A 5?cm defect in the bladder dome was identified and repaired in two layers

A 5?cm defect in the bladder dome was identified and repaired in two layers. the omentum is rare. The only previous case report from 1958 described a case of double omental herniation secondary to almost complete absence of both greater and lesser omenta.2 We present a unique case of the management of a pregnant woman with a large pelvic pseudocyst caused by complications related to congenital absence of omentum, resulting in acute renal failure, likely secondary to acute compartment syndrome (ACS). Case report A 34-year-old nulliparous woman, presented at 26 weeks gestation with right-sided abdominal pain. She had previously undergone two laparotomies, the first due to sub-acute bowel obstruction when she was 19 years old, where complete absence of omentum was confirmed. The second was carried out due to the formation of an infected pseudocyst, which was drained and marsupialised. It was reportedly not possible to remove the cyst in its entirety as it was inseparable from small bowel, mesentery, caecum, sigmoid and parts of the colon. During follow-up, she remained clinically well but ultrasound revealed a stable right-sided pseudocyst measuring 5.6?cm in diameter maximally. She conceived through in?vitro fertilisation, LECT1 necessitated due to tubal element infertility, and presented at 26 weeks gestation with right-sided abdominal pain. Ultrasound exposed the pseudocyst had improved in size, measuring 14?cm in diameter. Conservative management was planned, but she re-presented at 27 weeks with worsening pain and vomiting. She experienced a leucocytosis (14.2??109/l) and an elevated C-reactive protein (CRP; 69?mg/l). Intravenous cefuroxime and metronidazole were commenced, and intramuscular steroids for fetal lung maturation were given. She remained stable until 28 weeks gestation when she developed worsening pain, distension, an increased CRP (182?mg/l) and deteriorating renal function (creatinine 94?mmol/l). Magnetic resonance imaging confirmed a 14??12??18?cm intraperitoneal cyst in addition to multiple dilated loops of small bowel and bilateral slight hydronephrosis. An ultrasound-guided drainage of the cyst was attempted but proved unsuccessful. She consequently developed gradually worsening acute kidney injury (AKI) (creatinine 248?mmol/l; estimated glomerular filtration rate 19?ml/min/1.73?m2) despite aggressive intravascular filling. In view of this, the decision was made for operative delivery with drainage of the cyst at 29+2 weeks gestation. A midline laparotomy was performed. The bladder was densely adherent to the inferior aspect of the peritoneal cyst up to level of umbilicus. Superiorly, the transverse colon was adherent to the cyst and the underside of linea alba. The cyst was opened and evacuated. A midline classical incision was made to the uterus and a male infant was born by breech extraction, weighing 1370?g. Apgar scores were 8, 9 and 10 at 1, 5 and 10?min, respectively, and the arterial wire BRL-15572 pH was 7.05 having a base excess of ?11.6?mEq/L. The uterus was closed in three layers. A 5?cm defect in the bladder dome was identified and repaired in two layers. The cyst wall proved to be histologically benign, and no bacterial growth was BRL-15572 recognized. Post operatively, her renal function dramatically improved and within 24?h, her creatinine had decreased to 129?mmol/l. From the fourth post-operative day time, her renal function experienced normalised, and she experienced an uneventful recovery. Blood checks including anti-glomerular basement membrane antibodies, immunoglobulins, myeloperoxidase, Proteinase-3 and paraprotein were all normal, as was urinary Bence Jones Protein. Discussion ACS is definitely defined as a sustained intra-abdominal pressure (IAP) 20?mmHg, associated with fresh organ dysfunction.3 It is thought to contribute to renal BRL-15572 failure through both pre-renal and BRL-15572 renal mechanisms including renal vein compression, improved renal vascular resistance and the launch of inflammatory cytokines, catecholamines, renin and angiotensin.4 ACS has been increasingly recognised like a potentially life-threatening complication in severely ill individuals having a reported mortality rate of up to 68%.5 However, the condition is both poorly understood and rarely regarded as in pregnancy. The effect upon the fetus is also not well.