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Background Adhesive small bowel obstruction (ASBO) is an important cause of hospital admission, is associated with significant morbidity and mortality, and therefore is a substantial burden for healthcare systems worldwide. Icodextrin 4% solution (Adept, Shire Pharmaceuticals, UK) is a high-molecular-weight a-1,4 glucose polymer approved in Europe for use as intraoperative lavage and postoperative instillation to reduce the occurrence of post-surgery intra-abdominal adhesions. The present clinical study aimed to evaluate the safety and effectiveness of icodextrin 4% in decreasing the incidence, extent, and severity of adhesions in patients after abdominal surgery for ASBO. Methods The study was a single-center prospective, randomized investigation. The study is designed and conducted in compliance with the principles of Good Clinical Practice regulations. Safety and efficacy of icodextrin 4% in the study group are compared to no anti-adhesion treatment in a parallel control group with blinded evaluation of primary endpoints. Primary endpoints are the evaluation of the therapeutic role of icodextrin 4% in reducing ASBO recurrence incidence and the need of laparotomies for ASBO recurrence, as well as adhesion formation (with evaluation of their incidence, extent, and severity). A sum of 181 patients with ASBO and surgical indication to laparotomy were enrolled and randomized in two groups. Patients were submitted to adhesiolysis with bowel resection if required with or without anastomosis. The first group received traditional treatment (control group), whereas the second group was treated with the addition of icodextrin 4% solution before the abdominal closure. Results Ninety-one patients were randomized to have icodextrin 4% solution administered intraperitoneally, and 90 patients were randomized to have the traditional treatment. The two study groups were homogeneous regarding their baseline characteristics. The ASBO recurrence rate was 2.19% (2/91) in the icodextrin groups vs 11.11% (10/90) in the control group after a mean follow-up period of 41.4 months ( p  < 0.05). No differences were found in the need of laparotomies for ASBO recurrence in the studied groups. The adhesion severity score seems lower in the group treated with the addition of icodextrin ( p  = n.s.). Conclusions The data resulting from this RCT showed that the use of icodextrin 4% solution in ASBO is safe and reduces intra-abdominal adhesion formation and the risk of re-obstruction.

Peritoneal inclusion cysts (PICs) are benign multilocular cysts that consist of fluid localized between intraperitoneal adhesions. They usually present in women in the third and fourth decades of life with a history of prior pelvic or abdominal surgery, especially months to 20 years ago. PICs have low mortality and the potential for high morbidity. Transvaginal ultrasound with color Doppler has an important role in the differential diagnosis. Also, a very important role is played by CA 125 plasma level or use of the ROMA algorithm. But thanks to laparoscopy and the possibility of biopsy from suspicious lesions the correct diagnosis can be established. Treatment of PICs depends individually on the patient’s condition, symptoms, other diseases, and desire for procreation. Among other contemplated are hormonal oral contraceptive, an image-guided aspiration, minimally invasive or open surgery. The issue of diagnosis and treatment of PICs requires the continuation of multicentre, randomized clinical trials to find and standardize effective, personalized treatments for PICs.

Background SMARCA4 -deficient undifferentiated tumor ( SMARCA4 -UT) is a rare and highly malignant primary tumor characterized by the loss of SMARCA4 expression. Despite advancements in oncology, diagnosing and treating SMARCA4-UT remain significant clinical challenges. Case demonstration A 67-year-old male with a history of smoking presented to the hospital with complaints of abdominal distention and pain lasting for more than four days. Abdominal computed tomography (CT) revealed a high-density mass measuring approximately 41 × 37 mm in the right lower quadrant. Additionally, chest CT identified a high-density mass measuring 63 × 48 mm in the upper lobe of the right lung. The patient underwent partial small bowel resection, and postoperative pathological examination confirmed a diagnosis of SMARCA4 -UT originating in the small mesentery. Unfortunately, the patient succumbed to respiratory failure 21 days after the diagnosis. Conclusion SMARCA4 -UT is an exceedingly rare and aggressive undifferentiated tumor. This case highlights a presentation of SMARCA4 -UT with abdominal pain and distention as initial symptoms. Clinicians should consider SMARCA4 -UT in middle-aged or elderly male patients with a history of smoking who present with large masses. Comprehensive chest imaging is essential to exclude the thoracic primary disease in such cases.

