Omental Infarction Research Articles

EP553 - Omental Infarction mimicking acute cholecystitis - A Case Report

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.

Primary omental infarction- a benign cause of acute abdomen.

Omental infarction (OI) is an uncommon cause of acute abdominal pain. A high index of clinical suspicion is required for diagnosis of OI as the incidence is less than 1 %, presenting with abdominal pain. We report primary OI's clinical and radiological profile from a single tertiary care hospital in India. In this retrospective cross-sectional study, the electronic medical and radiology records of patients withabdominal pain were reviewed over seven years (2015-2022). Variables were systematically collected and analyzed. A total of 22 patients diagnosed with primary OI were included in this study. Male preponderance (63.6 %) was noted with a mean age of 47.45 years (SD±13.84; range: 18-72 years). Most patients belonged to class I obesity (according to the Asia-Pacific body mass index classification) with a mean BMI of 26.56 kg/m2 (SD±3.21 kg/m2). All patients had abdominal pain as the primary symptom, with a mean duration of 8.64days (SD±10.15; range: 1-42days). The most common locations of pain were the right hypochondrium (27.3 %) and diffuse (27.3 %), followed by the right iliac fossa (18.1 %). Most (95.45 %, n=21/22) patients were treated conservatively, and only one required surgical intervention. Primary OI is a rare and benign cause of acute abdomen. Obesity is a risk factor but does not correlate with the size or severity of OI. Radiological imaging, like a computed tomography (CT) scan, is essential for diagnosis. Aconservative management line should be the first approach in treating primary OI before considering surgical options.

Efficacy and safety of transcatheter arterial embolization of omental artery aneurysm: A single-center experience.

Omental artery aneurysm (OAA) is an extremely rare visceral artery aneurysm. Ruptured OAAs are associated with a high mortality rate. Transcatheter arterial embolization (TAE) has been used to treat OAA in recent years. However, the risk of omental ischemia due to TAE remains unclear. Therefore, this study aimed to investigate the efficacy and safety of TAE of OAA as a first-line treatment. Fifteen patients with true aneurysms or pseudoaneurysms who underwent OAA-TAE between 1 April 2010 and 31 December 2022 were included in this study. The technical and clinical outcomes, the incidence of omental infarction after TAE as a major complication, OAA-TAE techniques, radiological findings on computed tomography angiography and angiogram, and patient characteristics were evaluated. Fifteen patients (nine men, six women; age, 69.8 ± 18.59 years) underwent TAE of OAAs (mean aneurysm size of 9.30 ± 6.10 mm) located in the right gastroepiploic (n = 9), left gastroepiploic (n = 1), and epiploic (n = 5) arteries. All patients with ruptured (n = 6) and unruptured (n = 9) OAA successfully underwent TAEs using coils, n-butyl-2-cyanoacrylate, or gelatin sponges. Hepatic artery thrombosis and coil migration were observed during the procedure; however, these adverse events were manageable. Transfusion of red blood cell units (4.66 ± 1.63 units) was required only in cases with ruptured OAAs after TAE. Additional surgery or TAE due to rupture or rerupture of OAA and omental infarction was not required during the postoperative and follow-up periods. The OAA-TAE can effectively treat ruptured and unruptured OAAs, and the risk of omental infarction after OAA-TAE may not be high.

Omental Infarction: A Forgotten Entity

Omental infarction is a cause of acute abdominal pain. It is a challenging diagnosis to make due to its infrequent occurrence, low awareness, and non specific presentation. It is generally recommended to manage it conservatively because of its self-limited nature. However, some physicians opt for surgical management due to the potential risk of abscess formation with conservative treatment. Omental infarction commonly occurs following torsion. The anatomical features of the omental sheet, such as its increased length, freely mobile lateral edge, and a weak blood supply, make it more susceptible to twisting along its long axis, leading to congestion. If the twist is severe enough or if there is prolonged obstruction to venous flow, arterial inflow may be compromised, resulting in infarction and potential complications like necrosis. Here, the authors present a case of a 64-year-old diabetic male who presented to the Emergency Department with acute right upper quadrant pain. He was diagnosed with omental infarction through Computed Tomography (CT) of the abdomen. The authors attempted conservative management, but his pain persisted despite analgesics. Subsequently, the authors opted for surgical intervention and performed an omentectomy. In cases of acute abdominal pain, conditions like omental infarction are often overlooked and should be considered in the differential diagnosis.

