Omental Infarction Research Articles

Not only fat: omental infarction and its mimics in children. Clinical and ultrasound findings: a pictorial review.

Acute abdominal pain in children is the most common cause of emergency department admissions. Omental infarction is a rare cause of acute abdominal pain in this age group, accounting for approximately 15% of cases in children and 0.024-0.1% of cases of surgery for suspected appendicitis at the same age. Its clinical presentation may mimic similar diseases such as acute appendicitis, epiploic appendagitis, and mesenteric panniculitis. Ultrasound is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients and it can be used with confidence in the diagnosis and management of omental infarction in children. In this brief review, we focus on the main ultrasound findings and their diagnostic clue for omental infarction and its mimics.

Endoscopic management of symptomatic walled-off omental fat necrosis.

Endoscopic management of symptomatic walled-off omental fat necrosis.

Primary omental infarction: a rare cause of acute abdomen

Primary omental infarction (POI) is a rare cause of acute abdomen. It frequently mimics other causes of acute abdomen. It is being diagnosed more frequently with the advancement of radiology. Here we report a case of a 35 years old man admitted in emergency with pain right side abdomen since past 2 days. On physical examination patient was febrile with tenderness and guarding over right side of abdomen, TLC (total leucocyte count) - 13.2×109/l, mild rise in bilirubin with rest blood investigations being normal. CT (computed tomography) abdomen was s/o omental infarction. On diagnostic laparoscopy gangrenous omentum with torsion over a vascular pedicle was noted, omentectomy was performed laparoscopically. In conclusion omental infarction should be kept as a differential diagnosis in acute abdomen especially right-side abdominal pathologies. It can be managed conservatively but if signs of sepsis are there it is wise to perform a diagnostic laparoscopy.

Primary omental infarction: a report of a series of cases in an Indian tertiary care hospital

Primary omental infarction is a relatively rare and often presents as right sided abdominal pain. It is often diagnosed as appendicitis and is usually picked up intra-operatively, or - as often seen nowadays - on imaging. We describe a series of four cases of primary omental infarction that presented to us with varying clinical features. Three of them had a short history of right sided abdominal pain, whereas the fourth patient had a longer history of left sided abdominal pain. All 4 were managed operatively, with the fourth having presented with an intra-abdominal abscess that required laparotomy. Primary omental infarction is a diagnosis which must be considered in any case of acute abdomen. Cases diagnosed with certainty on imaging may be managed conservatively but must be followed up closely. Need for surgical intervention should be considered in select cases.

Self-healing omental infarction diagnosed and followed-up using contrast-enhanced computed tomography: A case report and review of literature

Introduction: Omental infarction is a relatively rare disease characterized by acute abdomen. Nonsevere cases may be successfully treated without antibiotics. Although adult cases often require surgical treatment, it remains unknown under what circumstances patients may be treated conservatively, including whether antibiotics are necessary. We report a case of self-healing omental infarction with a clinical course confirmed by contrast-enhanced computed tomography (CT). Case Report: A 53-year-old man presented to our emergency department with right lower abdominal pain. Contrast-enhanced CT scan revealed elevated fat density in the greater omentum and we diagnosed omental infarction based on these findings. The symptoms gradually improved with conservative treatment and we confirmed improvement using contrast-enhanced CT and blood tests. Conclusion: Omental infarction is a relatively rare disease characterized by acute abdomen. Nonsevere cases may be successfully treated without antibiotics. We conclude that contrast-enhanced CT is useful for the diagnosis and follow-up of omental infarction that is treated conservatively.

