Omental infarction (OI) is a condition where the greater omentum is subjected to ischemic damage due to interrupted blood flow. It is rare and often characterized by right lower quadrant abdominal pain [1]. One in one thousand laparotomies performed is secondary to acute abdomen arising from OI.

OI can be classified into primary and secondary [2]. In primary disease, the exact pathogenesis is unknown. There is a greater incidence of OI on the right hand side, and literature suggests that the reason lies in abnormal vasculature, stemming from embryonic factors, making it particularly vulnerable to congestion and decreased blood flow [3]. This is often referred to as primary idiopathic segmental OI [4]. In some cases the omentum first twists around itself, which then leads to OI. Conditions that predispose to omental torsion are obesity, adhesions, increased peristalsis, intra abdominal masses, and increased abdominal pressure [5]. Obesity is thought to increase the risk of torsion because of the additional fat tissue that disrupts the arterial blood supply and increases the weight of the omentum [6]. Males are more affected by idiopathic OI than females. OI has been known to occur in children as well, notably those who are obese. Secondary OI results from various medical conditions such as trauma, surgery, vascular disease and hypercoagulable states.

Because of its uncommon occurrence and non specific presentation, OI is frequently misdiagnosed, as clinicians suspect more common causes of acute abdomen, namely appendicitis, acute cholecystitis, peptic ulcer disease and so on [7]. Constitutional symptoms such as fever, as well as gastrointestinal upset (nausea, vomiting, diarrhea) are usually absent. Right sided guarding may be elicited [3].

• Abdominal Mass

  His abdominal CT-scan and MRI showed a 12.5cm omental mass, suggestive of omental infarction with a hemorrhagic component. His gastroscopy and colonoscopy were negative, and the needle biopsy of the mass was not suggestive of malignancy. [websurg.com]

  Conditions that predispose to omental torsion are obesity, adhesions, increased peristalsis, intra abdominal masses, and increased abdominal pressure. [symptoma.com]

  An abdominal mass may be palpable in half of the patients. This right-sided acute pain and rebound tenderness is often mistaken for acute appendicitis. [ispub.com]

  Ultrasound scan shows the omental infarct typically appearing as a hyperechoic, noncompressible, ovoid intra-abdominal mass adherent to the anterior abdominal wall with localized point tenderness. [tropicalgastro.com]

  The typical ultrasound appearance of the infarcted omentum is a hyperechoic, no-compressible, ovoid intra-abdominal mass adherent to the anterior abdominal wall 19. [journals.lww.com]

• Lower Abdominal Pain

  The patients presented with lower abdominal pain, fever, and leukocytosis, and they exhibited a poorly defined heterogeneous low-attenuated mass containing fat in the anterior left lower abdomen. [ncbi.nlm.nih.gov]

  Of the 400 reported cases of OI, only 50 involved paediatric patients, with the majority presenting as right lower quadrant abdominal pain. [jusurgery.com]

  Although an intravenous painkiller and fluid therapy were administered, his right lower quadrant pain worsened. Abdominal radiography showed nonspecific distribution of bowel gas without any sign of bowel obstruction. [synapse.koreamed.org]

  Case presentation A 30-year-old man presented to the emergency department at Riyadh care hospital with lower abdominal pain of two days duration. [ispub.com]

  In the secondary group, four patients presented with mid and lower abdominal pain which differed in character from their postoperative pain, one had a fever and two patients reported a sensation of a lump in the lower abdomen. [saudisurgj.org]

• Abdominal Tenderness

  She had severe generalized abdominal tenderness with rebound tenderness and guarding, mainly on the right lower abdominal quadrant, with all other system examinations normal. [dovepress.com]

  The physical examination revealed marked abdominal tenderness localized to the right lower abdomen. [oatext.com]

  Physical examination showed a slightly overweight patient with a temperature of 37.3 o C with diffuse abdominal tenderness in the right quadrants and an exquisitely painful point in his right flank, with no palpable mass. [em-consulte.com]

• Left Flank Pain

  A 75-year-old woman presented with acute lower abdominal and left flank pain with rebound tenderness. [ncbi.nlm.nih.gov]

