Intrathoracic omental herniation through the esophageal hiatus in a young patient

Intrathoracic omental herniation mimics posterior mediastinal lipomatous tumor

Intrathoracic omental herniation is an esophageal hiatal hernia that does not involve the stomach and has been previously misdiagnosed as a lipomatous tumor. We report the case of a 72-year-old man who was referred to our hospital for investigation of a chest abnormal shadow. The large mediastinal mass with fat density was not recognized 5 years ago. Although it mimicked a mediastinal lipomatous tumor, we could preoperatively diagnose it as intrathoracic omental herniation. Contrast-enhanced computed tomography was effective in making an accurate diagnosis, showing the mass and vessels passing through the esophageal hiatus from the abdominal cavity. Laparoscopic surgery was performed, and the hiatus was repaired. To diagnose the mediastinal lipidic mass as intrathoracic omental herniation preoperatively can provide less invasive procedure.

Omental herniation through the esophageal hiatus: A rare cause of gastric outlet obstruction and its CT findings

A man in his 60s visited the emergency department because of epigastric pain and vomiting. Noncontrast helical abdominal CT revealed a lipomatous mass on the right side of the lower esophagus. Caudal slices showed that the mass appeared to displace the gastric antrum causing gastric outlet obstruction. Further observation revealed a linear structure from the greater curvature of the stomach into the omental vessels. Based on these findings, a diagnosis of intrathoracic omental hernia through the esophageal hiatus was made. Intraoperatively, a defect in the lesser omentum was seen, and the greater omentum herniated through the defect into the esophageal hiatus. Omental herniation through the lesser omentum into the esophageal hiatus can present as gastric outlet obstruction.

Life-threatening massive empyema: A novel complication of intrathoracic omental herniation

Intrathoracic omental herniation (ITOH) is the herniation of the omentum through the esophageal hiatus without herniation of the stomach. It is a rare disease and serious complications due to ITOH have not been reported in the literature. Here, we reported the case of 47-year old man who presented to the emergency department with dyspnea and chest pain. Enhanced computed tomography (CT) demonstrated a large retrocardiac mass and ITOH was suspected. During the observation period in the emergency department, the patient's condition rapidly deteriorated. Follow-up CT showed large parapneumonic effusion and empyema. Emergency surgery was performed and the omental sac was removed. The patient's vital signs were restored and his symptoms were relieved. He was discharged on hospital day 15 without complications. Emergency physicians should be aware that severe complications of ITOH could develop and that if the patient's symptoms and vital signs worsen, emergency surgery should be considered.

A case of omental herniation through the esophageal hiatus successfully treated by laparoscopic surgery

Case

We report a rare case of omental herniation through the esophageal hiatus. A 46‐year‐old man visited our emergency department complaining of epigastralgia. Abdominal examination revealed muscular defense and rebound tenderness in his upper abdomen. A computed tomography scan showed a fat density mass in the posterior mediastinum. A laparoscopic operation was carried out under the diagnosis of omental herniation through the esophageal hiatus.

Outcome

Abdominal pain disappeared dramatically after the operation. The postoperative course was uneventful.

Conclusion

Although a fat density mass in the posterior mediastinum is likely to be diagnosed as a lipomatous tumor, omental herniation through the esophageal hiatus should be taken into consideration as a possible diagnosis for acute abdominal pain in the emergency department.

Omental mesothelial cyst herniated to the thorax through the esophageal hiatus: a case report

Both mesothelial cyst in the omentum and omental herniation through the esophageal hiatus without abdominal visceral involvement are rare. We report a case of omental mesothelial cyst herniated to the thorax through the esophageal hiatus.