Multidetector Computed Tomography Evaluation of Omental Infarct

Abstract Background Omental infarction is a rare cause of acute pain abdomen and is difficult to diagnose clinically due to nonspecific clinical features. Multidetector computed tomography (MDCT) imaging of the abdomen is essential for the diagnosis of omental infarction and is also crucial to rule out appendicitis and other causes of acute pain abdomen. Objective The main purpose of this article is to describe the MDCT features of omental infarction in clinching the diagnosis and differentiating it from its clinical mimics. Methods CT findings of five patients with diagnosed omental infarction were retrospectively reviewed from 2014 to 2019. All patients presented with pain abdomen on the right side of the abdomen with various clinical diagnoses. MDCT was done for diagnosis and features evaluated include size of the lesion, location, relation to colon, and findings that were correlated to clinical presentation and etiology. Results Age distribution ranged between 36 and 55 years with female predominance. Out of five cases, one was secondary omental infarction due to inguinal hernia causing omental torsion and the other four cases were of unknown etiology. Three cases were managed conservatively and the other two cases were surgically managed. Three lesions were in right iliac fossa and two lesions were in the supraumbilical region on the right side. Conclusion Omental infarction should be considered important in the differential diagnosis of acute pain abdomen mimicking acute appendicitis and requires CT abdomen to establish diagnosis. Knowledge of typical imaging findings and application for diagnosis are important, as it is a self-limiting disease and can avoid unnecessary surgical interventions.

“Tethered Fat Sign”: The Sonographic Sign of Omental Infarction

Our purpose is to describe the ultrasound sign for a correct non-invasive diagnosis of omental infarction in children. From January 2014 to December 2018, a total of 234 children (109 boys and 125 girls, age range 3–15 y) with acute right-sided abdominal pain, admitted to our hospital with a presumptive diagnosis of acute appendicitis, were prospectively evaluated. In all patients, abdominal ultrasound was performed, and the omental fat was always evaluated. In 228 patients, the omental fat resulted to be normal or hyperechogenic, never tethered, and they results affected by other causes of abdominal pain different from omental infarction (such as appendicitis, pancreatitis, urolithiasis and others). In the remaining 6 children, we found a hyperechoic mass between the anterior abdominal wall and the ascending or transverse colon in the right abdomen quadrant, suggesting the diagnosis of omental infarction. This subhepatic mass was always tethered to the abdominal wall, motionless during respiratory excursions. We named this finding the “tethered fat sign.” The diagnosis was confirmed with laparoscopy in 4 children. The other 2 children were treated with conservative therapy. In these 2 patients, a sonographic follow-up was performed, showing a progressive reduction in size of the right-sided hyperechoic mass. In conclusion, our study suggests that the presence of the “tethered fat sign” may be an accurate sonographic sign for non-invasive diagnosis of omental infarction in children.

Fat misbehaving in the abdominal cavity: a pictorial essay.

Intra-abdominal fat is abundantly present in both the peritoneum and retroperitoneum. Fat necrosis or inflammation are common findings in abdominal imaging. The most common pathologies that we encounter are epiploic appendagitis, omental infarction, mesenteric panniculitis, and encapsulated fat necrosis. Less common entities that can occur are pancreatic saponification, heterotopic mesenteric ossification, and pseudolipoma of the capsule of Glisson. These entities can mimic more urgent pathologies such as appendicitis, diverticulitis, or malignancies.

Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis

ABSTRACT Background Despite acute appendicitis is the most common underlying etiology of the acute abdomen, a considerable list of other pathologies should be considered; despite sharing almost the same clinical presentation. This study aimed to re-enhance the importance and sensitivity of CT scan as a solitary imaging tool, in the evaluation of patients with acute right lower abdominal pain. Patients and methods It is a retrospective study of the last 1000 patients, referred with acute right lower abdominal pain for CT scan examination. Biphasic CT scan abdomen protocol was applied for all. Results Cecal carcinoma was detected in three patients (0.3%), epiploic appendicitis in five (0.5%), omental infarct in two (0.2%), appendicular mucocele in two (0.2%), appendicular NET in one (0.1%), cecal diverticulitis in four (0.4%), Chron’s disease in six (0.6%), intussusception in one (0.1%) and FB in one (0.1%) and appendicular perforation in one (0.1%), acute simple appendicitis 398 (39.8%) and 577 (57.7%) were unremarkable. Conclusion Despite acute appendicitis is the most common cause of the acute abdomen, many other surgical and non-surgical etiologies should also be considered, with a higher sensitivity of CT as a solitary diagnostic tool of imaging.

