Idiopathic Omental Infarction, Diagnosed and Managed Laparoscopically: A Case Report

Ahmed Abdulaziz,Tamer El Zalabany,Ahmed Al Ansari,Abdul Rahim Al Sayed

doi:10.1155/2013/193546

Abstract

Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2°C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5 × 4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6 × 4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.

Highlights

Idiopathic omental infarction due to torsion of the omentum is a rare cause of acute abdomen
Among a variety of acute abdomens, acute torsion of omentum is the least suspected under the impression of, most commonly, common cases such as acute appendicitis, acute cholecystitis, acute diverticulitis, mesenteric thrombosis, ovarian cyst, and perforated peptic ulcer [3]
Omental infarction should be considered with any patient presenting with acute right lower-quadrant pain

Summary

Introduction

Idiopathic omental infarction due to torsion of the omentum is a rare cause of acute abdomen. Torsion of the omentum is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised [1, 2]. Among a variety of acute abdomens, acute torsion of omentum is the least suspected under the impression of, most commonly, common cases such as acute appendicitis, acute cholecystitis, acute diverticulitis, mesenteric thrombosis, ovarian cyst, and perforated peptic ulcer [3]. Most patients present with acute right-lower quadrant pain, and not surprisingly, they are usually misdiagnosed as having appendicitis [2]. Ultrasonography (US) and computed tomography (CT) scanning are helpful tools for identifying the characteristic signs of omental infarction and signifying the deferential diagnosis. Laparoscopy is used in the diagnosis and treatment of such rare conditions

Case Presentation

Discussion

Conclusion