Diagnosis: compaction of the greater omentum with isolated nodes. Blood supply of the greater omentum

The main threat from oncological pathologies of the female genital organs is that every malignant tumor has the ability to spread throughout the woman’s body, forming foci of secondary growth - metastases. Previously it was believed that metastases form only on late stages tumor growth. But today, most doctors are inclined to believe that the risk of their occurrence exists from the very moment the tumor appears. Therefore, when treating great attention is paid not only to the elimination of the tumor node, but also to the prevention of relapse, namely, the fight against metastases.

How are they formed?

Secondary tumor foci are formed from individual cells of the neoplasm, which split off from it and spread to neighboring, and even distant, organs with current and lymphatic fluid. These cells penetrate into the lymph first, so those located close to the affected organ The lymph nodes pose the greatest threat in terms of relapse.

While it's going on active growth primary tumor, metastases are in a dormant state, because all the body’s forces are spent on feeding the “main” tumor. But when this neoplasm stops in its growth, having reached last stage development, or when it is removed from the patient’s body through medical intervention, metastases begin to develop. Then secondary foci form, that is, the disease begins to progress or recur.

How to deal with them?

The main way to prevent metastasis of malignant neoplasms is a thorough inspection of nearby organs and tissues and their removal. Thus, in case of oncological pathologies of the uterus and ovaries, not only regional lymph nodes, but also tissues are removed greater omentum– its resection is performed.

Resection of the greater omentum

Resection of the greater omentum is a surgical procedure during which a fragment of the splanchnic peritoneum is excised, between the folds of which blood vessels and lymphatic vessels, and adipose tissue. The abundance of vessels in the space of the greater omentum creates high probability its “contamination” with tumor metastases. Timely removal of potentially affected tissue significantly increases the effectiveness of treatment and the survival rate of patients.

In addition to surgical intervention, treatment is carried out to prevent tumor metastasis antitumor drugs and radial. These measures make it possible to eliminate cells that nevertheless managed to penetrate the body tissues and were not removed during the operation. In this regard, resection of the greater omentum also improves effectiveness. therapeutic measures, since after its removal the process becomes easier further treatment radioactive drugs.

Another advantage that this manipulation provides is a slower accumulation of ascitic fluid in the abdominal cavity, which often occurs after gynecological oncological operations.

How is the omentum resected?

Some doctors are inclined to believe that resection of the greater omentum should be done only during abdominal operations, since laparoscopic interventions do not make it possible to perform a thorough revision. But with good equipment and high professionalism of the surgeon, it is quite possible to perform resection by laparoscopy. The specific method of surgical intervention is determined individually, taking into account the characteristics of the course of the disease, the patient’s body and the capabilities of the medical institution.

Stuffing box I Stuffing box

a wide and long fold of the splanchnic (visceral) peritoneum (See Peritoneum), between the layers of which there is loose connective tissue, rich in blood vessels and fatty deposits. Large S., consisting of 4 layers of peritoneum, starts from the greater curvature of the stomach, is fixed to the transverse colon and, covering the intestine in front, descends in the form of an apron ( rice. ). Performs protective function for injuries and inflammatory diseases abdominal organs, for example with Appendicitis e. Small S. - doubled peritoneum stretched between the liver, top part duodenum and lesser curvature of the stomach. Large S. is often used to cover sutures during operations on the stomach and intestines, as well as for tamponade of wounds of the liver and spleen. Acute inflammation large S. (epiploitis) can occur as a result of its infection, twisting or injury; accompanied by symptoms acute abdomen(See Acute abdomen).

Big Soviet encyclopedia. - M.: Soviet Encyclopedia. 1969-1978 .

