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Dias SJT, Gobishangar S, Sureska GM, Vaishnavi T, Priyatharsan K, Theepan JMM. Omental torsion - A mimicker of the acute appendicitis - A case report. Int J Surg Case Rep 2023; 112:108958. [PMID: 37856966 PMCID: PMC10667894 DOI: 10.1016/j.ijscr.2023.108958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Omental torsion is due to the twisting of the omentum along its axis and is observed in young male patients. The first description of omental torsion was first made by Eitel in 1899. CASE PRESENTATION A 35-year-old male presented with right iliac fossa pain, nausea, occasional vomiting and loss of appetite for four days. His clinical and radiological findings were suggestive of acute appendicitis. However, he was diagnosed with greater omental torsion intraoperatively and successfully managed with laparoscopic omentectomy. DISCUSSION Omental torsion is a rare condition with a low incidence. Preoperative diagnosis of omental torsion continues to be a challenge as the symptoms reported in the literature are usually confused with other abdominal pathologies such as appendicitis or cholecystitis etc. Preoperative US or CT scans are mandatory, and these procedures can accurately accomplish the pre-operative diagnosis. In search for the treatment of choice, laparoscopy proved its effectiveness as a diagnostic tool since it allows for confirming the diagnosis, evaluating the severity of the ischemia, and ruling out other surgical pathologies and therapeutic tools. At the same time, the open surgery approach can be described in many cases as being too invasive. CONCLUSION Greater omental torsion should be considered a differential diagnosis in all patients with acute abdominal emergencies.
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Laasri K, Marrakchi S, El yousfi Z, Jerguigue H, Omor Y, Latib R. Omental infarction found incidentally during metastatic workup: A report of 2 cases. Radiol Case Rep 2023; 18:991-995. [PMID: 36684618 PMCID: PMC9849957 DOI: 10.1016/j.radcr.2022.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 01/07/2023] Open
Abstract
Omental infarction is an uncommon cause of acute abdominal pain that can occur in different several locations. We report 2 cases of omental infarction diagnosed at computed tomography (CT) scan performed as part of routine oncological surveillance, one right-sided and the other left sided. This paper illustrates the range of CT scan findings and highlights the important clinical implications of this radiological diagnosis.
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Muacevic A, Adler JR, Al Awa A. Idiopathic Omental Infarction Presenting With Recurrent Abdominal Pain. Cureus 2023; 15:e33796. [PMID: 36819437 PMCID: PMC9927794 DOI: 10.7759/cureus.33796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/16/2023] Open
Abstract
Omental infarction is a rare cause of acute abdominal pain, and its rarity is mainly due to its relatively rich blood supply by multiple collateral vessels. It usually presents with right lower quadrant pain, as left-sided torsion is infrequent and is usually diagnosed intraoperatively. Since omental infarction is frequently diagnosed by CT scan, conservative management should be considered in most patients to avoid subjecting the patients to unnecessary surgical intervention. We present a rare case of idiopathic omental infarction in which the patient was initially radiologically diagnosed with Meckel's diverticulitis but was later found to have omental infarction on diagnostic laparoscopy.
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Diagnostic Value of CT Window Technique for Primary Omentum Infarction. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4173738. [PMID: 36267314 PMCID: PMC9578888 DOI: 10.1155/2022/4173738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/17/2022] [Indexed: 12/05/2022]
Abstract
Objective The diagnostic value of CT window width technique in primary omentum infarction was evaluated by this study. Methods The abdominal CT data of 32 patients with clinically diagnosed abdominal omentum infarction were retrospectively selected and analyzed. The fixed window position was 50 HU, and the window width was 135 HU, 250 HU (abdomen), 350 HU (mediastinum), and 500 HU, respectively. The detection rate of lesions was analyzed and compared. Results Window widths of 135 HU, 250 HU (abdomen), 350 HU (mediastinum), and 500 HU have a detection rate of 12.5% (4 cases), 62.5% (20 cases), 100% (32 cases), 100% (32 cases) for abdominal omental lesions, respectively. However, 500 HU showed worse abdominal bowel and parenchymal organs than 350 HU. Conclusion According to the comprehensive image quality, the ideal window width for diagnosis of primary omentum infarction is 350HU (mediastinal) window width.