Omental Infarction, a Rare Case of Abdominal Pain: A Case Report and Literature Revue

Omental infarction is a rare cause of acute abdomen resulting from vascular compromise of the greater omentum. This condition has a non-specific clinical presentation that mimics other causes of acute abdomen, namely, acute appendicitis and cholecystitis. A confident diagnosis can usually be made on computed tomography (CT) and the typical natural history is one of spontaneous resolution. We present a case of a 59-year-old female patient, who has undergone surgery twice for a white line hernia, with the most recent operation having been performed one year ago. She presented to the emergency department with recent worsening of chronic abdominal pain. Omental infarction should be included in the differential diagnosis list of acute abdominal pain because it can occur at any site. In addition, because this disease runs a self-limited course, conservative care is recommended. Thus, unnecessary operations can be avoided in cases where omental infarction is diagnosed by imaging studies.

A rare occurrence: A case report of acute appendicitis and omental infarction unveiled by epigastric pain in a heavy smoker

Omental Infarction (OI) is a rare condition that can mimic common causes of acute abdominal pain, primarily affecting individuals aged 40 to 50, with a male predominance. Imaging techniques like ultrasound and computed tomography aid in diagnosis. Treatment options range from conservative management to surgery, depending on severity and complications. OI often leads to right-sided abdominal pain in 90% of cases, with histological features including focal necrosis and fibroblastic reactions. Acute appendicitis is a common cause of acute abdominal conditions, especially in children and adolescents. Having a patient simultaneously presenting with acute appendicitis and omental infarction is extremely rare, with only three cases reported in the literature to date to our knowledge. We present the case of a 32-year-old male, a heavy smoker, who presented with epigastric pain and vomiting. Initial clinical suspicion was a perforated ulcer, but imaging revealed swollen appendicitis with adjacent fat stranding and evidence of epiploic infarction near the stomach. Laparoscopic surgery confirmed the diagnosis of acute appendicitis, with an appendectomy performed and identification of the infarcted omentum, which was preserved. After the operation, the patient had a successful recovery and was discharged on the second postoperative day. This case firstly emphasizes the rarity of the association between acute appendicitis and omental infarction in the same patient and underscores the importance of considering Omental Infarction (OI) in the differential diagnosis of acute abdominal pain. Imaging plays a crucial role in accurate diagnosis, and a high degree of suspicion and prompt diagnosis are crucial for optimal patient outcomes.

Technical and Diagnostic Performance of Rapid MRI for Evaluation of Appendicitis in a Pediatric Emergency Department

Rationale MRI is increasingly used for diagnosis of pediatric appendicitis in theemergency care setting. Scan and room time are important to optimize workflow,especially in situations with limited MRI availability and accessibility. To describe our process to optimize and implement a rapid, non-contrast, free-breathing MRI protocol for appendicitis and to characterize the accuracy fordiagnosis. Initial MRI protocol implemented for suspected appendicitis included five respiratory-triggered axial and coronal single shot fast spin echo (SSFSE) and radialT2W sequences with and without fat suppression (FS). This protocol was reassessedbased on image quality. Subsequently, the coronal and axial T2W SSFSE FS sequence were removed. A three-sequence exam comprised the rapid MRI appendicitisprotocol used for the remainder of the study. All examinations were performed on a 1.5T scanner. For all examinations, the following information was obtained: scan time, diagnosis ofappendicitis (by radiology report), surgery and pathology reports, and alternativediagnoses documented in radiology reports. MRI examination scan durations werecompared between the five-sequence and three-sequence protocols, with Mann-Whitney U test, and proportions of false diagnoses were compared toFisher's exact test. 216 examinations were performed; 21 and 195 performed with five-and three-sequence protocol, respectively. The median duration of the five-sequence protocol was 20 (16.9-23.5) minutes vs.11 (9.5-13) minutes for the threesequence protocol (p<0.0001). The majority (n=157, 80.5% of 195) of examinations were performed in a goal time of<15min. 23 examinations took longer than 20min (n=12, n=11 for the three-and five-sequence protocols, respectively) were due to repeat sequences or addition of non-standardsequences (requested by interpreting radiologist). 27 (90%) of the 30 reported positive cases were confirmed by pathology. There were threefalse-positive diagnoses (all three-sequence protocol exams) and onefalse-negativediagnosis (five-sequence protocol exam). Alternative diagnoses, including pancreatitis,omental infarct, masses, and ovarian pathology, were made in 42 (19%) cases. A three-sequence, non-contrast, free- breathing MRI examination can beperformed in less than 15min in the emergency department and has highdiagnostic accuracy for acute appendicitis in children and young adults.

