2583 Omental Infarction as a Cause of Acute Abdominal Pain

Abstract

INTRODUCTION: Although rare, omental infarction is becoming an increasingly recognized cause of acute abdominal pain. The purpose of this vignette is to recognize omental infarction as a cause of acute abdominal pain and to discuss its management. CASE DESCRIPTION/METHODS: A 58-year-old male with history of aortic rupture, coronary artery disease, internal jugular thrombus, and prior stroke presented with three days of progressively worsening, constant, and sharp RUQ abdominal pain. It did not radiate and was unrelated to food intake. He had no relief with OTC pain medication. He denied fevers, nausea, vomiting, inability to tolerate food or liquids, change in bowel habits, or blood in his stool or urine. He denied alcohol, tobacco, or illicit drug use. On exam, the patient appeared uncomfortable; however, was afebrile with normal blood pressure, respirations, and heart rate. He had tenderness in the RUQ and epigastric regions with voluntary guarding but no rebound tenderness. Initial work up was without leukocytosis, transaminitis, acidosis, kidney injury, or elevated lipase. Abdominal x-ray was without free air. An abdominal CT was performed and showed a fat-containing mass lesion within the RUQ anterior to the liver measuring 2.7 × 1.9 cm with adjacent inflammation representing an omental infarction. The patient was managed with IV fluids and pain medication. No surgical intervention was warranted, and the patient was admitted to the medicine team for conservative management. Following 24 hours of observation, he was transitioned to an oral pain regimen and was advanced to a regular diet. He was discharged with pain medication to follow up with his primary care provider. DISCUSSION: Over 400 cases of omental infarction have been described in the literature. It most commonly occurs in middle-aged men. Pain is usually right sided, which may be secondary to longer, more mobile omentum that increases the risk of torsion and disruption of blood supply. Omental infarction can be both idiopathic or secondary to the presence of intra-abdominal pathology. Suspected risk factors for idiopathic presentations include obesity, laxative use, trauma, and excess exercise/strain. CT scan alone is sufficient for diagnosis given specific findings that include fatty oval shaped mass or hyper attenuating streaky infiltration. Management is typically conservative with IV fluids, pain control, and observation. Surgery is reserved for those with acute decompensation or progression of pain despite conservative measures.