Fibrous Tumors of the Omentum
FRANK W. NORMAN, M.D., Santa Rosa
FIBROUS TUMORS of the omentum are not often
diagnosed preoperatively. They may be noted at
exploratory laparotomy but usually only inciden-
tally unless they are part of an adhesive band pro-
ducing bowel obstruction or their pedicles become
twisted and cause infarction and abdominal pain.
Although not rare, such tumors are considered un-
common enough to warrant this report.
REPORT OF A CASE
A 48-year-old white stenographer sought medical
advice because of constant low abdominal distress
of 24 hours' duration. She had had no previous pain
of this type. Her bowel habits were entirely normal
and she had very little gas, bloating or indigestion
before the onset of the constant low abdominal pain.
There was no dysuria, urinary frequency, nausea
The patient had had appendectomy, cesarean sec-
tion and removal of a fibroid tumor from the uterus
eight years previously, subtotal hysterectomy six
years previously and bilateral vein stripping and
ligations five years previously. There had been no
vaginal bleeding since the hysterectomy.
The patient's mother had died of carcinoma of the
intestine, an aunt of heart disease, and her father
had peptic ulcer.
The temperature was 1010 F, respirations 20 per
minute, the pulse rate 88 and blood pressure 130/82
mm of mercury.
No organs or masses were palpable in the abdo-
men. There were several vertical operative scars in
the low midline. Pronounced tenderness was noted
over the entire lower abdomen, with rebound and
percussion tenderness especially under the surgical
scars. Peristalsis was normal and active.
On pelvic examination, the cervical stump ap-
peared to be slightly cyanotic and deviated to the
right. Bimanual pressure revealed a firm cystic
mass, well fixed, occupying most of the left ade-
Submitted Februy 12. 1963.
nexal area but extending slightly to the right of the
midline and displacing the cervical stump. The mass
was extremely tender on movement and could be
felt bimanually through the abdominal wall when
it was located with the pelvic examining finger.
On rectal examination the mass was noted to pro-
trude posteriorward into the cul-de-sac, compressing
the rectum. Proctoscopic examination to a level 15
cm above the anus was done with ease and old
brown feces were observed. The rectal mucosa ap-
peared normal. A guaiac test on a fecal specimen
was negative for blood.
As the pelvic mass was thought to be probably a
twisted ovarian cyst, exploratory laparotomy and
removal of the mass were recommended. The pa-
tient was put in hospital.
Leukocytes numbered 12,200 per cu mm with the
cell differential within normal range. The hemato-
crit was 46 per cent and the corrected sedimenta-
tion rate (Wintrobe) was 38 mm in one hour. No
abnormality was noted on urinalysis. On x-ray ex-
amination of the abdomen a slightly increased soft
tissue density in the left pelvic area, compatible
with a pelvic mass, was observed.
The abdomen was opened through incision at the
midline where there was considerable scar tissue
from previous operations. There was a small amount
of serous fluid in the peritoneal cavity. The omen-
tum was adhered to the anterior peritoneal wall.
No abnormalities were noted on palpation of the
abdominal organs. Five irregularly shaped ivory-
like tumors about 2 cm in diameter dangled from
the edge of the omentum on stalks from 1 to 2 cm
long. They looked somewhat like the small tassels
seen around the edge of a Mexican hat. The pelvis
was then inspected and a dusky purplish mass was
seen in the cul-de-sac. It was attached by thin and
fibrinous adhesions to the salpinx, the ovaries and
the small bowel. This incarcerated mass was at-
tached to the omentum by a pedicle which had been
twisted approximately eight times. The pedicle
joined the edge of the omentum near one of the
smaller masses (see Figure 1). The stalk was tran-
sected and the tumor was carefully dissected from
the surrounding tissues. It was then apparent that
VOL. 99. NO. 6