See what “Oil seal” is in other dictionaries:

STUFFING BOX- (omentum, epiploon), large hollows of the peritoneum, going from one organ of the abdominal cavity to another and consisting of leaves of the peritoneum, large and small peritoneal sacs (Fig. 1). Usually C, i.e., the layers of the peritoneum, covers the vascular pedicle, ... ... Great Medical Encyclopedia

Fat fold in the peritoneum * * * (Source: “United Dictionary of Culinary Terms”) Omentum Omentum fat fold in the peritoneum. Dictionary of culinary terms. 2012… Culinary dictionary

In engineering, a seal is a sealed gap between a moving and a stationary part (for example, a piston rod and a cylinder). An oil seal with soft (asbestos, felt, rubber) and hard (e.g. metal) packings is used...

OIL SEAL, oil seal, male 1. A section of the peritoneum rich in fat deposits from the stomach to the lower part of the abdominal cavity (anat.). 2. A type of food from this part of the animal’s body (kul.). 3. A lubricating device at the piston that prevents steam from escaping... ... Dictionary Ushakova

Seal, device, gap, gasket Dictionary of Russian synonyms. omentum noun, number of synonyms: 9 belly (29) ... Synonym dictionary

stuffing box- a, m. sale adj. outdated Loving greasy. Well, how can I go to the mazurka with him as an officer! It would be a key fob for a watch! Dad winced, barking: Oil seal. White beginning of the century. // Star. Arbat 40… Historical Dictionary of Gallicisms of the Russian Language

In anatomy, a wide and long fold of the visceral layer of the peritoneum in mammals and humans, part of the mesentery. The connective tissue of the omentum is rich blood vessels and adipose tissue. Protective organ of the abdominal cavity... Big Encyclopedic Dictionary

SEALING, huh, husband. (specialist.). 1. Fat fold in the peritoneum. 2. A part that hermetically closes the gap between the moving and stationary parts of the machine. | adj. omental, oh, oh. Ozhegov's explanatory dictionary. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 … Ozhegov's Explanatory Dictionary

- (omentum), a wide and long fold of the visceral layer of the peritoneum of mammals, in which there is a loose connective tissue, tissue rich in blood vessels and fatty deposits. Large S. double fold of the dorsal mesentery of the stomach, consisting of 4 leaves, ... ... Biological encyclopedic Dictionary

- (Stuffing box, stuffing gland) a part for sealing the gaps between holes and parts moving in them in order to prevent the leakage of liquid or gas. Compaction is achieved through various packings. Samoilov K.I. Marine... ...Marine Dictionary

A sealing device for rods, rods and tubes where they pass through an opening in the wall (lid) separating two spaces with unequal pressure. C. a critical part that serves to prevent the passage (leakage) of steam, water... ... Technical railway dictionary

Inflammatory disease of the omentum, which is a fold of the visceral peritoneum. The disease manifests itself as acute diffuse abdominal pain, nausea, fever, headache, and vomiting. Patients assume a forced half-bent position, and sharp pain occurs when straightening the torso. Diagnostics includes examination by a surgeon, omentography, CT scan of the abdominal cavity, and diagnostic laparoscopy. Treatment acute pathology surgical. The omentum is removed, the abdominal cavity is inspected, and drainage is installed. At chronic course Antibacterial and anti-inflammatory drugs are prescribed in combination with physiotherapy.

General information

Omentitis is a pathology of the abdominal cavity, which is manifested by inflammation of the omentum - a duplication of the peritoneum, consisting of abundantly vascularized loose connective tissue and fatty tissue. Anatomically, the lesser and greater omentum are distinguished. The latter starts from the stomach, is fixed to the transverse colon, continues down, freely covering small intestine. The lesser omentum consists of 3 ligaments that stretch from left to right from the diaphragm to the stomach, then to the liver and duodenum. Rarely isolated lesions of the greater omentum (epiploitis) occur and ligamentous apparatus(ligamentite). Omentitis occurs more often in children and adolescents due to imperfect functioning immune system And gastrointestinal tract.