Omental Infarction that Imitates Acute Cholecystitis

Omental Infarction that Imitates Acute Cholecystitis

A rare case of acute abdomen: Omental infarct

Omentum infarction occurs when the omentum is torsioned around its long axial axis and compresses the vascular structure. Although omentum infarction is rare, it is an important pathology that should be considered in acute abdomen.

Post-myomectomy omental infarction: a case report

BackgroundOmental Infarction (OI) is uncommon and mimics common causes of acute abdomen. It is important to differentiate it from other abdominal conditions that require emergency management. It was first reported in literature in 1896 and about 400 cases have been reported till date.Case presentationWe reported on a 41 year-old Para 0+0 Ibo house wife who presented with 10 years history of supra-pubic mass and five months history of excessive menstrual flow. After physical examination, a diagnosis of symptomatic uterine fibroid was made. She had myomectomy and the raw surface created after the excision of the myomas was covered with omentum. Wound infection developed on the 8th post-operative day leading to a wound breakdown and later partial extrusion of infarcted omental tissue through the dehisced wound. During re-exploration, the infarcted omental tissue was extracted and the residual abdominal abscess was drained. Surgical site wound infection occurred on the 3rd day after re-operation and a sub-acute intestinal obstruction developed on the 4th day thereafter which responded to conservative management.ConclusionCareful surgical technique is imperative when utilizing the omentum for reconstructive abdominal surgery. Torsion of the omentum and creation of excess tension while using the omentum for reconstructive procedures should be avoided and increase awareness of this uncommon disease condition by the surgeon is also important. This case is to report a rare finding of omental infarction following myomectomy.

Laparoscopic Approach to a Patient with Omental Infarction: A Case Report

Background: Omental infarction is an entity that seldom manifests with gastrointestinal symptoms and often presents a diagnostic challenge. Due to its nonspecific presentation, it is usually not included as a differential diagnosis of acute abdomen, especially in an emergency setting. Case Presentation:: We present the case of a 38-year-old overweight female, seen in the emergency department, with a complaint of sudden onset of worsening epigastric abdominal pain for four days. The pain became more localized at the right iliac fossa two days before the admission. A physical examination revealed severe right iliac fossa tenderness and positive rebound tenderness. : A computed tomography of the abdomen was done and showed a localized area of mesenteric fat stranding in the right lumbar region reaching up to the inferior border of the right lobe of the liver with adjacent peritoneal fold thickening, likely suggesting inflammatory etiology. However, the appendix was visualized normally with a mild enhancement of the distal part suggesting secondary mild acute appendicitis. : A decision for diagnostic laparoscopy was made, where we found a 4x4 cm infarcted greater omental segment, which was excised and sent for histopathology. Conclusion:: Idiopathic omental infarction is a rare cause of acute abdomen in adults and needs to be considered as a potential differential diagnosis, especially if the clinical finding does not correspond with common conditions, like acute appendicitis.

Lesser Omental Infarction Presenting with ST-Segment Changes on Electrocardiography in A 37-Year Old Male: Coincidence or Causation?