• Peritoneal Disease

  Surgery Volume 75, Issue 4 （April 2013） 臨床雑誌外科 75巻4号 （2013年4月） CTで術前診断し腹腔鏡下に手術しえた特発性分節性大網梗塞の1例 御井 保彦 1, 阿部 紘一郎, 宗實 孝, 有川 俊治, 高橋 洋 1 三木市立三木市民病院 外科 キーワード： 梗塞, 術前診断, 腹腔鏡法, 腹膜疾患, 網, 腹部CT Keyword: Infarction, Omentum, Peritoneal Diseases, Laparoscopy pp.404 [webview.isho.jp]

• Murphy's Sign

  On examination, the patient was tender and Murphy’s sign was elicited. A presumptive diagnosis of acute cholecystitis was made but an ultrasound of the abdomen revealed a thin-walled gallbladder without calculi. [cureus.com]

  Murphy’s sign was elicited. His examination was otherwise unremarkable. Urinalysis was normal. Blood tests revealed an elevated white cell count (10.9 × 10 9 /L) and C-reactive protein of 98 mg/L. All other blood tests were normal. [ncbi.nlm.nih.gov]

• Protein S Deficiency

  Omental gangrene and porto-mesenteric thrombosis in a patient of protein C and protein s deficiency. Indian J Surg 2013;75 Suppl 1:409-11. 10. Park KE, Chung DJ, Kim W, Hahn ST, Lee JM. [jmgims.co.in]

• Suggestibility

  Suggestive clinical features and diagnostic workup are addressed. [ncbi.nlm.nih.gov]

  His abdominal CT-scan and MRI showed a 12.5cm omental mass, suggestive of omental infarction with a hemorrhagic component. His gastroscopy and colonoscopy were negative, and the needle biopsy of the mass was not suggestive of malignancy. [websurg.com]

• Microscopic Hematuria

  Routine investigations showed leucocytosis and microscopic hematuria in urinalysis. He was put on antibiotics and analgesics, recovered in 2 days and discharged since he was not willing for surgery. [saudisurgj.org]

As the clinical picture is unreliable in diagnosis, more emphasis has been placed on imaging modalities. Because of their improved availability, accuracy, and thus detection rate, fewer exploratory laparotomies are being done [2] [8]. Furthermore, this may explain the apparent increased incidence of omental infarction, added to more awareness of the condition by physicians [9]. Radiology is thus paramount, as it confirms the diagnosis and influences management.

In primary omental OI, abnormalities are likely to be present in the right lower quadrant, whereas secondary OI mostly appears at the site of the causative injury. The distinction between idiopathic omental infarction, and infarction secondary to torsion can only be definitively made intra-operatively.

Imaging:

• Abdominal ultrasound: This may show a focused hyper-echoic accumulation of fat that is not compressible.
• Computerized tomography (CT): This may show a well demarcated lesion with fat stranding, between the anterior abdominal wall and the bowel [10]. Omental torsion may be indicated by twisted blood vessels, which is known as the swirl sign [8]. The whole lesion may have a hyperdense rim around it. Pelvic and abdominal CT scanning is the imaging modality of choice [11].

• Hemorrhagic Ascites

  Primary omental leiomyosarcoma masquerading as hemorrhagic ascites. Hum Pathol. 1984; 15 :233-237. 9. Wagner JC, Sleggs CA, Marchand P. Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province. [wjgnet.com]

• Fibrinoid Necrosis

  Final pathological examination revealed hemorrhagic infiltrations, thrombosis of the tissue, acute inflammatory cellular infiltrate, and fibrinoid necrosis, and POI was diagnosed [Figure 3]. [onlinejets.org]

You can help by adding to it. ( October 2014 ) Treatment [ edit ] Conservative treatment may include antibiotics, anti-inflammatory medication, and pain medication. [en.wikipedia.org]

All patients received analgesic, anti-inflammatory and antibiotic treatment, which has also been proposed by other authors, 1,2 although antibiotic treatment has been disputed in other cases. 3,4 After clinical improvement, patients were discharged from [elsevier.es]

Diagnosis was confirmed by abdominal CT, and she was successfully managed with conservative treatments including analgesics and prophylactic antibiotics. [ekjm.org]

Surgical intervention, however, may be necessary in order to establish definitive diagnosis and treatment. We present 2 children with SOI diagnosed as acute appendicitis preoperatively. Laparoscopy established the diagnosis and treatment. [ncbi.nlm.nih.gov]