Causes of omentitis

Based on etiology inflammatory process, the disease can be primary and secondary. Primary omentitis is formed as a result of traumatic injury, infectious infection and intraoperative damage to the peritoneum. In this case, the infection occurs directly in the peritoneal duplication. Isolated damage to the omentum area is found in tuberculosis and actinomycosis. In surgery, predominantly secondary inflammation occurs, which occurs as a result of the following reasons:

• Contact transmission of infection. The disease is formed when inflammation passes from a nearby organ as a result of cholecystitis, pancreatitis, appendicitis, etc.
• Endogenous infection. With the flow of blood or lymph from the primary infectious focus (in the lungs, gastrointestinal tract, liver, etc.), pathogenic microorganisms enter the omentum and cause its inflammation.
• Intraoperative infection. Occurs as a result of violation of asepsis and/or antisepsis during intra-abdominal interventions (insufficient sterilization of instruments, surgeon’s hands, surgical field, leaving in the abdominal cavity foreign objects- ligatures, napkins).
• Abdominal surgeries. Carrying out surgical manipulations for appendicitis, strangulated hernia, etc. can lead to torsion of the omentum, impaired blood circulation in it, and the development of ischemia and inflammation. The cause of omentitis may be resection of an organ with a poorly formed stump.

Pathogenesis

Due to the abundant blood supply and large amount of loose adipose tissue, the omentum is quickly involved in the process of inflammation. The organ has resorptive and adhesive abilities and performs a protective function in the body. At mechanical damage, ischemia, infectious process The immunological activity of cells, the ability to absorb fluid from the abdominal cavity increases, and the hemostasis system is activated. With omentitis, there is hyperemia, swelling of the folds of the peritoneum with fibrous layering and infiltrative compaction of tissue. At histological examination signs of inflammation are detected (thrombosis and congestion of blood vessels, hemorrhages, islands of necrosis), areas of leukocyte infiltration, a large number of eosinophils, lymphocytes. With tuberculous omentitis, multiple whitish tubercles are visualized. Small formations acquire a reddish color when the organ comes into contact with air during surgical procedures.

Classification

Based on the severity of the inflammatory process, acute and chronic omentitis are distinguished. Acute form the disease is accompanied by vivid severe symptoms with increasing intoxication, chronic is characterized by a sluggish course with periods of exacerbation and remission. Depending on the degree of inflammatory-destructive changes, 3 stages of omentitis are distinguished:

1. Serous. It manifests itself as swelling and hyperemia of omental tissue without signs of destruction. The inflammatory process is reversible. At this stage, complete tissue regeneration is possible when conservative therapy.
2. Fibrous. The hyperemic omentum becomes covered with a coating of fibrin and acquires a whitish-gray color. There are isolated hemorrhages and impregnation of organ tissues with fibrin threads and leukocytes. As a result of the disease, incomplete regeneration with replacement of part of the affected areas is possible connective tissue and the formation of adhesions.
3. Purulent. The organ becomes gray, purplish-cyanotic, dark brown tint, indicating deep intracellular damage. Often the greater omentum is fixed to the appendix, forming a single conglomerate. The histological picture is represented by multiple large focal hemorrhages, areas of impaired tissue microcirculation and necrosis. It is possible for acute omentitis to become chronic. The outcome purulent process is the replacement of the necrotic part of the organ with connective tissue and the formation of adhesions.

Symptoms of omentitis

The clinical picture of the pathology depends on the nature of the inflammatory process and the causes of the disease. In acute omentitis, patients complain of intense sharp pains in the abdomen, without clear localization. Signs of intoxication develop: vomiting, increased body temperature to febrile levels, headache, dizziness. On examination, notice muscle tension abdominal wall, sometimes a painful formation of dense consistency is palpated. A pathognomonic sign is the inability to straighten the torso, due to which the patient is in a semi-bent state. Adhesive processes in the abdominal cavity can lead to disruption of the passage of food through the intestines, constipation, partial or complete intestinal obstruction.