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Foula MS, Sharroufna M, Alshammasi ZH, Alothman OS, Almusailh BA, Hassan KA. Non-operative management of primary omental torsion, a case report and literature review. Clin Case Rep 2021; 9:e04474. [PMID: 34295491 PMCID: PMC8283845 DOI: 10.1002/ccr3.4474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/15/2021] [Accepted: 05/24/2021] [Indexed: 11/09/2022] Open
Abstract
Primary omental torsion is a rare cause of acute abdomen especially in obese patients with inconsistent history, examination, and laboratory findings. The liberal use of computed tomography in casualties has increased its preoperative diagnosis. Despite the controversy, the non-operative approach should be attempted as a first line of management while the laparoscopic resection should be only considered after failure of non-operative management.
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Affiliation(s)
- Mohammed S. Foula
- Department of SurgeryKing Fahd University HospitalImam Abdulrahman Bin Faisal UniversityKhobarSaudi Arabia
| | - Mohammed Sharroufna
- Department of SurgeryKing Fahd University HospitalImam Abdulrahman Bin Faisal UniversityKhobarSaudi Arabia
| | | | - Omar S. Alothman
- Department of SurgeryKing Fahd University HospitalImam Abdulrahman Bin Faisal UniversityKhobarSaudi Arabia
| | | | - Khairi A. Hassan
- Department of SurgeryKing Fahd University HospitalImam Abdulrahman Bin Faisal UniversityKhobarSaudi Arabia
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Diab J, Badiani S, Berney CR. Diagnosis and Management of Adult Omental Infarction: 10-Year Case Series. World J Surg 2021; 45:1734-1741. [PMID: 33721073 DOI: 10.1007/s00268-021-06043-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Omental infarction is a rare cause of an acute abdomen with nonspecific signs that can be easily mistaken with other more common intra-abdominal pathologies. The increased use of radiological imaging has brought this diagnosis to attention with respect to management plan. We present the experience of an Australian hospital network with the diagnosis and management of omental infarction to raise awareness of this uncommon pathology. METHODS A retrospective review of medical records of adult patients diagnosed with omental infarction from 2010 to 2020 was conducted across four major hospitals in South Western Sydney. Data relating to clinical presentation, investigations, management and outcomes were obtained. RESULTS Omental infarction was diagnosed in 61 patients (mean 51.1 years, range: 19-76 years old). All patients presented with nonspecific abdominal pain with the most common sites being the right iliac fossa followed by the right upper quadrant, respectively, over an average period of 2.7 days. Computed tomography and/or diagnostic laparoscopy identified omental infarction in all cases. Forty-two patients (68.9%) had successful conservative management, six failed conservative management and 19 patients had emergency laparoscopic omentectomy. The average hospital length of stay was 3.4 days with no significant morbidity or mortality. CONCLUSION Omental infarction generally presents with nonspecific clinical signs often masquerading as other more common abdominal diagnosis like cholecystitis or appendicitis. A trial of conservative management initially coupled with appropriate imaging should be recommended within the first 24-48 h before considering surgical treatment in refractory cases.
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Affiliation(s)
- Jason Diab
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia. .,School of Medicine, University of Sydney, Sydney, Australia. .,School of Medicine, University of Notre Dame, Sydney, Australia.
