Abdominal omentum cyst

　　The etiology of omental cysts is not clear, but most of the cysts are due to congenital maldevelopment or ectopic growth of lymphatic vessels.

　　1. Lymphatic obstruction: A segment of the lymphatic vessel is blocked and dilated, forming a cyst.

　　1. Variational cysts of embryonic cells can be developed from the proliferation of embryonic tissue or ectopic embryonic tissue cells.

　　2. Traumatic hemorrhage is formed by the organization of hematoma, which may be caused by foreign bodies or surgical injury.

　　4. Pseudocysts caused by inflammatory reaction are mostly due to inflammatory reaction and fat necrosis.

　　Omental cysts can complicate cyst hemorrhage, infection, torsion, and even rupture.

　　1. Intracystic hemorrhage

　　After infection and hemorrhage, the cyst rapidly increases in size and is prone to bacterial infection. Because the cyst is often multicystic, the infection is difficult to control. The patient may have high fever or long-term low fever, intermittent abdominal pain, malaise, poor appetite, weight loss, anemia, and other symptoms of poisoning. Clinically, it is easy to misdiagnose it as tuberculous peritonitis.

　　2. Cyst rupture

　　Sudden severe abdominal pain occurs with increased abdominal distension when the abdomen is struck by an external force or due to increased intra-abdominal pressure for various reasons. It is accompanied by obvious anemia and manifestations of hemorrhagic or inflammatory peritonitis. It is often admitted to the hospital as an acute abdomen.

　　3. Cyst torsion

　　Medium and small cysts occurring in the free margin of the omentum have a wide range of movement. Due to the effect of gravity, the cysts may twist, resulting in persistent abdominal pain with intermittent exacerbation, nausea and vomiting. An abdominal mass is found during physical examination, and it is often confirmed to be a twisted omental cyst during surgery.

　　Omental cysts are generally asymptomatic and are often found incidentally during abdominal surgery. Occasionally, large cysts may cause a feeling of abdominal fullness or heavy pressure.

　　1. Symptoms

　　The course of omental cysts is usually long, manifested as an abdominal mass or progressive abdominal distension. The mass is often found accidentally at night, with a feeling of heavy pressure in the abdomen when lying flat. In the case of concurrent intestinal volvulus or intestinal obstruction, severe abdominal pain may occur.

　　2. Physical examination

　　An abdominal mass can be palpated, mostly located in the upper abdomen, soft with a cystic sensation, with a large range of movement, without tenderness or deep tenderness, occurring in medium and small cysts in the middle and small omentum, with clear boundaries. However, giant cysts or those with complications are difficult to palpate and are easily misdiagnosed as tuberculous peritonitis or ascites. When lying flat, the entire abdomen is dull, and only the two ribs or腰部 are tympanic. Intestinal sounds can be heard in the deep part, and the entire abdomen has a sensation of vibration, but there is no mobile dullness.

　　The etiology of omental cysts is not yet clear, and it may be related to environmental factors, genetic factors, dietary factors, as well as the infection and obstruction of lymphatic vessels, and nutrition. Therefore, it is impossible to prevent the disease directly based on the etiology. Early detection, early diagnosis, and early treatment are of great significance for the indirect prevention of the disease. At the same time, it can also reduce the occurrence of infectious complications. For patients with infection, antibiotics should be used as soon as possible.

　　Patients with omental cysts can undergo X-ray, ultrasound, and laparoscopic examinations.

　　First, X-ray examination

　　1. Plain film: A shadow of soft tissue filled with fluid can be seen in the abdomen. Sometimes, dermoid cysts may have calcification, and structures such as bones or teeth. Barium meal examination may show signs of small intestinal displacement or compression, with the small intestine displaced to the posterior upper abdomen and the sides of the spine, and the stomach displaced upwards.

　　2. Barium meal gastrointestinal造影: The transverse colon is displaced upwards, and the ascending and descending colon is displaced laterally and medially.

　　3. CT scan: It can be seen that the anterior abdomen is cystic, with clear edges, septated masses, and most can be diagnosed.

　　Second, Ultrasound examination

　　Ultrasound examination can confirm the cystic mass.

　　Third, Laparoscopic examination

　　Laparoscopic examination can directly visualize the mass.

　　After the operation for omental cysts, patients should first eat easily digestible and absorbable food, gradually transitioning to normal diet, and eating more high-protein and high-vitamin foods, avoiding raw, cold, greasy, hard, and spicy foods.

　　Once an omental cyst is diagnosed, surgical treatment should be given.

　　1. Laparoscopic surgery

　　Laparoscopic surgery is suitable for unilocular cysts. After entering the abdomen, the cystic fluid inside is first aspirated with a needle, and then the omentum is moved out of the abdominal wall for surgical resection. It causes less damage and recovers quickly.

　　2. Routine surgery

　　For the treatment of solitary small cysts, they should be completely excised. When the cyst is densely adherent to the stomach and intestinal tract and cannot be separated, the cyst and the corresponding part of the stomach and intestinal tract can be excised together. For giant cysts, fluid should be gradually aspirated and decompressed before excision. If the cyst is directly pulled out of the abdominal cavity after entering the abdomen, it will cause a sudden and significant decrease in abdominal pressure, affecting cardiac and pulmonary function and hemodynamic balance, which may cause life-threatening conditions. After the excision of a giant cyst, a longer period of abdominal bandage application is needed to prevent the descent of abdominal organs and abdominal wall.After the excision of the omental cyst, careful exploration should be made of the small omental sac, gastrocolic ligament, hepatogastric ligament, splenogastric ligament, and mesocolon of the colon to avoid missed diagnosis..