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Omental Infarction: A Rare Cause of Acute Abdominal Pain FREE TO VIEW

Shanchiya Ravindradas, MD; Gbolahan Ogunbayo, MD; Suresh Kulandhaisamy, MD
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Rochester General Health System, Rochester, NY

Chest. 2015;148(4_MeetingAbstracts):517A. doi:10.1378/chest.2260355
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SESSION TITLE: Imaging Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Acute abdomen is a common cause of morbidity and mortality. Differential diagnoses of acute abdominal pain are well described in literature. Despite this, one in nine patients with acute abdominal pain undergo unnecessary emergency laparotomy. We present a rare cause of acute abdomen whose prompt diagnosis precluded surgical intervention.¹

CASE PRESENTATION: A 53 year- old man with a history of pancreatitis presented with a three-day history of worsening right-sided abdominal pain with associated nausea and non-bilious vomiting. The pain was non-radiating and severely debilitating. It was worse with respiration with no relieving factors. The pain was not related to food. He denied weight loss, change in bowel habits, recent travel or sick contacts. On examination, he was in distress, tachycardic, pale and clammy. His abdomen was distended and tender to superficial palpation with guarding and rebound tenderness in the right upper quadrant. Bowel sounds were hypoactive. Laboratory tests revealed leukocytsis of 12,600/L and acute kidney injury with a creatinine of 1.2mg/dL. Lactate, lipase, amylase, liver enzymes as well as hepatitis panel were all normal. A computerized tomography (CT) scan of his abdomen revealed a 19X8X6cm portion of the omentum in the right upper quadrant with surrounding inflammatory change and reactive bowel wall thickening supporting the diagnosis of an omental infarct. The patient was managed conservatively with bowel rest, analgesia and fluid resuscitation. His symptoms resolved and he was discharged two days later.

DISCUSSION: Omental infarction is a rare cause of acute abdomen with an incidence of 0.0016-0.37%.² Its low incidence leads to frequent misdiagnosis, a lapse that is offset by a relatively uneventful course and uncomplicated recovery, but which may increase morbidity if misdiagnosed as a surgical abdomen. As in our patient, a CT scan is the most sensitive and specific test to diagnose omental infarction. The mainstay of treatment is conservative except in complicated cases where surgery is needed.³ The condition is self-limiting and usually resolves within 14 days.

CONCLUSIONS: Omental infarction usually presents as acute onset of right-sided pain. CT abdomen is the diagnostic test of choice. Treatment is conservative management or surgery in complicated cases. Acute omental infarction is rare and thus can be missed if not thought about.

Reference #1: 1. Itenberg E., Mariadason J., Khersonsky J., Wallack M. Modern management of omental torsion and omental infarction: a surgeon's perspective. J Surg Educ. 2010;67(January-February (1):44-47.

Reference #2: 2. Battaglia L., Belli F., Vannelli A., Bonfanti G., Gallino G., Poiasina E. Simultaneous idiopathic segmental infarction of the great omentum and acute appendicitis: a rare association. World J Emerg Surg.2008;3(October):30.

Reference #3: 3. Singh A.K., Gervais D.A., Lee P., Westra S., Hahn P.F., Novelline R.A. Omental infarct: CT imaging features. Abdom Imaging. 2006;31(September-October (5)):549-554.

DISCLOSURE: The following authors have nothing to disclose: Shanchiya Ravindradas, Gbolahan Ogunbayo, Suresh Kulandhaisamy

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