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Hassanesfahani M, Tian J, Keating L, Khan N, Louis MA, Malhotra R. Omental infarction following robotic-assisted laparoscopic inguinal hernia repair. J Surg Case Rep 2024; 2024:rjae343. [PMID: 38784200 PMCID: PMC11115987 DOI: 10.1093/jscr/rjae343] [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: 04/18/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Omental infarction (OI) is a rare condition with an overall incidence of less than 0.3%. It can occur spontaneously or can be secondary to trauma, surgery, and inflammation. While previously a diagnosis of exclusion, due to development in imaging technology, OI can now be identified based on CT findings. OI symptoms can mimic an acute abdomen, prompting potentially unnecessary surgical exploration. Treatment options range from conservative management to interventional radiology or surgical resection of the infarcted omentum. We are presenting the first case of OI following robotic-assisted inguinal hernia repair. This case highlights the importance of considering OI in differential diagnoses for patients presenting with acute abdominal pain, the utility of imaging workup in identifying OI, and guidance for conservative treatment approaches to reduce unnecessary surgical intervention.
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Affiliation(s)
- Maryam Hassanesfahani
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Jane Tian
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Luke Keating
- Medisys Health Network, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Noman Khan
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Martine A Louis
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
| | - Rajinder Malhotra
- General Surgery Department, Flushing Hospital Medical Center, Flushing, Queens, NY 11355, United States
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Komatsu K, Nozawa H, Sonoda H, Abe S, Emoto S, Murono K, Sasaki K, Ishihara S. Colectomy, especially right hemicolectomy, is a possible predisposing factor of omental torsion. ANZ J Surg 2023; 93:3006-3007. [PMID: 37641485 DOI: 10.1111/ans.18674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Koichi Komatsu
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinya Abe
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
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Eboreime O, Yorwin G, Ohenhen V. Post-myomectomy omental infarction: a case report. J Med Case Rep 2023; 17:279. [PMID: 37337268 DOI: 10.1186/s13256-023-03924-y] [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: 12/29/2020] [Accepted: 03/28/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Omental Infarction (OI) is uncommon and mimics common causes of acute abdomen. It is important to differentiate it from other abdominal conditions that require emergency management. It was first reported in literature in 1896 and about 400 cases have been reported till date. CASE PRESENTATION We reported on a 41 year-old Para 0+0 Ibo house wife who presented with 10 years history of supra-pubic mass and five months history of excessive menstrual flow. After physical examination, a diagnosis of symptomatic uterine fibroid was made. She had myomectomy and the raw surface created after the excision of the myomas was covered with omentum. Wound infection developed on the 8th post-operative day leading to a wound breakdown and later partial extrusion of infarcted omental tissue through the dehisced wound. During re-exploration, the infarcted omental tissue was extracted and the residual abdominal abscess was drained. Surgical site wound infection occurred on the 3rd day after re-operation and a sub-acute intestinal obstruction developed on the 4th day thereafter which responded to conservative management. CONCLUSION Careful surgical technique is imperative when utilizing the omentum for reconstructive abdominal surgery. Torsion of the omentum and creation of excess tension while using the omentum for reconstructive procedures should be avoided and increase awareness of this uncommon disease condition by the surgeon is also important. This case is to report a rare finding of omental infarction following myomectomy.
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Affiliation(s)
- Ofunre Eboreime
- Igbinedion University Teaching Hospital, Okada, Edo State, Nigeria.
| | - Godwin Yorwin
- Delta State University Teaching Hospital, Oghara, Nigeria
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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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Mitrovic M, Velickovic D, Micev M, Sljukic V, Djuric P, Tadic B, Skrobic O, Djokic Kovac J. Encapsulated Omental Necrosis as an Unexpected Postoperative Finding: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57090865. [PMID: 34577788 PMCID: PMC8470421 DOI: 10.3390/medicina57090865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
Postsurgical fat necrosis is a frequent finding in abdominal cross-sectional imaging. Epiploic appendagitis and omental infarction are a result of torsion or vascular occlusion. Surgery or pancreatitis are conditions that can have a traumatic and ischemic effect on fatty tissue. The imaging appearances may raise concerns for recurrent malignancy, but percutaneous biopsy and diagnostic follow-up assist in the accurate diagnosis of omental infarction. Herein we describe a case of encapsulated omental necrosis temporally related to gastric surgery. Preoperative CT and MRI findings showed the characteristics of encapsulated, postcontrast nonviable tumefaction in the epigastrium without clear imaging features of malignancy. Due to the size of the lesion and the patient’s primary disease, tumor recurrence could not be completely ruled out, and the patient underwent surgery. Histopathological analysis confirmed the diagnosis of steatonecrosis of the omentum.
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Affiliation(s)
- Milica Mitrovic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.); (J.D.K.)