A Case of Idiopathic Omental Infarction Improved with Conservative Treatment

A Case of Idiopathic Omental Infarction Improved with Conservative Treatment

Omental Infarction: Unusual Complication after Laparoscopic Proctocolectomy

Omental Infarction is an under-explored origin of acute abdominal pain and has uncertain etiology. Because of its low incidence and nonspecific presentation, it can be difficult to diagnose. However, the increasing use of CT scans in patient evaluation has unveiled this phenomenon. We present the first case of postoperative omental infarction after laparoscopic proctocolectomy with end ileostomy in a 71-year-old male patient, who was successfully treated by removal of the infarct.

CASE OF DU PERFORATION WITH SECONDARY OMENTAL NECROSIS- A RARE CASE REPORT

Introduction: The Omentum is rich in blood supply. Omental Infarction can be classified as primary or secondary depending on the pathogenesis.
 Aims and Objectives: To report a case of DU perforation with secondary Omental Infarction.
 Case Details: A 21 year old male patient came with complaints of generalized dull aching abdominal pain, associated with persistent vomiting and high grade fever since 3 days. On examination, he was drowsy, BP was not recordable and peripheral pulses were not palpable. Abdominal examination revealed guarding and rigidity. X-ray erect abdomen showed gas under the right dome of the diaphragm (pneumoperitoneum).
 The patient was taken up for an exploratory laparotomy. Intraoperatively, findings included: 1) A 0.5*0.5cm in size perforation over the anterior first part of the duodenum, 2) approximately 3L of haemorrhagic peritoneal fluid 3) necrosed omentum and 4) petechial patches over the parietal wall of peritoneum. Primary repair of the DU perforation with omental plug (modified graham’s repair) with omentectomy of the necrosed part of omentum was done.
 The HPE report of excised specimen of omentum was suggestive of intense congestion and necro-inflammatory reaction of the omentum with necrosis and netrophilic infiltrate.
 Conclusion: A rare case of DU perforation with secondary omental necrosis is being reported.
 Keywords: DU Perforation; Omental Necrosis; Omental Infarction; Modified Graham’s patch
 Abbreviations: OI- Omental Infarction, DU- Duodenum.

2690 Omental Infarct: A Rare Cause of Acute Abdomen

INTRODUCTION: Omental infarct is a rare cause of acute abdominal pain resulting from vascular compromise of the greater omentum. This condition usually has a nonspecific clinical presentation with right lower quadrant being the most common location and is usually managed conservatively. We present a rare case of idiopathic omental infarct. CASE DESCRIPTION/METHODS: 35-year-old obese caucasian male with past medical history significant for hypertension and GERD presented to the emergency department with chief complaint of right lower quadrant pain which started 3 days ago without any precipitating event. Initial labs were unremarkable with vital signs only significant for elevated blood pressure. CT of the abdomen and pelvis with contrast showed significant inflammation in the right side of the abdomen most likely representing omental infarct. On call general surgeon was consulted who suggested no acute surgical intervention and patient to be managed medically with ciprofloxacin and metronidazole. On call vascular surgeon was consulted; advised there was no immediate need for anticoagulation as there was no evidence of acute vascular issues such as embolization and/or dissection involving the celiac or the superior mesenteric arteries. Following day, the patient improved clinically and was discharged with total of 10 days of antibiotic treatment and to follow-up outpatient with general surgeon. DISCUSSION: Omental infarct is a rare cause of acute abdominal pain. Clinical presentation includes sudden onset of acute abdominal pain located mostly in the right lower quadrant with tenderness and absence of any other GI symptoms. Omental Infarction can be isolated event or in succession to omental torsion. A diagnosis of primary/idiopathic omental infarct is made when no identifiable etiology is determined. Secondary causes of omental infarction include hypercoagulability, vasculitis, abdominal adhesions, cysts, and tumors. Other contributing factors include obesity, local trauma, heavy food intake, coughing, sudden body movements, laxative use, and hyperperistalsis. CT of the abdomen may show focal area of fat stranding, swirling of omental vessels, omental torsion, and/or hyperdense peripheral halo. The disease is often self-limiting and managed conservatively. Complications such as abscess can occur which may require surgical or radiologically-guided drainage.