Background: Omental infarction is a rare cause of acute abdominal pain. While the clinical presentation and diagnostic workup of omental infarction have been well-described in the literature, there is currently no published data on the relationship between omental infarction and Electrocardiogram (ECG) changes. Case presentation: A 37-year-old male presented with acute onset of epigastric pain, He had associated ECG changes, including ST elevation in V1 (1 mm), ST depression in leads II, aVF, and V4 so he was diagnosed with omental infarction after exclusion of acute coronary syndrome (ACS) via cardiac catheterization and echocardiography. The patient was managed conservatively with pain control and close observation and was discharged home in stable condition, The ECG changes resolved on follow-up 2 weeks later. Conclusion: Omental infarction should be considered in the differential diagnosis of patients presenting with acute abdominal pain and ECG changes. Further studies are needed to elucidate the pathophysiology of ECG changes in omental infarction and to develop optimal management strategies for these patients.

Ultrasound Diagnosis of Primary Epiploic Appendagitis: A Case Report

A rare differential diagnosis for severe abdominal pain is acute epiploic appendagitis. Its symptoms resemble those of acute diverticulitis, acute appendicitis, or omental infarction quite a bit. The primary imaging method used for diagnosis is computed tomography (CT). We are describing the case of a 27-year-old guy who underwent an abdominal ultrasonography after complaining of severe left lower quadrant abdominal pain. It identified an oval and non-compressible hyperechoic mass in the left iliac fossa. The mass was surrounded by a hypoechoic rim and there was no color Doppler signal. In the absence of CT, radiologists must be able to diagnose acute epiploic appendagitis on ultrasound in order to avoid unnecessary hospital admission, pricey laboratory tests, antibiotic treatment, and unnecessary surgery. In this instance, the patient was spared from ionization exposure from a potential CT scan and other invasive treatments including surgery with associated costs because of the reliable ultrasound diagnosis of epiploic appendagitis. After receiving conservative medical treatment, the patient was placed under surveillance and then discharged.

Omental Infarction: Challenges in Managing Acute Abdomen During COVID-19 Pandemic

Omental Infarction: Challenges in Managing Acute Abdomen During COVID-19 Pandemic

EP-66 Omental infarct – A rare cause of Right iliac fossa pain in a child

Abstract Introduction Idiopathic omental infarction is a very rare cause of abdominal pain in the pediatric age group. We report a case of suspected acute appendicitis in an 8-year-old child, noted to have omental infarct on diagnostic laparoscopy. Case presentation An 8-year-old male child with no other medical issues presented to the acute surgical take with a 2-day history of right iliac fossa pain. The pain was of sudden onset and there were no other associated urinary or bowel symptoms. On clinical examination, there was right iliac fossa tenderness. There were mildly raised inflammatory markers. An ultrasound scan performed showed a possible blind-ending tubular structure measuring 7mm in the right iliac fossa with a small amount of free fluids. A presumptive diagnosis of acute appendicitis was made and the patient was taken to theatre. Upon diagnostic laparoscopy, we noted blood in the RIF with a normal-looking appendix and area of omental infarction adjacent to the appendix. We proceeded to excise the area of mesenteric infarction using an energy device. The appendix was removed to avoid future diagnostic confusion. Conclusion Idiopathic omental infarction is an extremely rare cause of abdominal pain in children and may mimic acute appendicitis. Ultrasound imaging may be misleading. Laparoscopic exploration allows for accurate diagnosis as well as treatment.

Imaging of Mischievous Intra-abdominal Fat Presenting with Abdominal Pain: A Pictorial Review.

