Primary omental infarct presenting as acute abdomen in Emergency Department

Abstract

Introduction: Omental infarction is a rare cause of acute abdomen resulting from vascular compromise of the greater omentum. Vague symptoms and non-specific signs at presentation make the clinical presentation diagnostically challenging. Evidence to guide the management of omental infarct is still controversial and limited. However, general approach is to manage it conservatively and to consider surgery only if there is a deterioration in the clinical condition. We report a case of omental infraction presented to the ED with acute abdomen that showed fruitful recovery by conservative management without requiring surgery or prolonged hospitalization. Case Report: A 23-year-old Ethiopian male patient, presented to the ED with colicky abdominal pain of few hours duration, which was sudden in onset and was increasing in the severity. The pain started in the right side of the abdomen just lateral to the umbilicus associated with anorexia. On the physical examination; he appeared to be in pain and on the palpation of the abdomen, there was tenderness and minimal rebound tenderness over the right iliac fossa and to a lesser degree over the right lumbar region. CT scan with contrast revealed an ill-defined focal area of increased fat stranding in the omental fat in the right lumbar region, anterior to the mid ascending colon, typical to that of focal area of omental infraction. Conclusion: Omental infarction is a rare benign cause of acute abdomen. The widespread availability of CT allows us to recognize the cases while they are in the Emergency Department.