2583 Omental Infarction as a Cause of Acute Abdominal Pain

INTRODUCTION: Although rare, omental infarction is becoming an increasingly recognized cause of acute abdominal pain. The purpose of this vignette is to recognize omental infarction as a cause of acute abdominal pain and to discuss its management. CASE DESCRIPTION/METHODS: A 58-year-old male with history of aortic rupture, coronary artery disease, internal jugular thrombus, and prior stroke presented with three days of progressively worsening, constant, and sharp RUQ abdominal pain. It did not radiate and was unrelated to food intake. He had no relief with OTC pain medication. He denied fevers, nausea, vomiting, inability to tolerate food or liquids, change in bowel habits, or blood in his stool or urine. He denied alcohol, tobacco, or illicit drug use. On exam, the patient appeared uncomfortable; however, was afebrile with normal blood pressure, respirations, and heart rate. He had tenderness in the RUQ and epigastric regions with voluntary guarding but no rebound tenderness. Initial work up was without leukocytosis, transaminitis, acidosis, kidney injury, or elevated lipase. Abdominal x-ray was without free air. An abdominal CT was performed and showed a fat-containing mass lesion within the RUQ anterior to the liver measuring 2.7 × 1.9 cm with adjacent inflammation representing an omental infarction. The patient was managed with IV fluids and pain medication. No surgical intervention was warranted, and the patient was admitted to the medicine team for conservative management. Following 24 hours of observation, he was transitioned to an oral pain regimen and was advanced to a regular diet. He was discharged with pain medication to follow up with his primary care provider. DISCUSSION: Over 400 cases of omental infarction have been described in the literature. It most commonly occurs in middle-aged men. Pain is usually right sided, which may be secondary to longer, more mobile omentum that increases the risk of torsion and disruption of blood supply. Omental infarction can be both idiopathic or secondary to the presence of intra-abdominal pathology. Suspected risk factors for idiopathic presentations include obesity, laxative use, trauma, and excess exercise/strain. CT scan alone is sufficient for diagnosis given specific findings that include fatty oval shaped mass or hyper attenuating streaky infiltration. Management is typically conservative with IV fluids, pain control, and observation. Surgery is reserved for those with acute decompensation or progression of pain despite conservative measures.

Omental Infarction: A Rare Cause of Acute Abdomen

Omental infarction is an uncommon but important cause of acute abdominal pain, which frequently mimics other surgical presentations. Low incidence and non-specific presentation contribute to Omental infarction being misconstrued for appendicitis, peptic ulcer perforation, acute pancreatitis or mesenteric ischemia. Its etiology remains uncertain, predisposing factors include obesity, strenuous activity, trauma, and sometimes idiopathic. Its diagnosis has traditionally been one of exclusion, based on intraoperative and pathologic findings. Here, we report the case of idiopathic omental infarction in a 51-year-old male. We discuss the diagnosis of primary omental infarction as well as the role of conservative and surgical management.

EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features

Transabdominal gastrointestinal ultrasound (GIUS) is unique in its capacity to examine the bowel non-invasively and in its physiological condition, including extra-intestinal features such as the splanchnic vessels, mesentery, omentum and lymph nodes- even at the bedside. Despite this, and its extensive documentation for its usefulness, it has only been fully implemented in a few European countries and expert centres. Therefore, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) established a GIUS Task Force Group in 2014 consisting of international experts from 9 European countries with the objectives to standardize and promote the use of GIUS in a clinical setting. This is achieved by publishing clinical guidelines and recommendations on indications and use of GIUS and so far,4 guidelines have been published: first on "examination techniques and normal findings", second on "inflammatory bowel disease", third on "acute appendicitis and diverticulitis" and fourth on "transrectal and perineal ultrasound".This paper describes the ultrasound features of miscellaneous disorders such as celiac disease, cystic fibrosis, omental infarction, Meckel's diverticle, endometriosis, intestinal neoplasia, mucocele, amyloidosis, GVHD, foreign bodies, vasculitis, and pneumatosis cystoides intestinalis. Bowel ultrasound can be indicated in most of these conditions to investigate intestinal symptoms but in other cases the alterations of the bowel can be also an incidental finding that suggest other examinations which finally help to discover an unknown pathological condition.

