omental cyst
Introduction
Introduction to omental cyst Omental cysts are rare in clinical practice. Small cysts generally have no clinical symptoms, and large cysts are often treated by the patient to find a mass in the abdomen. Omental cysts are divided into two types: true cysts and pseudocysts. The true cyst is mainly a retention cyst caused by lymphatic obstruction, a small number of congenital ectopic lymphatic vessels develop; another true cyst is a congenital dermoid cyst. Pseudocysts are formed after the inflammatory reaction. basic knowledge Sickness ratio: 0.001%-0.002% Susceptible people: no specific people Mode of infection: non-infectious Complications: peritonitis
Cause
Causes of omental cyst
Lymphatic obstruction (25%):
The etiology of omental cyst is unknown, but most cysts are caused by congenital dysplasia or ectopic growth of lymphatic vessels. Some segments of the lymphatic vessels are blocked and enlarged, and cysts are formed.
Inflammation (20%):
Pseudocysts are often secondary to omental traumatic hematoma, inflammation, fat necrosis or foreign body reaction. Its wall thickness is only fibrous tissue, unlined endothelial cells, mostly single rooms, containing turbid inflammatory exudate or blood.
Embryonic cell variation (15%):
Cysts can be developed by the proliferation of legacy embryonic tissue or ectopic embryonic tissue cells.
Injury bleeding (20%):
It may be foreign body or surgical damage caused by hematoma.
Prevention
Omental cyst prevention
The disease and lymphatic vessels are blocked to enlarge and form cysts. The variant cysts of embryonic cells can be proliferated by residual or ectopic embryonic tissue. It can also be degraded by hematoma due to hemorrhagic hemorrhage, which may be foreign body or surgical injury. . Moreover, due to the inflammatory reaction, pseudocysts often occur after the inflammatory reaction, which may be the result of fat necrosis, or may be caused by other causes. Therefore, the cause is diversified and preventive measures should be taken for the cause. Increase exercise to improve physical fitness to reduce the incidence of this disease.
Complication
Omental cyst complications Complications peritonitis
Combined bleeding, infection, torsion, and even rupture.
1. Intracapsular hemorrhage infection After the hemorrhage, the cyst is rapidly enlarged, easy to be infected, because the cyst is mostly multi-atrial, the infection is not easy to control, the patient has high fever or long-term low fever, intermittent abdominal pain, lack of energy, poor appetite, weight loss, anemia, etc. Symptoms of poisoning, clinically misdiagnosed as tuberculous peritonitis.
2. Cyst rupture in the external force against the abdomen or various reasons lead to increased intra-abdominal pressure, sudden severe abdominal pain, abdominal distension, accompanied by obvious anemia, obvious blood or even inflammatory peritonitis, often admitted to hospital for acute abdomen.
3. Cyst torsion occurs in the free part of the greater omentum, small cysts, a wide range of activities, due to gravity-related cyst torsion, clinical manifestations of persistent abdominal pain with paroxysmal aggravation, nausea, vomiting, physical examination found abdominal mass, mostly in The omental cyst was reversed during surgery.
Symptom
Omental cyst symptoms Common symptoms Intestinal appetite loss of abdominal pain, ascites peritonitis, thin cystic mass
1. Symptoms: The course of cysts is usually longer, which is characterized by abdominal swelling of the abdomen or abdomen. The mass is often found at night. When the abdomen has a feeling of heavy pressure on the back, and the intestinal torsion or intestinal obstruction occurs, severe abdominal pain may occur.
2. Physical examination: the abdomen can be swollen and swollen, mostly located in the upper abdomen, soft and sac sexy, with a large degree of activity, no tenderness or deep tenderness, occurring in the greater omentum, small cysts, the boundaries are clear, but giant Cysts or complications, palpation is unclear, easily misdiagnosed as tuberculous peritonitis, ascites, etc., in the supine position, the abdominal abdomen is voiced, only two ribs or waist are drum sounds, and the bowel sounds are heard in the depths. There is a sense of vibration in the whole abdomen, but there is no moving dullness.
Examine
Examination of omental cyst
X-ray inspection
(1) plain film: visible soft tissue shadows filled with liquid in the abdomen, skin-like cysts may sometimes have calcification, bone or teeth and other structures, barium meal examination may have small intestinal displacement or compression signs, the small intestine is moved to the posterior upper abdomen and spine On both sides, the stomach shifts upwards.
(2) Gastrointestinal angiography: See the transverse colon shifting upwards, and lifting the colon to the posterior lateral side.
(3) CT scan: visible anterior abdominal cystic, clear edges, separated mass, more can be diagnosed.
2. B-ultrasound can be confirmed as a cystic mass.
3. Laparoscopy can be used to look directly at the mass.
Diagnosis
Diagnosis and differentiation of omental cyst
Diagnostic criteria
Despite the above many clinical manifestations and a variety of auxiliary examination methods, omental cysts are still easily misdiagnosed. The literature reports that the preoperative diagnosis rate of omental cysts is only 57%.
1. Clinical features may have intermittent abdominal pain, loss of appetite and weight loss, conscious lumps in the abdomen; abdominal examination: visible abdominal distension, more in the upper abdomen can be palpable painless, movable circular cystic mass.
2. B ultrasound, CT can be diagnosed and exact positioning.
Differential diagnosis
1. Tuberculous peritonitis: The disease is mainly seen in children, adolescents and women. There are many subacute and chronic manifestations in the clinic. Most of them have low fever, infirmity, weight loss, anemia, diarrhea and other symptoms of poisoning. Ascites is more common. There is often mild tenderness and muscle tension, showing a typical "dough-like" feel, and the tuberculin test has diagnostic value.
2. Non-specific mesenteric lymphadenitis: This disease occurs in preschool and school-age children, more boys; children often have a history of recent upper respiratory tract infection; typical symptoms are umbilical, right lower abdomen and right abdominal cramps, pain Children in the intermittent period felt good and the white blood cell count increased.
3. Echinococcus granulosus cyst: This disease is most common in pastoral residents, more males, clinical manifestations have no differential significance, but by sedimentation test, complement fixation test, Casoni test can be identified.
4. Mesenteric cysts: Mesenteric cysts and omental cysts are difficult to identify clinically. Selective superior mesenteric artery angiography is important. Mesenteric cysts can push the mesenteric vessels up or apart.
5. Ascites: The huge cyst needs to be differentiated from the ascites. The omental cyst is located in the lateral plain of the abdomen. It is located in front of the intestine. For those who have difficulty in diagnosis, it can be used for puncture, and then reduced or equal to inject air into the cyst. It is expressed as a gas-liquid level rather than a free gas under the armpit.
6. Ovarian cysts: Giant cysts need to be differentiated from ovarian cysts.