Hydatid disease is a zoonotic parasitic infection caused by Echinococcus granulosus and is not uncommonly encountered in South Africa, especially in certain endemic areas. It generally affects the liver and lungs, with primary isolated peritoneal involvement being extremely rare. We report the case of a 14-year-old female with an isolated peritoneal hydatid cyst, initially thought to be a simple ovarian cyst, with no apparent hepatic or pulmonary involvement. This case highlights the potential consideration of hydatid disease in the differential of peritoneal cystic masses, even in the absence of hepatic or pulmonary involvement, especially in patients from endemic regions.

A response to the case report by Zhang et al. and supplement another case of giant peritoneal loose body discovered due to abdominal pain. A 68-year-old man was admitted to the hospital with abdominal pain. CT revealed an ovoid mass in the pelvis measuring approximately 11.5 × 8.6 × 7.4 cm. During laparotomy, yellowish-white mass was identified within the pelvis. Histological examination revealed that the mass was hyalinized fibrous connective tissue with focal calcification. We report an extremely rare and interesting case.

Background Reactive nodular fibrous pseudotumor is a rare benign fibroinflammatory lesion of the gastrointestinal tract and mesentery that can closely mimic malignant disease on clinical examination and imaging. Most reported cases are associated with prior abdominal surgery, trauma, or inflammation. Omental involvement is particularly uncommon, and preoperative diagnosis remains difficult because of its rarity and the limited description of multimodality imaging findings. We report a rare case of omental reactive nodular fibrous pseudotumor in a young man without any history of abdominal surgery, trauma, or abdominal discomfort, highlighting its unusual presentation and diagnostic features. Case presentation A 31-year-old man presented with a palpable abdominal mass that had been present for more than 1 month. He had no previous abdominal surgery, trauma, or gastrointestinal symptoms. Contrast-enhanced computed tomography revealed multiple well-defined solid masses in the greater omentum with scattered calcifications. The lesions were similar in attenuation to skeletal muscle on unenhanced images and showed mild progressive enhancement after contrast administration. Magnetic resonance imaging demonstrated low signal intensity on both T1-weighted and T2-weighted images with a similar gradual enhancement pattern. Ultrasound and contrast-enhanced ultrasound showed hypoechoic lesions with limited enhancement. Because malignancy could not be excluded radiologically, surgical resection was performed. Histopathological examination demonstrated spindle cell proliferation within dense hyalinized collagenous stroma with focal chronic inflammatory infiltrates. Immunohistochemical findings supported the diagnosis of reactive nodular fibrous pseudotumor. The patient recovered well after surgery and remained recurrence-free during more than 4 years of follow-up. Conclusions This case indicates that reactive nodular fibrous pseudotumor should be included in the differential diagnosis of solid omental masses, even in patients without a history of abdominal surgery or inflammation. Multimodality imaging may provide important clues to its fibrous nature, but definitive diagnosis still depends on histopathological confirmation. Greater awareness of this rare entity may reduce misdiagnosis and help avoid unnecessary aggressive treatment.

Objective The study aimed to evaluate the long-term outcomes of surgical management in patients with peritoneal endometriosis, focusing on postoperative pain trajectories, re-operation rates, fertility outcomes, and the potential influence of hormone therapy. Methods This retrospective study included 67 patients with histologically confirmed peritoneal endometriosis who underwent laparoscopic surgery. Surgical management consisted of excision in 62.7% of cases, ablation using bipolar coagulation in 13.4%, and a combination of both techniques in 23.9%. Pain symptoms (dysmenorrhea, dyspareunia, and chronic pelvic pain) were assessed preoperatively at 6 and 12 months, and at a median follow-up of 42 months. Associations between surgical technique, postoperative hormone therapy, and pain outcomes over time were analyzed using mixed linear models. Results Both excision and ablation were associated with significant and sustained reductions in pain symptoms over time. Dysmenorrhea showed improvement postoperatively, with additional benefit observed in patients receiving hormonal therapy. The type of surgery had no significant effect on dysmenorrhea. Dyspareunia and chronic pelvic pain also improved during follow-up, independent of surgical technique or hormone use. Re-operation was required in 17.9% of cases, with no difference between excision and ablation. Among the 27 patients who wished to conceive, 62.9% achieved pregnancy postoperatively, irrespective of surgical approach. Conclusions Both excision and ablation using bipolar coagulation are effective surgical options for peritoneal endometriosis, leading to long-term pain relief and favorable fertility outcomes. Postoperative hormone therapy appears to enhance pain control, particularly for dysmenorrhea. Overall, symptom improvement was more strongly associated with time since surgery than with the specific surgical technique, supporting individualized and multimodal treatment strategies.

