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A Journal on Surgery

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Chirurgia 2004 February;17(1):27-30


language: Italian

A case of cystic neoformation of the lesser epiploon: omental cyst or gastric duplication?

Gelmini R., Tazzioli G., Farinetti A., Saviano M.


Mesenteric and omental cysts, arising between their peritoneal layers, are infrequent lesions but they have to be considered in case of expansive abdominal process because of the difficulty in diagnosis and choice of treatment. Often, they are occasionally found and characterized by aspecific symptoms and radiological and ultrasound unclear pictures. The treatment of choice is a radical exeresis and a definitive diagnosis is usually reached after surgery and on histopathological findings even if a nosological classification is difficult for the pathologist. A case of cystic neoformation localized in the supramesocolic region, between left hepatic lobe and lesser gastric curve is reported and the diagnostic problems linked to a clinical and radiological picture with no ambiguous interpretation are underlined. The preoperative differential diagnosis, in fact, was in doubt between a post-traumatic pancreatic pseudocyst and a cyst of different origin. The intraoperative aspect excluded a pancreatic origin and turned to the hypothesis of a gastric cystic duplication in the lesser epiploon contest, originated from the lesser gastric curve and the gastroesophageal junction. The neoformation was not dissociable from the muscular tunica of the gastric wall. A radical exeresis was performed associated with a partial resection of the lesser gastric curve and gastroesophageal junction. The pathological examination, confirming the difficult nosologic classification of these lesions, showed a different interpretation excluding the hypothesis of a gastric duplication because of the absence of a surface epithelium in the neoformation lumen.

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