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Mesenteric cysts Cysts may occur in any region of the mesentery ( Figure 65.16 ). They are most often observed in mesentery adjoining the small intestine (60%) or the colon (40%) and can be classified as follows: /uni25CF chylolymphatic; /uni25CF enterogenous;...

Mesenteric sclerosis and panniculitis Mesenteric sclerosis This is also termed sclerosing encapsulating peritonitis or abdominal cocoon syndrome ( Figure 65.14 ). It occurs mostly in patients on long-term peritoneal dialysis. It is a disease of the mesothelia...

Mesenteric stretch during colonoscopy Development of pain doing colonoscopy is frequently attributed to distension of the colon and stretch of the colon wall. In reality , substantial volumes of gas would be required to insu ffl ate the colon to the degree a...

Non-gastrointestinal causes of acute bacterial peritonitis Pelvic infection via the Fallopian tubes is responsible for a high proportion of ‘non-gastrointestinal’ infections. The most Francis Glisson , 1597–1677, Regius Professor of Medicine, Cambridge, UK. ...

PERITONEAL (MESOTHELIAL) SAC AND HERNIA FORMATION The processus vaginalis refers to a peritoneal tube that advances into the inguinal ligament in tandem with migra tion of the testes. The lumen of the processus vaginalis is in continuity with the peritoneal ...

PERITONEAL INCLUSION CYSTS Introduction These are benign cysts lined by peritoneal mesothelium. They can arise at any location of the peritoneum, in continuity with the surface of either parietal or visceral peritoneum. They can gradually expand and rarely r...

PERITONITIS Peritonitis is inflammation of the peritoneum and can be cate gorised as localised or di ff use, acute or chronic or according to the primary underlying pathology . In the clinical setting, the most useful categorisation of peritonitis is based on ...

RETROPERITONEAL SPACE COLLECTIONS These are fluid collections in the retroperitoneal space and these di ff er from intraperitoneal collections because of their location ( Figure 65.21 ). They are a common finding in moder ate to severe acute pancreatitis. Fluid ...

ROTATIONAL DISORDERS Malrotation Malrotation refers to a failure of formation of the mid-region switch (described in Development of the mesentery and peritoneum ) ( Figure 65.13 ) and is the most common abdom inal surgical emergency in the neonatal period. E...

Retroperitoneal lipoma The patient may seek advice on account of a swelling or because of indefinite abdominal pain. The swelling sometimes reaches an immense size. Diagnosis is usually by CT scan. A retroperitoneal lipoma sometimes undergoes myxomatous degen...

Retroperitoneal sarcoma Retroperitoneal sarcomas are rare tumours accounting for only 1–2% of all solid malignancies (10–20% of all sarcomas are retroperitoneal). The peak incidence is in the fifth decade of life, although they can occur at almost any age. T...

Retroperitoneal fibrosis This is a relatively rare diagnosis characterised by development of a flat grey/white plaque of tissue that usually develops in the low lumbar region and later spreads laterally and upwards to encase the common iliac vessels, ureters a...

Secondary peritoneal malignancy Peritoneal carcinomatosis Peritoneal carcinomatosis is common and refers to malignant nodules on the surface of the peritoneum. It normally arises in conjunction with ovarian malignancy or malignancy in an organ of the mesenter...

Special considerations: Abscess formation following intestinal surgery and anastomosis The development of an abscess following intestinal resection and anastomosis signifies infection of a haematoma or an anas - tomotic leak. Locules of gas or free contrast ...

Special considerations: Prevention of abscess formation after appendicitis During appendectomy , it is important to aspirate the pelvic, paracolic and subhepatic spaces prior to closure of the abdom - - inal wall. This simple measure can reduce the incidence ...

Special considerations: Subphrenic abscess This refers to the presence of pus immediately beneath the diaphragm. Patients may complain of shoulder tip pain. The diaphragm also develops at the same level as the C5 dermatome. If the parietal peritoneum under ...

Spontaneous bacterial peritonitis Spontaneous bacterial peritonitis (SBP; sometimes called primary bacterial peritonitis) is an acute bacterial infection of ascitic fluid. There is often a history of cirrhosis and ascites. The clinical picture is highly variab...

THE GREATER OMENTUM The greater omentum corresponds to the anterior wall of the upper region of the mesentery . Rutherford Morison called the greater omentum ‘the abdominal policeman’. The greater omentum attempts, often successfully , to limit intraperitonea...