Chronic omentitis is characteristic of postoperative and tuberculous inflammation, manifested by discomfort and aching pain in the abdomen, symptoms of intoxication are absent or mild. With deep palpation of the anterior abdominal wall, a mobile formation of doughy consistency is determined, often painless.

Complications

Isolation of inflammation leads to the formation of an omental abscess. When the abscess breaks through, peritonitis develops, and when it gets into pathogenic microorganisms into the bloodstream - bacteremia. In heavy advanced cases necrosis of the peritoneal fold occurs. This condition accompanied by severe intoxication body and can lead to the development of infectious-toxic shock and, in the absence of urgent measures- To fatal outcome. Chronization of omentitis, fixation of the organ to the peritoneum (visceral or parietal layer) entails the occurrence of tense omentum syndrome, which is characterized by positive symptom Knokha (increased pain when hyperextending the body).

Diagnostics

Due to the rarity of the disease and the lack of a specific clinical picture, preoperative diagnosis presents significant difficulties. To diagnose omentitis, it is recommended to carry out the following examinations:

• Examination by a surgeon. This pathology is almost never diagnosed during a physical examination, but a specialist, suspecting acute surgical pathology, refers the patient for additional instrumental diagnostics.
• Omentography. Represents X-ray examination with the introduction of radiopaque agents into the abdominal space. Allows you to detect an increase in the inflamed organ, adhesions, and foreign bodies.
• Abdominal CT. Visualizes additional formations, inflammatory infiltrate and changes neighboring organs. Helps identify the cause of intestinal obstruction.
• Diagnostic laparoscopy. This method is the most reliable in diagnosing the disease, allowing for a detailed assessment of changes in the omentum, the condition of the peritoneum, the nature and amount of fluid in the abdominal cavity. If tuberculous omentitis is suspected, material can be collected for histological examination.
• Laboratory research. Are nonspecific method diagnostics For acute stage The disease is characterized by leukocytosis, neutrophilia, accelerated ESR.

Differential diagnosis of omentitis is carried out with other inflammatory intraperitoneal diseases (appendicitis, cholecystitis, pancreatitis, colitis). The pathology may have similar symptoms to peritonitis, perforated gastric ulcer, 12-PC, intestinal obstruction other etiology. The disease is differentiated from benign and malignant neoplasms intestines, mesentery. For additional diagnostics and to rule out diseases of nearby organs, an ultrasound scan of the peripheral organs is performed.

Treatment of omentitis

At severe lesions organ and expressed clinical picture carry out urgent surgical intervention. During the operation, based on the extent of the lesion, an omentectomy and a thorough examination of the abdominal cavity are performed. The resection line is invaginated and sutured with thin catgut threads. Injected into the abdominal cavity antibacterial drugs and install drainage. IN postoperative period antibiotics and analgesics are prescribed.

With confirmed chronic omentitis, conservative therapy is possible. In a hospital setting, antibacterial drugs are prescribed according to the sensitivity of the infectious agent, anti-inflammatory and painkillers. Patients are advised to rest bed rest. After the inflammation subsides, a course of physiotherapeutic procedures (UHF, magnetic therapy, solux therapy) is performed.

Prognosis and prevention

The prognosis of the disease depends on the severity of the pathology and the extent of damage to the omentum. With timely surgery and proper management rehabilitation period the prognosis is favorable. After a few months, patients return to to the usual way life. Generalized lesion with acute intoxication entails the development of severe life-threatening conditions (shock, sepsis). Prevention of omentitis consists of a thorough intra-abdominal revision when performing laparotomy, timely treatment acute and chronic diseases. Ultrasound monitoring is recommended for patients after undergoing interventions on the obstructive pelvis 1-2 times a year.

Big seal This is a fold of the peritoneum formed from its four leaves.

