Haemorrhagic endometrial cyst of the greater omentum presenting as an abdominal emergency

Athanasios Marinis, Alexandros Apostolopoulos, Nikolaos Paschalidis
In: Hellenic Journal of Surgery · 2015 · vol. 87(6) , pp. 488–489 · doi:10.1007/s13126-015-0264-8 · W2298569190
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This case report describes a rare instance of a 38-year-old woman with severe abdominal pain caused by a hemorrhagic endometrial cyst in her greater omentum, confirmed by laparotomy and histopathology.

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This case report describes a 38-year-old woman who presented to the emergency department with severe diffuse abdominal pain and vomiting, with a similar self-resolving episode two months earlier. The authors used ultrasound and CT to identify a 3.5 cm omental cystic lesion near bowel loops, and because symptoms worsened on day 3 of menses, they performed urgent laparotomy, finding a “chocolate cyst” in the greater omentum; histopathology confirmed omental endometriosis. The paper’s main limitation is that it is a single-patient report without broader diagnostic or management evaluation. This paper is centrally about endometriosis — specifically, hemorrhagic endometrial (omental) cyst presenting as an abdominal emergency.

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Abstract

Endometriosis is a complex disease created by the presence of ectopic endometrial tissue in the peritoneal cavity or adnexa.Cysts of the greater omentum, or omental cysts are a rare condition. Composed of ectopic endometrial tissue located in the greater omentum, they are usually asymptomatic and rarely cause symptoms. We present a rare case report herein of a 38-year-old female who presented to the Emergency Department complaining of severe diffuse abdominal pain, mainly in the epigastrium, with associated vomiting. A similar episode had previously been experienced two months earlier with spontaneous resolution. Interestingly, the patient was on the third day of her menses. Ultrasonography showed a small amount of free fluid in the pouch of Douglas. Computed tomography of the abdomen revealed a 3.5 cm cystic lesion in the anatomic region of the omentum in contact with bowel loops. Due to worsening of the patient's symptoms, an urgent laparotomy was performed. A lower midline incision was made and a chocolate cyst contained within the upper portion of the greater omentum was identified. Histopathology confirmed the diagnosis of omental endometriosis. The patient was referred to the gynaecology department for further treatment. Similar content being viewed by others

References

Kumar S, Agrawal N, Khanna R, Khanna AK. Giant lymphatic cyst of omentum: a case report. Cases J. 2009;2:23. Measday B. Omental Endometriosis. Br Med J. 1961;1(5223):409. Ayoade BA, Olawoye OA, Salami BA, Tade AO, Musa AA, Banjo AAF, Agboola AJ, Adebayo SB. Omental Cyst, An usual cause of cachexia. Nigerian Medical Practitioner. 2007;51:107–9 Howard Jones III. Gynecologic Surgery. In: Townsend C, Beauchamp D, Evers M, Mattox K, editors. Sabiston Textbook of Surgery: the biological basis of modern surgical practice. Philadelphia: Elsevier Saunders; 2012. p.2016. Hamilton, C, Staney M, Gregory T, Kohn E. Gynecology. In: Brunicardi FC Editor-in-Chief. Schwartz’s Principles of Surgery. USA: McGraw Hill; 2015. p. 1689. Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician. 2006;74:594–600. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Marinis, A., Apostolopoulos, A. & Paschalidis, N. Haemorrhagic endometrial cyst of the greater omentum presenting as an abdominal emergency. Hellenic J Surg 87, 488–489 (2015). https://doi.org/10.1007/s13126-015-0264-8 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s13126-015-0264-8

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