EP553 - Omental Infarction mimicking acute cholecystitis - A Case Report

Abstract

Abstract Introduction Spontaneous torsion and infarction of the omentum is a rare presentation with a variety of clinical presentations. We report a middle-aged male patient who presented with signs and symptoms mimicking acute cholecystitis. Case Presentation A 47-year-old man presented with an 18-hour history of right upper quadrant (RUQ) pain. Pain was constant, worse on movement and inspiration. On examination, he was exceptionally tender in the RUQ with positive Murphy’s sign. Initial investigations showed a mild inflammatory response, and the working diagnosis was acute cholecystitis. An abdominal ultrasound scan demonstrated a thin-walled gallbladder, free from gallstones and no evidence of acute cholecystitis. Given the patients ongoing severe pain and examination findings, a CT scan of abdomen and pelvis with contrast was performed. This demonstrated an oval shaped area of localized omental fat stranding in the RUQ, suggestive of omental infarction. The patient was managed conservatively with analgesia and discharged once symptoms were adequately controlled. Discussion Torted, infarcted omentum is a rare cause of acute abdominal pain. It is more frequently observed in 40–50-year-olds with male predominance. Most commonly it mimics symptoms and signs of acute appendicitis. However, this is a rare case mimicking acute cholecystitis. In this case, the necrotic segment was adherent with the anterior abdominal wall, causing significant pain and tenderness. When the clinically presentation of acute cholecystitis is not reflected by abdominal ultrasound, cross sectional imaging should be obtained to ensure definitive diagnosis is established in timely manner.