Diagnosis and Management of Adult Omental Infarction: 10-Year Case Series.

Abstract

Omental infarction is a rare cause of an acute abdomen with nonspecific signs that can be easily mistaken with other more common intra-abdominal pathologies. The increased use of radiological imaging has brought this diagnosis to attention with respect to management plan. We present the experience of an Australian hospital network with the diagnosis and management of omental infarction to raise awareness of this uncommon pathology. A retrospective review of medical records of adult patients diagnosed with omental infarction from 2010 to 2020 was conducted across four major hospitals in South Western Sydney. Data relating to clinical presentation, investigations, management and outcomes were obtained. Omental infarction was diagnosed in 61 patients (mean 51.1years, range: 19-76years old). All patients presented with nonspecific abdominal pain with the most common sites being the right iliac fossa followed by the right upper quadrant, respectively, over an average period of 2.7days. Computed tomography and/or diagnostic laparoscopy identified omental infarction in all cases. Forty-two patients (68.9%) had successful conservative management, six failed conservative management and 19 patients had emergency laparoscopic omentectomy. The average hospital length of stay was 3.4days with no significant morbidity or mortality. Omental infarction generally presents with nonspecific clinical signs often masquerading as other more common abdominal diagnosis like cholecystitis or appendicitis. A trial of conservative management initially coupled with appropriate imaging should be recommended within the first 24-48h before considering surgical treatment in refractory cases.