Primary omental infarction: a rare cause of acute abdomen

Authors

  • Neeraj Pawar Department of General Surgery, Max Hospital, Delhi
  • Anand Kishore Department of General Surgery, Max Hospital, Delhi

DOI:

https://doi.org/10.18203/2349-2902.isj20202424

Keywords:

POI, TLC, CT, Post-operative day

Abstract

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.

References

Maclean DA. Primary torsion of the omentum in children. J R Coll Surg Edinb. 1977;22:430-2.

Wengert PA, Azizkhan RG. Primary idiopathic segmental infarction of the greater omentum. J Pediatr. 1970;77:459-60.

Park TU, Oh JH, Chang IT, Lee SJ, Kim SE, Kim CW, et al. Omental infarction: case series and review of the literature. J Emerg Med. 2012;42:149-54.

Puylaert JBCM. Right-sided segmental infarction of the omentum: clinical, US, and CT findings. Radiology. 1992;185:169-72.

Bush P. A case of haemorrhage into the greater omentum. Lancet. 1896;147:286.

Eitel GG. Rare omental torsion. NY Med Rec. 1899;55:715-6.

Steyaert H, Valla JS. Laparoscopic approach to primary infarction of the greater omentum. Surg Laparoscopy Endoscopy Percutaneous Techniques. 1997;7(2):97-8.

Lutolf ME, Gebauer SAM, Yee J. Torsion of the greater omentum with infarction: the vascular pedicle sign. Clin Radiology. 2001;56(12):999-1002.

Crofoot DD. Spontaneous segmental infarction of the greater omentum. Am J Surg. 1980;139(2):262-4.

Varjavandi V, Lessin M, Kooros K. Omental infarction risk factors in children. J Pediatr Surg. 2003;38:233-5.

Singh AK, Gervais DA, Lee P. Omental infarct: CT imaging features. Abdom Imaging. 2006;31:549-54.

Jublin BCM, Puylaert. Right sided segmental infarction of the omentum: clinical, US and CT findings. Radiology. 1992;185:169-72.

Khersonsky J, Itenberg E, Mariadason J, Wallack M. Modern management of omental torsion and omental infarction: a surgeon's perspective. J Surg Education. 2010;67(1):44-7.

Danikas D, Theodorou S, Espinel J, Schneider C. Laparoscopic treatment of two patients with omental infarction mimicking acute appendicitis. JSLS. 2001;5(1):73-5.

Randone B, Violi V, Roncoroni L, Sarli L. Laparoscopic diagnosis and treatment of primary torsion of the greater omentum. Surg Laparosc Endosc Percutan Tech. 2008;18(1):102-5.

Downloads

Published

2020-05-26

Issue

Section

Case Reports