The omentum begins from the greater curvature of the stomach, descends first in the form of a double layer of peritoneum and passes to the transverse colon; this area of ​​the greater omentum is called ligamentum gastrocolicum. The free part of the large oil seal covers the hinges like an apron small intestine, consists of four layers of peritoneum. Posterior it is above the transverse intestine and is part of its mesentery (mesocolon transversum), and then passes into the parietal layer of the peritoneum on the posterior wall of the abdomen.

The spaces between the peritoneal layers of the omentum are filled with abundant fatty tissue; in some well-fed people, the deposition of fat can be very significant, which is why the organ is called the omentum. Between the leaves of the greater omentum are aa. gastroepiploicae dextra et sinistra with accompanying veins; from these vessels there are branches to both walls of the stomach and the greater omentum (rami epiploici). Along the vessels there is a chain of gastroepiploic lymph nodes (lymphoglandulae gastroepiploicae), which increase in size and number with.

Omental bag(bursa omentalis) is designated big gap peritoneum of considerable extent, lying in the frontal plane between the stomach in front and the posterior peritoneal wall in the back. The anterior wall of the omental bursa has a small omentum at the top, back wall stomach, a section of the greater omentum, which is called liq. gastrocolicum.

The posterior wall of the omental bursa is the parietal layer of peritoneum, covering the pancreas, aorta, a small section of the inferior vena cava, the upper pole of the left kidney, and the adrenal gland; from above the cavity is limited by the caudate lobe of the liver; from below - the transverse colon, its mesentery. On the right, the omental bursa opens with an opening (foram en epiploicum Winslowi), which is limited in front by the hepatoduodenal ligament, behind by the inferior vena cava with covering peritoneum, above by the caudate lobe of the liver, below by the initial part of the duodenum. IN normal conditions the hole allows two fingers through.

The physiological significance of the omentum for the body is not fully understood. Experience convinces us that with penetrating wounds of the abdominal wall, the omentum often covers the hole, thereby protecting the abdominal cavity from infection and preventing prolapse of the viscera; with simultaneous damage to the chest and abdominal cavities, the omentum passes through the damaged area in the diaphragm and first penetrates the chest cavity, and then extends to the hole in chest wall and closes it.

In all inflammatory diseases in the abdominal cavity, the omentum always takes part in, delimiting inflammation from the rest of the abdominal cavity. The significance of the omentum is not limited to the two indicated functions and is undoubtedly physiologically more complex. However, when removing the free part of the oil seal, no pathological symptoms loss of functions in the body is not observed.

Small seal(omentum minus) consists of three ligaments that transform into one another. Lower section The lesser omentum is called the hepatoduodenal ligament, which runs from the portal of the liver to the horizontal part.

Big seal in initial stage development is an anterior and posterior duplication, not fused to each other. In this regard, the vascular system of the anterior and the vascular system of the posterior duplication of the greater omentum are initially formed. These systems are interconnected by anastomoses along the lower edge of the omentum, where the anterior duplication passes into the posterior one.

The posterior duplication of the omentum fuses with the mesocolon, with the peritoneum covering the pancreas. This determines the connection of the vessels of the posterior duplication of the omentum with the branches of the vessels of the transverse mesentery colon, with the vessels of the pancreas.

The arteries of the anterior duplication of the omentum originate from the right and left gastroepiploic arteries. A. gastroepiploica dextra arises from the gastroduodenal artery, and gastroepiploica sinistra - from the splenic artery or its lower branch in the region of the hilum of the spleen.

3-10 omental arteries depart from the right gastroepiploic artery, running radially to the free edge of the greater omentum. Larger number arteries goes to the greater curvature of the stomach.

Left gastroepiploic artery located at the gate of the spleen in the gastrosplenic ligament, then passes through the gastrotransverse colon ligament. This artery gives off 2-6 omental arteries, which go to the free edge of the omentum. Arterial branches extend to the greater curvature of the stomach in greater numbers. The right and left gastroepiploic arteries usually anastomose with each other approximately at the level of the middle of the greater curvature of the stomach. Anastomosis between them is rarely absent (in 3 cases out of 77, V.I. Shifrin).