| | - Sarit Badiani
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Christophe R Berney
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
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7
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Corvino A, Campanino MR, De Rosa N, Corvino F, Gisonni P. Left-sided omental infarction without torsion: report of a case with radiologic-pathologic correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00235-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Esposito F, Ferrara D, Schillirò ML, Grillo A, Diplomatico M, Tomà P. "Tethered Fat Sign": The Sonographic Sign of Omental Infarction. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1105-1110. [PMID: 32035686 DOI: 10.1016/j.ultrasmedbio.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/21/2019] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Francesco Esposito
- Division of Emergency Radiology, "Santobono" Children Hospital, Naples, Italy
| | - Dolores Ferrara
- Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Assunta Grillo
- Department of Radiology, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Mario Diplomatico
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Omental Infarction with Acute Appendicitis in an Overweight Young Female: A Rare Presentation. Case Rep Surg 2019; 2019:8053931. [PMID: 31093415 PMCID: PMC6476035 DOI: 10.1155/2019/8053931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/12/2019] [Accepted: 03/19/2019] [Indexed: 11/21/2022] Open
Abstract
Omental infarction is an uncommon cause of acute abdomen but one that clinically mimics more serious and common causes of acute abdomen like appendicitis and cholecystitis. Historically, it was diagnosed only intraoperatively during surgery for presumed appendicitis or other causes of acute abdomen. But with the increase in the use of imaging, especially abdominal computed tomography (CT) scan in the work-up for acute abdomen, more cases of omental infarction are being diagnosed preoperatively. This has also led to the observation that omental infarction is a self-limiting condition which can be managed conservatively. Currently, conservative management and surgery are the only treatment options for omental infarction with no consensus as to the best treatment modality. Having a patient with both acute appendicitis and omental infarction simultaneously is extremely rare with only two reported cases in the literature thus far. Here, we present a 10-year-old obese female who presented to our hospital with acute abdomen and was found to have acute appendicitis and omental infarction. The patient underwent laparoscopic appendectomy and resection of the infarcted omentum and had uneventful recovery and was discharged on the second postoperative day. In this report, we present a review of current literature on omental infarction and highlight the importance of imaging especially abdominal CT scan in the nonoperative diagnosis and treatment of omental infarction.
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Kataoka J, Nitta T, Ota M, Takashima Y, Yokota Y, Fujii K, Higashino T, Ishibashi T. Laparoscopic omentectomy in primary torsion of the greater omentum: report of a case. Surg Case Rep 2019; 5:76. [PMID: 31073707 PMCID: PMC6509293 DOI: 10.1186/s40792-019-0618-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/02/2019] [Indexed: 01/27/2023] Open
Abstract
Background Torsion of the greater omentum is a rare cause of acute abdominal pain in adults and children. It is very difficult to make a correct diagnosis of torsion clinically because it mimics other acute pathologies; however, the preoperative diagnosis can be easily confirmed with the use of computed tomography (CT). Herein, we report a case of laparoscopic omentectomy for primary torsion of the omentum, which was not improved by conservative treatment. Case presentation A 50-year-old Japanese man presented to our hospital with acute right lower quadrant abdominal pain of a few hours’ duration. Routine blood tests showed a white blood cell count of 8900/mm3, and the C-reactive protein (CRP) level was 8.13 mg/dl. Contrast-enhanced CT scan of the abdomen revealed twisting of the omentum with a local mass of fat density and fluid distributed in a whirling oval-shaped mass pattern at the right flank and iliac fossa. Therefore, the patient was admitted to our hospital based on a diagnosis of omental torsion. The patient was treated with conservative treatment with analgesics, anti-inflammatories, and antibiotics. Although his symptoms were ameliorated, his laboratory and radiological findings worsened. We performed laparoscopic omentectomy 6 days after admission. The resected omentum was 24 cm × 22 cm in size and was twisted and dark red in color, suggesting infarction. Histological analysis revealed that the specimen was ischemic and hemorrhagic omentum, accompanied by inflammatory infiltration. The patient’s postoperative course was uneventful, and he was discharged 9 days later. Conclusion This is a rare case of primary torsion of the greater omentum that was treated successfully with laparoscopic omentectomy. Considering the increase in surgical difficulty due to inflammation from prolonged torsion and the limited efficacy of conservative treatment, we conclude that surgical intervention is warranted as early as possible when torsion of the greater omentum is suspected.