AimTo briefly discuss the imaging features of different types of intra-abdominal fat necrosis.BackgroundTrauma and ischemic insult may result in intra-abdominal fat necrosis. Fat necrosis may present with acute abdomen, clinically simulating with other etiologies, such as acute diverticulitis and acute appendicitis.Main bodyImaging plays a crucial role in making the exact diagnosis and differentiating it from other pathologies that may require surgical intervention. Computed tomography (CT) is the most commonly used imaging modality. A small fat attenuation lesion with a hyperattenuating rim in contact with the ventral surface of the sigmoid colon indicates epiploic appendagitis while a larger fat-attenuation lesion on the right side of the abdomen in between the colon and anterior abdominal wall indicates omental infarction. Fat stranding at the root of the mesentery with fat ring sign represents inflammatory mesenteric panniculitis while retractile or sclerosing mesenteritis appears as a fibrotic spiculated mass with or without calcification, mimicking mesenteric carcinoid. In patients with acute pancreatitis, the amount of inflamed fat correlates with clinical severity and outcome.ConclusionsFamiliarity with the imaging features of different types of intraabdominal fat necrosis helps in establishing an accurate diagnosis, thus avoiding unnecessary intervention.How to cite this articlePatel RK, Mittal S, Singh S. Imaging of Mischievous Intra-abdominal Fat Presenting with Abdominal Pain: A Pictorial Review. Euroasian J Hepato-Gastroenterol 2022;12(1):45–49.

Idiopathic Omental Infarction to Be a Rare Cause of Acute Abdomen: A Case Report

Omental infarction is a rare entity, representing hemorrhagic omental necrosis as a result of impaired omental perfusion. It can occur secondary to omental torsion or to inflammatory and neoplastic infiltration of the omental segment from adjacent organs. If the foregoing reasons can be excluded, omental infarction is called primary or idiopathic omental infarction. Occlusions of small omental arteries are rare and may be found in patients with thromboembolic disease, arteriolosclerosis, arteritis, or amyloidosis. The author presents a case of idiopathic omental infarction in a 66-year-old male presenting with abdominal pain. The patients underwent an emergent operation and recovered without any complication after surgery.

Omental infarction, unusual cause of abdominal pain

Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few cases are known. Objec tive: To analyze through a clinical case the characteristics and management of this pathology, to consider this entity in the differential diagnosis of acute abdominal pain. An 11-year- old child consulted the emergency department due to a 48-hour history of continuous abdominal pain, which had progressively increased. On the physical examination, the patient presented pain in the right side of the abdomen and the epigastric area, with no signs of peritoneal irritation, and was overweight (BMI 91st percentile). Biochemical analysis showed a slight increase in c-reactive protein (CRP) 41.31 mg/L (reference value < 3.0 mg/L) without leukocytosis and normal ultrasound study, without visualization of the appendix. Due to persistent pain, increased CRP, and absence of appen dix visualization in the ultrasound, the study was completed with an abdomen and pelvis CT scan which showed trabeculation of the fat of the anterior right subhepatic space, thus diagnosing omental infarction. The patient was hospitalized for conservative management with analgesia, anti-inflamma tory drugs, and fluid therapy, presenting good evolution in the first 48 hours. Omental infarction is an infrequent cause of acute abdominal pain in childhood. Imaging studies play a funda mental role in the differential diagnosis of this entity with other clinical conditions of similar course, thus avoiding unnecessary surgical interventions.

Omental infarction as an unusual cause of abdominal pain: a case report

El infarto omental es una causa infrecuente de abdomen agudo y de etiología no muy conocida, su presentación clínica inespecífica puede simular otras patologías más comunes, lo que hace su diagnóstico un reto clínico. Se presenta el caso de una mujer de 33 años que asiste a urgencias con clínica de dolor abdominal agudo, atípico, con hallazgos ecográficos sugestivos de apendicitis aguda, sin embargo, por la clínica inusual se realizó tomografía axial computarizada (TAC) de abdomen, con reporte sugestivo de diverticulitis. Ante la no concordancia clínica ni imagenológica, la paciente fue llevada a laparoscopia diagnóstica, como hallazgo intraoperatorio se evidenció isquemia del epiplón como único hallazgo, por lo cual se realizó omentectomía parcial. Siendo este un caso de importancia clínica debido a que el infarto omental debe considerarse entre los diagnósticos diferenciales de dolor abdominal agudo, en especial cuando la presentación es atípica y se han excluido las patologías más frecuentes. MÉD.UIS.2022;35(1): 43-8.

Greater omental infarction.

Greater omental infarction.