Right gastroepiploic artery longer and thicker than the left one. Its branches anastomose with each other, in the right and middle parts of the anterior duplication of the omentum they pass into the posterior duplication and there they anastomose with the branches of the middle colon, inferior duodenal-pancreas and spleno-epiploic arteries. The left gastroepiploic artery is shorter and thinner than the right. Its branches are located in the left third of the anterior duplication of the greater omentum. Anastomoses between these branches are less pronounced than in the right part of the omentum; anastomoses with the vessels of the posterior duplication are less common. Sometimes the left gastroepiploic artery is absent (2 cases out of 77, V.I. Shifrin).

Arteries of the posterior duplication of the omentum in its left part are branches of the splenic or left gastroepiploic arteries.

Splenoepiploic artery located arcuately in the posterior duplication of the omentum, 4-12 branches extend from it downwards and upwards. The branches running towards the free edge of the greater omentum anastomose with the branches of the arteries of its anterior duplication. The branches going to the ventricle anastomose with the branches of the middle colon artery and with the vessels of the pancreas. Thus, in the posterior duplication of the omentum, as in the anterior one, an arterial arch is formed, located below the arterial arch of the anterior duplication. In the right part of the posterior duplication of the greater omentum there are branches of the arteries of the pancreas and the mesentery of the transverse colon.
The initially separate arterial networks of the anterior and posterior duplications of the greater omentum are closely united after fusion of the duplications. Between them, anastomoses arise in all sections, where the anterior and posterior duplications are fused to each other.

The severity and breadth of distribution of the branches of individual vessels of the greater omentum vary individually. The location of the vessels, the shape and severity of the arterial arches, the localization of anastomoses are associated with the shape of the omentum, with the dissection of its free part in a multi-lobed form.

Greater omentum in adults

At the level of the transverse colon, fusion of the anterior and posterior duplications of the greater omentum does not always occur along its entire length. In this regard, the gastrocolic ligament passes into the free part of the omentum without a distinct border. In these places, the level of the omental band of the transverse colon is considered to be the conventional boundary between the parts of the greater omentum.

The shape of the gastrocolic ligament is very diverse. Even in adults, the omentum may have structural features characteristic of the period of intrauterine development. IN similar cases fusion of the anterior and posterior duplications of the omentum occurs only over a short distance - 2-3 cm each at the right edge at the level of the pylorus of the stomach and on the left, where the gastrocolic ligament passes into the gastrosplenic ligament. Between these areas, the anterior duplication of the omentum has no fusion with the posterior duplication and the transverse colon; it directly passes into the free part of the omentum, and the cavity of the lesser omentum directly passes into the cavity of the free part of the greater omentum. This form of the gastrocolic ligament can be considered “embryonic”, “underdeveloped”.

In other cases, the anterior duplication of the greater omentum is fused not only with the transverse colon, but in a significant part with its mesentery. This fusion can be quite wide, especially on the right. At the level of the gatekeeper or even to the right of midline of the body, in essence, there is a “gastromesenteric” ligament, and the gastrocolic ligament is expressed only to the left of the midline. This form of the gastrocolic ligament can be considered “reduced.” Often such a “reduced” gastrocolic ligament is also very short, only 2-3 cm.

