two had drains placed in the mass. Nine patients were managed conservatively. During the study period, on review of CT imaging, the minimum prevalence of postoperative OI after DP was found to be 22.8 %. A review of literature identified nine articles that reported a total of 34 patients who were diagnosed with OI after abdominal surgery. CONCLUSION The management of an asymptomatic postoperative OI should be conservative while an early invasive intervention should be performed in patients who are symptomatic or have infected OI.
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Affiliation(s)
- Ammar A Javed
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Fabio Bagante
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
- Department of Surgery, Chirurgia Generale e Epatobiliare, G.B. Rossi University Hospital,, University of Verona, Verona, Italy
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Matthew J Weiss
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Martin A Makary
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Kenzo Hirose
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - John L Cameron
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Christopher L Wolfgang
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Department of Radiology, The Johns Hopkins Hospital, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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