an ode to the omentum

did you know you have an omentum?  in fact, you have a greater and lesser omentum.  most of us know little of our omentum,  but none the less it serves a vital capacity in the guardianship of our abdominal organs and even our lives.

the omentum is a double fold of tissue that hangs down from our stomachs in a gentle veil to cover our intestines.  although the ancient egyptians used it to forecast good or evil omens for the survivors of the deceased, today we know it serves many remarkable purposes.  its fatty composition pads our abdominal organs, protecting them from the various intentional and unintentional assaults they must endure.  as we breath, the lower free edge of the omentum sweeps the surface of our bowels looking for and destroying rogue bacteria and other threats to our physical integrity.  if the omentum encounters the beginnings of infection, it will adhere itself to the involved area in an attempt to prevent the greater catastrophe of peritonitis (overwhelming infection of the abdominal cavity).   it has the ability to surround and revitalize an ischemic section of bowel (a section of bowel that is not getting enough blood flow to survive) by contributing its own blood flow to the jeopardized area.  Autopsies have shown various materials inadvertently left in the abdominal cavities of surgical patients to be completely encapsulated by the omentum.   it is our protector, a warrior and mother, both loving and fierce in its commitment to our survival.

once i stood across the operating table from a surgical resident, waiting for our attending to join us in what was anticipated to be a resection of a localized colon mass.  the patient was anesthetized, the OR staff scrubbed and sterile, and the instruments ready.  the attending was late. the resident, in her fifth year and fully capable of the operation in its entirety, decided to begin.  she opened the abdominal cavity.  as the edges of the incision were spread wide with the retractors, we were met with a saddening site.  there sat the omentum, heavy and caked, the color and consistency of dry clay. no glistening yellow lobes of fat, no red glow of life-sustaining blood vessels.  the resident attempted to lift the omentum to visualize  the bowel beneath.  it broke in half.  the entire OR was silent.  even i knew what a terrible omen that was.  the wound was closed, the surgery aborted.  metastatic colon cancer.  this man would die soon.

his omentum had valiantly but unsuccessfully tried to stave off disaster.  cancer had all but replaced the normal omental tissue. for many days, possibly months, his omentum had burdened itself with his disease so that he could live just a little bit longer, unaware of his fate. i had great respect for that omentum.  so please, take a moment to thank your omentum for the silent but important work it does for you everyday.