Along with these extreme forms of the structure of the gastrocolic ligament, there are numerous intermediate forms, which allowed some authors to identify up to 5 different “anatomical variants” of this ligament. Thus, F. P. Nechiporenko identifies the following forms:

1. Arc-shaped. In this form, the lower edge of the ligament is fused with the transverse colon only on the right and left, while in the middle part the gastrocolic ligament directly passes into the anterior duplication of the free part of the greater omentum. This form of flu occurs mainly in children under 1 year of age, but is sometimes observed in adults.
2. Falciform gastrocolic ligament. Fusion of the anterior and posterior omental duplications occurs along the entire length of the omental band of the transverse colon. The length of the ligament in its right and left parts is less than in the middle. The author observed a connection of this form in a significant number of cases. The falciform bifurcated ligament in its left part for 3-12 cm is not attached to the transverse colon: it consists of left and right parts (fixed) and a central part - not fixed. Ligaments of this form are the most common.
4. Quadrangular gastrocolic ligament fused with the transverse colon along its entire length. The length of the ligament in the lateral sections and in the center is almost the same.
5. Quadrangular bifid gastrocolic ligament. In the middle or left part, the ligament is not fused with the transverse colon for some extent.
The quadrangular gastrocolic ligament was encountered by F.P. Nechiporenko mainly in the oblique and transverse position of the transverse colon, while the falciform ligament was observed mostly in the horseshoe-shaped form of this colon.

The dimensions of the gastrocolic ligament are highly variable and are largely related to its shape. With a crescent-shaped ligament, its middle part has the greatest length, the right and left edges are short. With a quadrangular shape of the ligament, its length in the middle section is also greater than in the lateral sections, but this difference is insignificant. In some cases, the gastrocolic ligament is longer on the left or on the right side.

In the right part of the gastrocolic ligament, fusion with the mesentery of the transverse colon is often observed. Such adhesions at the level of the pylorus, the antrum of the stomach and the right part of the body of the stomach were encountered by F. P. Nechiporenko in 69 cases during a study of 102 corpses of adults.

The length of fusion of the ligament with the mesentery varies, sometimes extending 10-15 cm to the left of the pylorus of the stomach. This circumstance is of great practical importance during mobilization of the stomach along the greater curvature and when opening the omental cavity through the gastrocolic ligament.

The free part of the greater omentum in adults has an even greater variety of shapes than in children. Among all the diversity, two extreme ones can be distinguished, reflecting the process of ontogenetic development of the omentum:

1. A large omentum without an internal cavity, with a wide zone of fixation to the colon.
2. A small omentum with an internal cavity and a small zone of fixation to the colon.

The size of the free part of the greater omentum in adults is subject to large individual fluctuations. The omentum can completely cover the small and large intestines and descend into the pelvis. In other cases, the omental duplications do not descend below the omental band of the transverse colon, and the free part of the omentum is absent. The location of the lower edge of the greater omentum does not always coincide with its size. With a low location of the transverse colon, the omentum, which has a relatively small free part, appears at the entrance to the small pelvis or even descends into it. With a high location of the transverse colon, even a long omentum appears only at the level of the interspinous line. Because of this, judge the size of the large The maximum length of the omentum, according to N.N. Shavinsra (1933), is 30 cm.

Due to different shapes oil seal there may be significant differences in the length of its left, right and middle parts. The difference in their length can exceed 10 cm. The average length of the omentum, measured in the center, left and right, according to N.N. Shaviner, varies within the following limits: small omentums (4-9 cm long) - within 50%; medium oil seals (10-15 cm) - 36%; large omentums (16-21 cm) - 14%. The width of the greater omentum is also very variable, although these differences are somewhat less pronounced. Most often, the free part of the greater omentum has its greatest width at the level of the lower edge of the transverse colon. However, often the width of the oil seal in its middle or along the lower edge is greatest. This occurs somewhat more often than 13% of cases. The width of the omentum, as indicated by I. N. Shaviner, ranges in adults from 17.5 to 50 cm. The most complete idea of ​​the size of the free part of the greater omentum is given by measuring its area. Dimensions of the area of ​​the large oil seal different people can be compared regardless of the seal shape. The area of ​​the omentum (its free part) in adults ranges from 115 to 1150 cm2 (N. N. Shaviner). But, as already mentioned, the free part of the greater omentum may be absent altogether; thus the range of differences is even wider.