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Affiliation(s)
- Jun Kataoka
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino Habikino-city, Osaka, 583-0872, Japan.
| | - Toshikatsu Nitta
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino Habikino-city, Osaka, 583-0872, Japan
| | - Masato Ota
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino Habikino-city, Osaka, 583-0872, Japan
| | - Yuko Takashima
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino Habikino-city, Osaka, 583-0872, Japan
| | - Yuta Yokota
- Department of Internal Medicine, Gastroenterological Center, Shunjukai Shiroyama Hospital, Osaka, Japan
| | - Kensuke Fujii
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Takeshi Higashino
- Department of Internal Medicine, Gastroenterological Center, Shunjukai Shiroyama Hospital, Osaka, Japan
| | - Takashi Ishibashi
- Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino Habikino-city, Osaka, 583-0872, Japan
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McMillen B, Hekman DP, Nguyen MTT, Grewal D. Idiopathic omental infarction: managed conservatively. BMJ Case Rep 2019; 12:12/3/e226978. [PMID: 30852495 DOI: 10.1136/bcr-2018-226978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 49-year-old woman who presented with acutely worsening episodic abdominal pain. Workup was negative but CT of the abdomen showed right upper quadrant omental fat stranding, suggestive of fat necrosis or infarct. Treatment for the patient was largely supportive with pain management and fluid resuscitation.
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Affiliation(s)
- Brock McMillen
- Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel Paul Hekman
- Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Dennis Grewal
- Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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12
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Nijkamp JLG, Gerretsen SC, Stassen PM. Left-sided omental infarction: a rare cause of abdominal pain, discovered by CT scan. BMJ Case Rep 2018; 2018:bcr-2017-224138. [PMID: 29739764 DOI: 10.1136/bcr-2017-224138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Omental infarction in adults is a rarely occurring phenomenon, with left-sided omental infarction being even more seldom. 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 generally solves the problem. Omental infarction is the result of vascular obstruction and ends in tissue ischaemia. Because of the rich vasculature of the greater omentum, anastomoses reorganise the vascularisation, which explains the mostly benign course of omental infarction. By adding omental infarction to the list of differential diagnoses in patients who present with acute abdominal pain, future management of patients with an acute abdomen can be adjusted for the optimal approach to not overlook any surgery-requiring diagnosis as well as to prevent overtreatment.
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Affiliation(s)
- Jamie L G Nijkamp
- Internal Medicine, Maastricht Universitair Medisch Centrum+ Interne Geneeskunde, Maastricht, The Netherlands
| | - Suzanne C Gerretsen
- Radiology, Maastricht Universitair Medisch Centrum +, Maastricht, The Netherlands
| | - Patricia M Stassen
- Internal Medicine, Maastricht Universitair Medisch Centrum+ Interne Geneeskunde, Maastricht, The Netherlands
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Abstract
A 58-year-old female presented to the emergency department with intermittent right upper quadrant pain and nausea. 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. A computed tomography (CT) scan of the abdomen and pelvis demonstrated fat stranding involving the greater omentum and the right paracolic gutter. The patient was diagnosed with a focal omental infarction and underwent emergency laparoscopic surgery. Intraoperatively, the thickened and infarcted omental segment was dissected off the abdominal wall, liver, and mesocolon and removed through the umbilical port site using an Endo Catch™ (Covidien Ltd, Dublin, Republic of Ireland). This paper presents a rare case of omental infarction and illustrates how it can mimic the classic presentation of acute cholecystitis. The literature around the incidence, pathogenesis, and management of omental infarction is reviewed and presented to the reader.
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Tannoury J, Yaghi C, Gharios J, Abboud B. Omental ischemia. Presse Med 2016; 45:824-828. [PMID: 27614536 DOI: 10.1016/j.lpm.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022] Open
Abstract
Omental ischemia is a rare cause of acute abdomen. Clinical diagnosis is usually difficult because clinical signs and symptoms are similar to other common causes of abdominal pain. The most common differential diagnosis is acute appendicitis. Diagnosis is mainly based on ultrasound, and especially computed tomography scan analysis. There is, at present, no standard treatment modality for omental ischemia. When diagnosed by radiological imaging, omental ischemia can be managed conservatively. We hereby review incidence, etiology, pathology, clinical presentation, differential diagnosis, biological anomalies, radiological features, and treatment options of omental ischemia.