Omental Infarction: A Case Treated with Laparoscopic Surgery

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

INFARTO OMENTAL UM DIAGNOSTICO DIFERENCIAL DE ABDOME AGUDO

Introdução: O infarto omental é uma rara causa de abdome agudo inflamatório, sendo a torção omental uma de suas principais etiologias. A clínica do infarto omental se assemelha com as outras patologias do abdome agudo inflamatório com queixas inespecíficas. O diagnóstico é normalmente realizado durante exame de imagem ou procedimento cirúrgico. Objetivo: Descrever um caso de infarto omental que evoluiu com formação de abscesso. Relato de caso: Paciente masculino, 65 anos, procurou atendimento devido a dor abdominal difusa. Foram solicitados exames laboratoriais e TC abdominal. A TC abdominal apresentou imagem sugestiva de infarto segmentar do omento maior com áreas de necrose de permeio. Foi indicado o tratamento conservador com antibioticoterapia oral ambulatorial, analgesia e orientações para retorno. Uma semana após, retornou com relato de piora do quadro, evoluindo com aumento da dor abdominal, com maior intensidade em região abdominal esquerda e febre. Foi realizada nova TC abdominal, exames laboratoriais e EAS, para avaliar evolução da lesão. O estudo comparativo com a TC realizada 7 dias antes mostra discreto aumento da reação inflamatória da estrutura lesional acima descrita e acrescido ao espessamento da parede abdominal adjacente. Foi indicada a omentectomia da lesão e foi enviada para análise histológica. Paciente foi internado com antibioticoterapia intravenosa e após 3 dias recebeu alta hospitalar. Conclusões: Em pacientes com abdome agudo apresentando uma clínica inespecífica, é importante pensar no infarto omental, pois, apesar de ser uma patologia rara, pode gerar complicações caso ocorra erro diagnóstico ou atraso do mesmo.

UNUSUAL CAUSES OF THE ACUTE ABDOMINAL PAIN: IMAGING AND CLINICAL FINDINGS

Introduction: Acute abdominal pain is a common complaint of patients in the emergency department that needs to be evaluated rapidly and comprehensively. With a wide range of etiologies, acute abdominal pain is still a major diagnostic challenge in the emergency department. Radiological imaging is the corner stone of the diagnostic work up along with clinical and laboratory findings. Case report: In this case report, we present our 4 cases of acute abdominal pain caused by rare disorders (epiploic appendagitis, omental infarction, mesenteric panniculitis and cecal diverticulitis) that were initially diagnosed mistakenly based on clinical findings. These good mimickers masqueraded themselves as common etiologies of acute abdomen such as acute appendicitis, diverticulitis and cholecystitis. Conclusion: After radiographs, ultrasonography (US) and computed tomography (CT) are the most common imaging modalities that are performed in emergency departments for acute abdominal pain. Both US and CT are highly accurate imaging modalities that commonly reveal the correct diagnosis. However, rare disorders may not be recognized in the acute setting. We present our cases with US and CT images to remind radiologists and emergency physicians of these mimickers of acute abdominal pain in order to prevent unnecessary surgeries.

Torsion of lesser omentum: A rare presentation of acute abdomen

Intraperitoneal Focal Fat Infarction is a rare cause of acute abdomen. There are two types, Omental Torsion and Epiploic Appendagitis. We present a case of 19 years old male who presented to ER with severe pain in epigastrium and right iliac fossa. Clinical diagnosis of acute appendicitis was made, but epigastric pain remained unexplained. CT scan was reported as non-significant. Diagnostic Laparoscopy picked lesser omental infarction and acute appendicitis. Patient was successfully managed by Laparoscopic Surgery. Symptoms not explained by a single pathology should be thoroughly investigated. CT Scan is the best investigation. Laparoscopic surgery is an effective and safe approach for small segmental omental torsion.