Lecture notes for medical students

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2. Omentum

3. Omentum
Anatomy and Surgical Disorders

4. -
-

5. Anatomy of Omentum

6. Anatomy of Omentum
Broad peritoneal sheet associated
with stomach are termed Omentum
Two omenta
Lesser omentum
Greater omentum

7. -
 Lesser omentum
 Two-layered fold of peritoneum
 Extends from porta hepatis,
 fissure of ligamentum venosum and the diaphragm
to lesser curvature of stomach and superior part of
duodenum

8. Lesser omentum
• Hepatogastric ligament from
porta hepatis to lesser curvature
of stomach
• Hepatoduodenal ligament
- Extends from porta hepatis
to superior part of
duodenum,
- at its free margine enclose 3
structures(3 key structures)
common bile duct Ant.
proper hepatic a At the Lt. of the
common bile duct
portal v post.

9. -
Contents of lesser omentum

10. -
• Blood vessels Rt. & Lt. gastric vessels
• Lymph nodes & lymphatic vessels
• Fat
• Autonomic N.S sympathetic +
parasympathetic (vagus nerve)
Contents of lesser omentum

11. -
Greater omentum
- It is the largest peritoneal fold.
- It consists of a double sheet, folded on
itself so that it is made up of four layers.
- The anterior two layers descend from the
greater curvature of stomach and superior
part of duodenum and hangs down like an
apron in front of coils of small intestine
- then turn up on the back of itself, and
ascend to the transverse colon .
- the two layers are separated to cover the
anterior and posterior surfaces of
transverse colon. Then they form the
transverse mesocolon

12. -
• The upper part of the greater
omentum which extends
between the stomach and the
transverse colon is termed the
gastrocolic ligament.
• In adult, the four layers of
greater omentum are
frequently adhered together,
and are found wrapped about
the organs in the upper part of
the abdomen

14. -
Contents of Greater omentum (between
the descended layers)

15. -
Contents of Greater omentum (between
the descended layers)
• Gastroepiploic vessels
• Lymph nodes & lymphatic vessels
• Fat
• Autonomic N.S sympathetic +
parasympathetic (vagus nerve)

16. -
Functions of greater omentum

17. -
• ① protective function: The greater omentum
contains numerous fixed macrophages, which
performs an important protective function.
• ② storehouse for fat: The greater omentum is
usually thin, and presents a cribriform apperarance,
but always contains some adipose tissue, which in
fatty people is present in considerable quantity.
• ③ migration and limation: The greater omentum
may limit spread of infection in the peritoneal
cavity. Because it will migrate to the site of any
inflammation in the peritoneal cavity and wrap
itself around such a site, the greater omentum is
commonly referred to as the “policeman” of the
peritoneal cavity.
Functions of greater omentum

18. Omental Cysts

19. Omental Cysts
– Cysts of the omentum are rare.
–True cysts:
–These are caused by obstruction of lymphatic channels.
– They may be unilocular or multilocular and contain serous fluid.
–True cysts have an endothelial lining and may assume large sizes.
–Dermoid cysts
–are uncommon and are lined with squamous epithelium and may
contain hair, teeth, and sebaceous material.
– False cysts:
– Pseudocyst of the omentum result from fat necrosis, trauma with
hematoma, or foreign-body reaction. These have a fibrous and
inflammatory lining and usually contain cloudy or blood-tinged
fluid.

20. Presentation

21. Presentation
• Abdominal mass: Large cysts present as a
palpable abdominal mass or produce diffuse
abdominal swelling. The uncomplicated
omental cyst usually lies in the lower
midabdomen and is freely movable, smooth,
and nontender. These may cause symptoms
of heaviness or pain or manifestations of
possible complications of omental cysts
such as torsion, infection, rupture, or
intestinal obstruction.

22. Investigations

23. Investigations
• Plain X-ray of the abdomen:
It may show a soft tissue haziness.
The presence of bone or teeth is diagnostic of dermoid
cyst.
• Barium meal follow-through:
It will demonstrate a displacement of bowel loops.
• Ultrasound or CT scan:
It shows a fluid-filled mass that often contains internal

24. Treatment

25. Treatment
• laparotomy and excision of the cyst

26. Torsion of Omentum

27. Torsion of Omentum
•uncommon condition-Omentumtwists on its long
axis, causing vascular compromise.
• This may vary from mild vascular constriction to
complete strangulation leading to frank gangrene.

28. ETIOLOGY

29. ETIOLOGY
• The omentum twists around a fixed point
commonly due to adhesions of the free end of
the omentum due to
–postoperative wounds,
–scarring
– internal or external hernias.

30. Clinical features

31. Clinical features
Pain is the initial and predominant symptom.
The onset of pain is sudden and constant and
increases in severity.

32. Investigations

33. Investigations
• CT scan may be of some use in diagnosing omental
pathology.

34. Treatment

35. Treatment
• It consists of resection of the involved
omentum.
• In patients with torsion, the underlying
condition (hernia, cysts, adhesions,) should
be corrected.

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