Peritoneal Mesothelioma Prognosis Mesothelioma in all its forms typically has a rather poor prognosis, which can vary based on a variety of factors including the location and stage. [mesotheliomadiagnosis.com]

Ultrasound focal area of increased echogenicity in the omental fat CT focal area of fat stranding swirling of omental vessels in omental torsion hyperdense peripheral halo Treatment and prognosis This condition is often self-limiting and can be managed [radiopaedia.org]

What Is the Prognosis for Peritoneal Mesothelioma? While the prognosis for all forms of mesothelioma is poor, the life expectancy for peritoneal mesothelioma cancer is better than other types of malignant mesothelioma. [mesothelioma.com]

Secondary omental infarction has poor prognosis compared to primary omental infarction due to underlying disease pathology. [jmgims.co.in]

OI is thought to be a self-limiting, benign condition with an excellent prognosis. It may resolve spontaneously and often only requires conservative management. [prognosisapp.com]

Although its etiology remains uncertain, predisposing factors include obesity [Surg. Today 30 (2000) 451], strenuous activity [N. Z. Med. J. 111 (1998) 211], trauma, and idiopathic omental torsion. [ncbi.nlm.nih.gov]

Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction. [pagepress.org]

Postoperative Omental Infarct After Distal Pancreatectomy: Appearance, Etiology Management, and Review of Literature. [jhu.pure.elsevier.com]

[…] imaging techniques and increased awareness among health care providers, more children are being diagnosed with OI earlier in the disease course, preventing misdiagnosis and subsequent complications. 5 It is possible that, combined with changes in the epidemiology [acgcasereports.gi.org]

Cardiology, Angiology (178) Pharmacology (171) Genetics (146) Oncology, Radiation Therapy (143) Gastroenterology and Hepatology (137) Obstetrics, Gynaecology (114) Endocrinology, Metabolism (113) Dermatology (110) Psychiatry, Psychology, Sexology (104) Epidemiology [portal.mefanet.cz]

JBR-BTR. 2002, 85: 193-199. 14. van Breda Vriesman AC, Lohle PN, Coerkamp EG, Puylaert JB: Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol. 1999, 9: 1886-1892. 10.1007/s003300050942. 15. [jmedicalcasereports.biomedcentral.com]

Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. European Radiology. 1999; 9 (9):1886–1892. [ PubMed ] [ Google Scholar ] 32. Karak PK, Millmond SH, Neumann D, Yamase HT, Ramsby G. [ncbi.nlm.nih.gov]

Puylaert, "Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history," European Radiology, vol. 9, no. 9, pp. 1886-1892, 1999. [32] P. K. Karak, S. H. Millmond, D. Neumann, H. T. Yamase, and G. [cyberleninka.org]

Its basic histological findings allow us to understand its pathophysiology. [em-consulte.com]

The most common mode of presentation is pain in the abdomen, with the right lower quadrant being the commonest location.1 The pathophysiology of primary idiopathic segmental omental infarction has been postulated to be secondary to venous idiopathic and [bhj.org.in]

Internal Medicine (534) Paediatrics, Neonatology (442) Pathology and Forensic Medicine (400) Surgery, Traumatology and Orthopaedics (323) Infectology (268) Physiology and Pathophysiology (256) Medical Chemistry and Biochemistry (223) Microbiology (213 [portal.mefanet.cz]

To our knowledge this is the first case in which corrosive ingestion has been the pathophysiological mechanism for the etiology of late omental infarction. [tropicalgastro.com]

Omental infarction Omental infarction has a pathophysiology and clinical presentation similar to that of epiploic appendagitis, with the infarcted fatty tissue being a right-sided segment of the omentum. [radiologyassistant.nl]

The importance of this case report lies in raising awareness of the diagnosis omental infarction as a cause of acute abdomen among doctors who work in the emergency department, in order to prevent unnecessary surgical interventions as conservative treatment [ncbi.nlm.nih.gov]

SOI produces characteristic radiological appearances on CT scan; hence, correct diagnosis using this form of imaging may prevent unnecessary surgery. We present the case of a young woman who was treated… CONTINUE READING [semanticscholar.org]

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