Haemorrhagic endometrial cyst of the greater omentum presenting as an abdominal emergency
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Hellenic Journal of Surgery (2015) 87:6, 488-489
Haemorrhagic Endometrial Cyst of the Greater Omentum Presenting as an Abdominal Emergency A. Marinis, A. Apostolopoulos, N. Paschalidis
Abstract Endometriosis is a complex disease created by the presence of ectopic endometrial tissue in the peritoneal cavity or adnexa.Cysts of the greater omentum, or omental cysts are a rare condition. Composed of ectopic endometrial tissue located in the greater omentum, they are usually asymptomatic and rarely cause symptoms. We present a rare case report herein of a 38-year-old female who presented to the Emergency Department complaining of severe diffuse abdominal pain, mainly in the epigastrium, with associated vomiting. A similar episode had previously been experienced two months earlier with spontaneous resolution. Interestingly, the patient was on the third day of her menses. Ultrasonography showed a small amount of free fluid in the pouch of Douglas. Computed tomography of the abdomen revealed a 3.5 cm cystic lesion in the anatomic region of the omentum in contact with bowel loops. Due to worsening of the patient's symptoms, an urgent laparotomy was performed. A lower midline incision was made and a chocolate cyst contained within the upper portion of the greater omentum was identified. Histopathology confirmed the diagnosis of omental endometriosis. The patient was referred to the gynaecology department for further treatment. Key words: Omentum; cyst; endometriosis; acute abdomen
Introduction Omental cysts are a rare entity affecting all age groups but mainly children and young adults. Usually asymptomatic, they only come to attention when they become complicated or increase to such large dimensions as to cause abdominal distention and symptoms of pressure on other organs. Omental endometriosis is a cyst located in the greater omentum composed of ectopic endometrial tissue. This is an even rarer entity, with just a few cases reported in the reviewed literature referring to localization in this anatomical position. We present the case of a patient with omental endometriosis that presented as an acute abdomen.
Case Presentation A 38-year-old female presented to the Emergency Department complaining of severe diffuse abdominal pain, mainly in the epigastrium, with associated vomiting. A similar episode had previously been experienced two months earlier with spontaneous resolution. Interestingly, the patient
A. Marinis, A. Apostolopoulos, N. Paschalidis First Department of Surgery, Tzaneion General Hospital Corresponding author: Athanasios Marinis, MD, PhD, FACS Zanni&Afentouli STRs, GR-18536, Piraeus, Greece Tel. 2014592493 Fax 2014592491 e-mail: [email protected] Received 16 Aug 2015; Accepted 22 Sept 2015 Hellenic Journal of Surgery 87
was on the third day of her menses. Past maternal history included two previous natural births. Physical examination noted a distressed patient with diffuse tenderness and guarding on palpation. Laboratory exams showed mild elevation of the WBC (white blood cells) and CRP (C-reactive pr
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