A middle-aged-woman presented with symptoms and signs of acute abdomen. Clinically a suspicion of acute appendicitis was raised, although the abdominal x-ray and ultrasound were normal. She was managed conservatively, which she failed to respond. In the view of persisting pain, a contrast enhanced CT (CECT) was done. CECT showed a whirling mass of fatty and fibrous tissue adherent to the anterior abdominal wall suggestive of omental torsion and the diagnosis was confirmed on laparotomy and she underwent excision of the ischaemic omentum. Omental torsion though rare, should be included in the differential diagnosis of acute abdomen. High index of suspicion is required to diagnose this entity. CECT abdomen shows the classical finding of fatty mass with whirling pattern. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during the surgical procedure.

Introduction Endometriosis patients often suffer from more severe pain in association with surgical procedures. The aim of this study was to investigate whether laparoscopically guided transversus abdominis plane block (LTAP) offers an opioid‐sparing effect compared to local wound infiltration (LWI) analgesia in laparoscopic surgery performed for suspected peritoneal endometriosis. Material and Methods In this single‐center prospective, randomized, controlled, double‐blinded clinical study, 46 patients were randomized to receive either levobupivacaine inserted in the four quadrants of the abdomen at LTAP points and saline at trocar sites (n = 23) or saline at the LTAP points and levobupivacaine at trocar sites (n = 23). The study size was based on a power calculation. The primary outcome, opioid consumption 24 h postoperatively, was measured using patient‐controlled analgesia pumps. Secondary outcomes included postoperative pain scores and other enhanced recovery after surgery (ERAS) measures, as well as patient outcome questionnaires at six months after surgery. Statistical analyses were performed on an intention‐to‐treat basis. The study was prospectively registered in Clinicaltrials.gov, ID: NCT04735770, Jan 19, 2021; https://clinicaltrials.gov/study/NCT04735770?term=LTAP&rank=2. Results There was no significant difference in the mean opioid consumption (iv morphine equivalents) between the study groups: 31.8 ± 25.5 mg in the LTAP group and 27.5 ± 19.3 mg in the LWI group (mean difference 4.3 mg, 95% CI −9.2 to 17.7, p = 0.52). No significant differences were found in the postoperative pains scores, mean operation times, mean total blood loss, or mobilization between the study groups. 17 (73.9%) patients in each group received histological diagnosis of peritoneal endometriosis of the samples obtained during surgery. Times to discharge were 24.4 ± 4.3 (LTAP) and 28.1 ± 14.8 h (LWI), p = 0.25. No complications related to LTAP or LWI were reported. Conclusions In this study performed on women suffering from long‐term abdominal pain preoperatively, no significant differences were found between LTAP and LWI as regards to postoperative opioid consumption, postoperative pain, ERAS factors, or safety. No statistically significant difference in the mean or median opioid consumption between laparoscopically guided transversus abdominis plane block (LTAP) and local wound infiltration analgesia (LWI) (control) analgesia for laparoscopic peritoneal endometriosis surgery.

Background Omental cysts are extremely rare intra-abdominal lesions that are typically benign and asymptomatic. When hemorrhagic necrosis occurs, it may mimic other acute abdominal emergencies, such as adnexal torsion. Omental cysts are easily misdiagnosed as other diseases because of their lack of specific clinical symptoms and signs, thus posing a diagnostic challenge. Case introduction We report a 32-year-old woman presenting with acute lower abdominal pain and fever, initially diagnosed with ovarian cyst torsion. Imaging revealed a large pelvic cystic mass; however, laparoscopic exploration identified a hemorrhagic omental cyst with necrosis and inflammatory adhesion. Complete excision was performed, and histopathology confirmed a benign omental cyst with hemorrhage and necrosis. The patient recovered uneventfully and showed no recurrence over 11 months of follow-up. Conclusion Analyzing this case allowed us to delve into the causes of misdiagnosis of omental cysts. This case emphasizes the diagnostic difficulty posed by complicated omental cysts and highlights the necessity of considering omental cyst in women presenting with acute abdomen and pelvic masses. Imaging aids diagnosis, but surgical exploration is the most direct and reliable method for confirming the cause of abdominal pain. Timely laparoscopic intervention facilitates accurate diagnosis and effective management.