Abstract
Introduction: The Omentum is rich in blood supply. Omental Infarction can be classified as primary or secondary depending on the pathogenesis.
 Aims and Objectives: To report a case of DU perforation with secondary Omental Infarction.
 Case Details: A 21 year old male patient came with complaints of generalized dull aching abdominal pain, associated with persistent vomiting and high grade fever since 3 days. On examination, he was drowsy, BP was not recordable and peripheral pulses were not palpable. Abdominal examination revealed guarding and rigidity. X-ray erect abdomen showed gas under the right dome of the diaphragm (pneumoperitoneum).
 The patient was taken up for an exploratory laparotomy. Intraoperatively, findings included: 1) A 0.5*0.5cm in size perforation over the anterior first part of the duodenum, 2) approximately 3L of haemorrhagic peritoneal fluid 3) necrosed omentum and 4) petechial patches over the parietal wall of peritoneum. Primary repair of the DU perforation with omental plug (modified graham’s repair) with omentectomy of the necrosed part of omentum was done.
 The HPE report of excised specimen of omentum was suggestive of intense congestion and necro-inflammatory reaction of the omentum with necrosis and netrophilic infiltrate.
 Conclusion: A rare case of DU perforation with secondary omental necrosis is being reported.
 Keywords: DU Perforation; Omental Necrosis; Omental Infarction; Modified Graham’s patch
 Abbreviations: OI- Omental Infarction, DU- Duodenum.
Highlights
The Omentum is rich in blood supply
Omental Infarction can be classified as primary or secondary depending on the pathogenesis
The Omentum is a highly vascular organ but recently many cases of omental infarction followed by necrosis have been reported
Summary
The omentum and intestinal mesentry are rich in lymphatics and blood vessels. The omentum contains areas with high concentrations of macrophages which aid in the removal of foreign material and bacteria. A 21 year old male patient came with complaints of generalized dull aching abdominal pain, more severe in the right iliac fossa associated with persistent nonbilious vomiting and high grade fever since 3 days. He had a history of asthma in childhood and no major surgical interventions in the past. Findings included: 1) A 0.5*0.5cm in size perforation over the anterior first part of the duodenum [Image1], 2) approximately 3L of haemorrhagic peritoneal fluid with pus flakes along entire erythematous small bowel, 3) necrosed omentum [Image 2] and 4) petechial patches over the parietal wall of peritoneum
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