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Affiliation(s)
- Jenny Tannoury
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of Gastroenterology and Hepatology, Beirut, Lebanon
| | - Cesar Yaghi
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of Gastroenterology and Hepatology, Beirut, Lebanon
| | - Joseph Gharios
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of General Surgery, Beirut, Lebanon
| | - Bassam Abboud
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of General Surgery, Beirut, Lebanon.
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15
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Tonerini M, Calcagni F, Lorenzi S, Scalise P, Grigolini A, Bemi P. Omental infarction and its mimics: imaging features of acute abdominal conditions presenting with fat stranding greater than the degree of bowel wall thickening. Emerg Radiol 2015; 22:431-6. [PMID: 25725796 DOI: 10.1007/s10140-015-1302-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/11/2015] [Indexed: 02/07/2023]
Abstract
The segmental omental infarction is a rare self-limited disorder presenting with aspecific clinical symptoms that may mimic several acute abdominal conditions. Therefore, a correct noninvasive diagnosis is important because treatment approaches range from monitoring to surgery. As omental infarction results in an important fat stranding that is much greater than the degree of bowel wall thickening, it suggests a narrower differential diagnosis: appendicitis, diverticulitis, epiploic appendagitis, and mesenteric panniculitis. In this pictorial essay, we point out the importance of imaging in identifying this typical sign allowing alternate diagnoses such as segmental omental infarction that can be conservatively managed.
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Affiliation(s)
- Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Pisa, Italy,
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16
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Litzau M, Lall MD. Idiopathic left upper quadrant omental infarction: diagnosed and managed conservatively in the ED. Am J Emerg Med 2014; 33:741.e1-2. [PMID: 25537141 DOI: 10.1016/j.ajem.2014.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Megan Litzau
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Michelle D Lall
- Department of Emergency Medicine, Emory University School of Medicine
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17
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Silva E, Carvalho AF, Rocha D, Rodrigues AM, Pereira R, Rodrigues AJ, Leão P. Omental whirl associated with bilateral inguinal hernia: a case report. J Med Case Rep 2014; 8:239. [PMID: 24985935 PMCID: PMC4090653 DOI: 10.1186/1752-1947-8-239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/16/2014] [Indexed: 11/14/2022] Open
Abstract
Introduction Torsion of the omentum is a rare cause of abdominal pain. It is clinically similar to common causes of acute surgical abdomen and is often diagnosed during surgery. Inguinal hernia is a common condition but not frequently related with torsion of the omentum. Case presentation A 40-year-old Caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal distension for 2 days. His medical history included an untreated left inguinal hernia in the last year. Computed tomography revealed densification of mesocolon with left omentum “whirl” component and other signs of omental torsion. During an exploratory laparoscopy, a wide twist of his omentum with necrotic alterations that extended to the bilateral inguinal hernial content was observed. Omentectomy and surgical repair of bilateral inguinal hernia were performed. Conclusions Torsion of the omentum is a rare entity and usually presents a diagnostic challenge. The use of abdominal computed tomography can help diagnosing torsion of the omentum preoperatively and, thus, prevents a surgical approach. Nonetheless, some cases of torsion of the omentum require surgical repair. Accordingly, a laparoscopic approach is minimally invasive and efficient in performing omentectomy.
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Affiliation(s)
| | | | | | | | | | | | - Pedro Leão
- General Surgery, Hospital of Braga, 4701-965, Braga, Apartado 2242, Portugal.
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18
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Abstract
Torsion of greater omentum is one of the rare causes of acute abdominal pain. It can be primary or secondary. Primary Omental Torsion (POT) occurs because a mobile, thicken segment of omentum rotates around a proximal fixed point in the absence of any associated or secondary intra-abdominal pathology. Secondary omental torsion is associated with a number of pre-existing conditions most common among them is inguinal hernia, other causes include tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting of omentum along its long axis resulting in impaired blood supply. This rare condition is more predominant in middle-aged males. It clinically mimics acute appendicitis. It should be kept in mind as a differential diagnosis for acute abdomen. Laparoscopy can aid in diagnosis and management but explorative laparotomy is the definitive and therapeutic procedure of choice. However the condition is not life threatening as omentectomy reduces the inflammation and focus of adhesions within the abdomen.
