Omental cyst: a case report and review of the literature

Background Omental cysts are rare, predominantly occur in children, and often initially present with symptoms masquerading as other more common intra-abdominal pathologies. In this case report, we present the case of a child with an omental cyst that originated from the lesser sac. Due to the location of this cyst, resection presented unique technical challenges that have not been described in existing literature. Case presentation A 4-year-old male patient presented with symptoms initially concerning for appendicitis. Ultrasound showed a normal appendix but a large volume of complex intraperitoneal fluid. Computed tomography subsequently demonstrated a large cystic structure spanning from the stomach to the bladder. The patient was taken to the operating room where a large omental cyst was found to originate from the lesser sac. The resection was difficult due to the thin wall of the cyst and the intimate association of the superior-most aspect of the cyst with the tail of the pancreas, but was ultimately successful. Conclusions Omental cysts are rarely suspected before detection on abdominal imaging. Surgical resection is the treatment of choice, and complete resection can result in a recurrence-free postoperative course. Laparoscopic resection has been reported, but laparotomy is reasonable when a minimally invasive approach may not allow for a safe resection without rupture of the cyst. Anatomical characteristics of the cyst, as demonstrated in our case, can present challenges in the treatment of this otherwise benign entity.

Calcified pseudocyst: an uncommon presentation of chronic pancreatitis

Pseudocysts are localised fluid collections, usually developing as a complication of acute or chronic pancreatitis. Pancreatic ductal or parenchymal calcifications are commonly seen in routine radiological imaging, but calcification of pseudocyst is extremely rare. Calcified pseudocysts have been reported in literature as case reports, but a calcified pseudocyst in the lesser sac, without underlying pancreatic calcification, has not been reported. We report a case of a pancreatic pseudocyst with a calcified wall, requiring surgical excision and histological examination confirming the diagnosis.

A rare presentation of a retroperitoneal cystic teratoma in an adult

Being of embryonal tissue origin, the teratomas are rare in adults, typically occurring either in the gonads or in the sacrococcygeal region in infancy and childhood. We present a case of a teratoma in the lesser sac of an adult female managed by en-bloc resection with the infiltrating stomach segment.

Lesser Sac Haematoma-Melioidosis - A Surgical Surprise

Melioidosis, a potentially fatal disease endemic in South East Asia and Northern Australia is caused by Burkholderia pseudomallei, a potential bioterror agent. It is a motile, aerobic non-spore forming gram negative bacillus often characterised by pneumonia and multiple abscesses, but it can also present as septic arthritis, cutaneous ulcer and osteomyelitis. Modes of acquisition are inhalation, inoculation and rarely ingestion from a contaminated environment.1 General and gastro surgeons rarely come across abdominal melioidosis and rare is a lesser sac haematoma secondary to mycotic aneurysm of splenic artery caused by melioidosis. Clinical manifestations can vary from asymptomatic infections to localised abscesses to fulminating diseases with multiorgan involvement and eventual death. Due to evolving lifestyle, extensive travel and climate changes the disease which was previously confined to specific countries has crossed its boundaries. Increase in cases of comorbid conditions like diabetes and immunocompromised states have added on to the cause of increasing rates of the disease worldwide. India has seen isolated case reports from few states. Most often Burkholderia pseudomallei is misreported as pseudomonas species especially in resource-poor laboratories making the disease potentially fatal due to error in the treatment protocol.2 Due to its high chance of recurrence, prolonged treatment with combinations of antibiotics is required for complete eradication.

A rare presentation of a retroperitoneal cystic teratoma in an adult.

Being of embryonal tissue origin, the teratomas are rare in adults, typically occurring either in the gonads or in the sacrococcygeal region in infancy and childhood. We present a case of a teratoma in the lesser sac of an adult female managed by en-bloc resection with the infiltrating stomach segment.

Intraabdominal lesser sac metastasis from Ewing’s sarcoma: An exceptional localization

Ewing’s sarcoma/primitive neuroectodermal tumor is rare and aggressive with a poor prognosis. Intraabdominal metastases are an uncommon condition. Metastasis in the lesser sac is an exceptional occurrence. To the best of our knowledge, this location has not been described previously. We report a case of a 15-year-old patient treated for Ewing’s sarcoma of the left arm 6 years back. She had developed a suspicious mass in the lesser sac 6 years following her primary tumor. The histopathologic exam revealed a tumor with “small round cells” that were positive for CD99, confirming the relapse of Ewing’s sarcoma. The relapse was successfully managed with chemotherapy and surgery. Intraabdominal, extraintestinal masses in patients treated previously for Ewing’s sarcoma should be considered as Ewing’s sarcoma relapse in the differential diagnosis. We fully describe the management of this atypical relapse, with different components of clinical, radiological, and histological findings.