Department of General Surgery, Strategic Support Force Medical Center, Beijing, China.
Department of Pathology, Strategic Support Force Medical Center, Beijing, China.
Ann Palliat Med. 2021 Jul;10(7):8384-8390. doi: 10.21037/apm-20-2128. Epub 2021 Apr 1.
Torsion of an epiploic appendage may result in epiploic appendagitis, which is a rare cause of acute abdominal pain. However, no previous reports have described an asymptomatic twisted epiploic appendage found during laparoscopaic surgery to the best of our knowledge. This case describes a 66-year-old man who was admitted to our medical center with yellowness of the skin and eyes that had lasted over two months. Physical examination showed slight yellow staining of the skin and sclera. Blood analysis indicated liver dysfunction and jaundice. Routine blood, C-reactive protein (CRP), and levels of tumor markers were normal. The contrast-enhanced abdominal and pelvic computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography revealed gallbladder atrophy and choledocholithiasis. The patient underwent laparoscopic surgery for the removal of the choledocholithiasis. The laparoscopic exploration unexpectedly revealed a twisted and ischemic epiploic appendage, which was surgically removed. The postoperative pathological examination uncovered necrosis of adipocytes and vascular obstruction, but there was no inflammation of the epiploic appendage. The patient had a satisfactory recovery during the 16-month follow-up period. This case describes and provides a feasible management approach for an asymptomatic twisted epiploic appendage discovered during surgery and highlights its pathological characteristics, reflecting the early stage of epiploic appendagitis.
网膜赘生物扭转可能导致网膜赘生物炎，这是一种罕见的急性腹痛原因。然而，据我们所知，以前没有报告描述过在腹腔镜手术中发现无症状扭转的网膜赘生物。本病例描述了一名 66 岁男性，因皮肤和眼睛发黄持续两个月以上而到我院就诊。体格检查显示皮肤和巩膜有轻微的黄色染色。血液分析显示肝功能障碍和黄疸。血常规、C 反应蛋白（CRP）和肿瘤标志物水平正常。腹部和盆腔增强 CT、磁共振成像和磁共振胰胆管成像显示胆囊萎缩和胆总管结石。患者因胆总管结石行腹腔镜手术取石。腹腔镜探查意外发现扭转和缺血性网膜赘生物，行手术切除。术后病理检查发现脂肪细胞坏死和血管阻塞，但网膜赘生物无炎症。患者在 16 个月的随访期间恢复良好。本病例描述并提供了一种可行的手术中发现无症状扭转网膜赘生物的处理方法，并强调其病理特征，反映了网膜赘生物炎的早期阶段。