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Affiliation(s)
- Ghosh Y
- Assistant Professor, Department of Surgery, Punjab Institute of Medical Sciences , Jalandhar, India
| | - Arora R
- Assistant Professor, Department of Surgery, Punjab Institute of Medical Sciences , Jalandhar, India
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Idiopathic omental infarction, diagnosed and managed laparoscopically: a case report. Case Rep Surg 2013; 2013:193546. [PMID: 24062963 PMCID: PMC3770034 DOI: 10.1155/2013/193546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 06/11/2013] [Indexed: 11/17/2022] Open
Abstract
Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2°C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5 × 4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6 × 4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.
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Bouilland O, Le Goudeveze S, Barbe O, Moncade F, Ann X. Infarctus du grand épiploon. Presse Med 2012; 41:881-2. [DOI: 10.1016/j.lpm.2011.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 11/30/2022] Open
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Park TU, Oh JH, Chang IT, Lee SJ, Kim SE, Kim CW, Choe JW, Lee KJ. Omental Infarction: Case Series and Review of the Literature. J Emerg Med 2012; 42:149-54. [DOI: 10.1016/j.jemermed.2008.07.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 05/16/2008] [Accepted: 07/12/2008] [Indexed: 11/29/2022]
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Hsu BCH, Chou DA. Primary idiopathic segmental infarction of the greater omentum. FORMOSAN JOURNAL OF SURGERY 2011. [DOI: 10.1016/j.fjs.2011.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Laparoscopic omentectomy for preoperative diagnosis of torsion of the greater omentum. Int J Surg Case Rep 2011; 3:100-2. [PMID: 22288058 DOI: 10.1016/j.ijscr.2011.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 10/11/2011] [Accepted: 11/06/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Torsion of the greater omentum is unusual. In most cases, the preoperative diagnosis was difficult due to the non-specific clinical presentation. PRESENTATION OF CASE We present a case of greater omental torsion in a 28-year-old man with an untreated right inguinal hernia since childhood. Computed tomography (CT) revealed characteristic signs of omental torsion, which was important in making correct diagnosis. We made correct preoperative diagnosis and performed laparoscopic omentecomy. The greater omentum distal to the twisted part was dark red and showed necrotic change. This case was secondary omental torsion associated with a right inguinal hernia. DISCUSSION Omental torsion should always be included in the differential diagnosis of acute abdomen. CONCLUSION CT multi-planar reconstruction (MPR) imaging played a particularly important role in making a precise diagnosis. Laparoscopic approach could be useful in both diagnostic and therapeutic intervention. A successful laparoscopic omentectomy was performed in the present case.
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Omental infarction caused by laparoscopy-assisted gastrectomy for gastric cancer: CT findings. Clin Radiol 2011; 66:966-73. [PMID: 21684534 DOI: 10.1016/j.crad.2011.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 04/05/2011] [Accepted: 05/05/2011] [Indexed: 11/21/2022]
Abstract
AIM To investigate the computed tomography (CT) imaging features of omental infarction in patients who underwent laparoscopy-assisted gastrectomy (LAG) for gastric cancer. MATERIALS AND METHODS A retrospective study was performed on 390 patients who underwent LAG for gastric cancer. Two radiologists evaluated the CT images for the presence of omental infarction. The CT pattern was characterized at initial presentation and the evolutional changes were evaluated. The initial CT appearance of omental infarctions were categorized into the following four types: type 1 (ill-defined, heterogeneous, fat density lesion); type 2 (well-defined fat density lesion with rim enhancement); type 3 (well-defined heterogeneous lesion with fat component); and type 4 (well-defined heterogeneous lesion without a fat component). RESULTS Of the 390 patients involved, nine patients (2.3%; six male and three female with a mean age of 57 years) were diagnosed with omental infarction. Infarctions averaged 4.1 cm (range 2-7.3 cm) in diameter. Among nine patients with omental infarction, two patients had type 1 lesions, two had type 2, two had type 3, and three type 4. All infarctions became smaller and better defined with evolution. In two patients who presented with type 1 lesions on initial CT, each lesion was progressed to type 2 and type 3 on follow-up CT. In two patients with type 3 lesions on initial CT, the lesions changed to type 4 on follow-up CT. CONCLUSION An awareness of the various CT features and evolutional changes in omental infarction after LAG for gastric cancer can help ensure the correct diagnosis and to avoid misdiagnosis for omental implants.
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Andreuccetti J, Ceribelli C, Manto O, Chiaretti M, Negro P, Tuscano D. Primary omental torsion (POT): a review of literature and case report. World J Emerg Surg 2011; 6:6. [PMID: 21269497 PMCID: PMC3038905 DOI: 10.1186/1749-7922-6-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/26/2011] [Indexed: 11/10/2022] Open
Abstract
Eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. Although omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon because it mimics the common causes of acute surgical abdomen. For this reason, in the absence of diagnosed preexisting abdominal pathology, including cysts, tumors, foci of intra-abdominal inflammation, postsurgical wounds or scarring, and hernial sacs, omental torsion still can represent a surprise. Explorative laparotomy represents the diagnostic and definitive therapeutic procedure. Presently laparoscopy is the first choice procedure.
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Affiliation(s)
- Jacopo Andreuccetti
- Department of General Surgery and Organ Transplantation, "Sapienza" Università di Roma, Umberto I Policlinico di Roma, Rome, Italy.
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Schnedl WJ, Krause R, Tafeit E, Tillich M, Lipp RW, Wallner-Liebmann SJ. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol 2011; 8:45-9. [PMID: 21102533 DOI: 10.1038/nrgastro.2010.189] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Epiploic appendagitis is a rare cause of abdominal pain. Diagnosis of epiploic appendagitis, although infrequent, is easily made with CT or ultrasonography in experienced hands. As reported in the literature, most patients with primary epiploic appendagitis are treated conservatively without surgery, with or without anti-inflammatory drugs. A small number of patients are treated with antibiotics and some patients require surgical intervention to ensure therapeutic success. Symptoms of primary epiploic appendagitis usually resolve with or without treatment within a few days. A correct diagnosis of epiploic appendagitis with imaging procedures enables conservative and successful outpatient management of the condition and avoids unnecessary surgical intervention and associated additional health-care costs. Gastroenterologists and all medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions, such as diverticulitis, cholecystitis and appendicitis. This article reviews epiploic appendagitis and includes discussion of clinical findings, pathophysiology, diagnosis and therapeutic possibilities.
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Affiliation(s)
- Wolfgang J Schnedl
- General Practice for General Internal Medicine, Haupstrasse 5, A-8940 Liezen, Austria.
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Conservative management of segmental infarction of the greater omentum: a case report and review of literature. Case Rep Med 2010; 2010. [PMID: 20886031 PMCID: PMC2945678 DOI: 10.1155/2010/765389] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 09/02/2010] [Indexed: 11/18/2022] Open
Abstract
Segmental omental infarction (SOI) is a rare cause of acute abdominal pain. Depending on the site of infarction, it mimics conditions like appendicitis, cholecystitis, and diverticulitis. Before the widespread use of Computed Tomography (CT), the diagnosis was usually made intraoperatively. 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 conservatively after accurate radiological diagnosis.
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Sandhu AS, Rao P, Arora S. Idiopathic Segmental Infarction of the Greater Omentum. Med J Armed Forces India 2009; 65:67-8. [PMID: 27408196 DOI: 10.1016/s0377-1237(09)80061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 08/29/2008] [Indexed: 10/18/2022] Open
Affiliation(s)
- A S Sandhu
- Senior Advisor (Surgery & Urology), Command Hospital (Southern Command), Pune- 411 040
| | - P Rao
- Prof & Head (Department of Surgery) Rural Institute of Medical Science & Research, Saifai, Dist: Etawah, UP- 206 301
| | - S Arora
- Senior Advisor (Pathology), 155 Base Hospital, C/o 99 APO
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