| | - Dejan Velickovic
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia; (D.V.); (V.S.); (O.S.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Marjan Micev
- Department for Pathology, Clinic for Digestive Surgery, Clinical Centre of Serbia, Dr Subotica No. 8, 11000 Belgrade, Serbia;
| | - Vladimir Sljukic
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia; (D.V.); (V.S.); (O.S.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Petar Djuric
- Center for Nephrology, University Hospital Zvezdara, Dimitrija Tucovica No. 161, 11000 Belgrade, Serbia;
| | - Boris Tadic
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
- Department for HBP Surgery, Clinic for Digestive Surgery, Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-62-388-288
| | - Ognjan Skrobic
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia; (D.V.); (V.S.); (O.S.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Jelena Djokic Kovac
- Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.); (J.D.K.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
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Slooter MD, Blok RD, de Krom MA, Buskens CJ, Bemelman WA, Tanis PJ, Hompes R. Optimizing omentoplasty for management of chronic pelvic sepsis by intra-operative fluorescence angiography: a comparative cohort study. Colorectal Dis 2020; 22:2252-2259. [PMID: 32683788 PMCID: PMC7818129 DOI: 10.1111/codi.15276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/09/2020] [Indexed: 12/17/2022]
Abstract
AIM Pelviperineal wound complications frequently occur after salvage surgery for chronic pelvic sepsis despite using an omentoplasty. Sufficient perfusion of the omentoplasty following mobilization is essential for proper healing. This study investigated the impact on short-term clinical outcomes of fluorescence angiography (FA) using indocyanine green for assessment of omental perfusion in patients undergoing salvage surgery. METHOD This was a comparative cohort study including consecutive patients who underwent combined abdominal and transanal minimally invasive salvage surgery with omentoplasty at a national referral centre for chronic pelvic sepsis between December 2014 and August 2019. The historical and interventional cohorts were defined based on the date of introduction of FA in April 2018. The primary outcome was pelviperineal non-healing, defined by the presence of any degree of pelviperineal infection at the final postoperative evaluation. RESULTS Eighty-eight patients underwent salvage surgery with omentoplasty for chronic pelvic sepsis, of whom 52 did not have FA and 36 did have FA. The underlying primary disease was Crohn's disease (n = 50) or rectal cancer (n = 38), with even distribution among the cohorts (P = 0.811). FA led to a change in management in 28/36 (78%) patients. After a median of 89 days, pelviperineal non-healing was observed in 22/52 (42%) patients in the cohort without FA and in 8/36 (22%) patients in the cohort with FA (P = 0.051). Omental necrosis was found during reoperation in 3/52 and 0/36 patients, respectively (P = 0.266). CONCLUSION After introduction of FA to assess perfusion of the omentoplasty, halving of the pelviperineal non-healing rate was observed in patients undergoing salvage surgery for chronic pelvic sepsis.
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Affiliation(s)
- M. D. Slooter
- Department of SurgeryCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - R. D. Blok
- Department of SurgeryCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands,LEXORCentre for Experimental and Molecular MedicineOncode InstituteCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - M. A. de Krom
- Department of SurgeryCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - C. J. Buskens
- Department of SurgeryCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - W. A. Bemelman
- Department of SurgeryCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - P. J. Tanis
- Department of SurgeryCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - R. Hompes
- Department of SurgeryCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
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Medina-Gallardo N, Curbelo-Peña Y, Stickar T, Gardenyes J, Fernández-Planas S, Roura-Poch P, Vallverdú-Cartie H. OMENTAL INFARCTION: SURGICAL or CONSERVATIVE TREATMENT? A CASE REPORTS and CASE SERIES SYSTEMATIC REVIEW. Ann Med Surg (Lond) 2020; 56:186-193. [PMID: 32642061 PMCID: PMC7334794 DOI: 10.1016/j.amsu.2020.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Omental infarction (OI) is an infrequent cause of acute abdominal pain and there is no consensus on whether conservative or surgical treatment is the best strategy when performing positive CT diagnosis. OBJECTIVES To assess which of the two treatments is the most commonly adopted and compare outcomes in terms of success rate in resolution of symptoms and hospital length of stay. ELIGIBILITY CRITERIA Case report and case series of patients with abdominal pain and positive diagnosis by CT of omental infarction. DATA SOURCES PubMed, Science Direct and Google Scholar in combination with cross-referencing searches and manual searches of eligible articles from January 2000 to June 2018. PARTICIPANTS Patients older than 18 years of age. METHODS Patient characteristics and results were summarized descriptively. Categorical variables were assessed by chisquare test or Fischer's exact test, and continuous variables by the Wilcoxon-Mann-Whitney or Kruskal-Wallis test. Risk factors for failure of the conservative management were identified using multivariate logistic regression. RESULTS 90 articles were included in the final analysis (146 patients). 107 patients (73.3%) received conservative treatment with a failure rate of 15.9% (patients needing surgery) and 39 patients (26.7%) received surgery as first treatment. The mean hospital length of stay was 5.1 days for the conservative treatment group and 2.5 days for the surgery group with statistically significant differences (p = 0.00). Younger age and white blood cells count ≥12000/μl were predictive factors of conservative treatment failure. CONCLUSIONS Although conservative treatment is effective in most patients, surgery has advantages in terms of hospital length of stay.
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Affiliation(s)
- N.A. Medina-Gallardo
- Department of General Surgery, Hospital Universitari de Vic - Consorci Hospitalari de Vic, Francesc Pla ‘El Vigatà', 1, 08500, Vic, Spain
| | - Y. Curbelo-Peña
- Department of General Surgery, Hospital Universitari de Vic - Consorci Hospitalari de Vic, Francesc Pla ‘El Vigatà', 1, 08500, Vic, Spain
| | - T. Stickar
- Department of General Surgery, Hospital Universitari de Vic - Consorci Hospitalari de Vic, Francesc Pla ‘El Vigatà', 1, 08500, Vic, Spain
| | - J. Gardenyes
- Department of General Surgery, Hospital Universitari de Vic - Consorci Hospitalari de Vic, Francesc Pla ‘El Vigatà', 1, 08500, Vic, Spain
| | - S. Fernández-Planas
- Department of General Surgery, Hospital Universitari de Vic - Consorci Hospitalari de Vic, Francesc Pla ‘El Vigatà', 1, 08500, Vic, Spain
| | - P. Roura-Poch
- Department of Epidemiology, Hospital Universitari de Vic - Consorci Hospitalari de Vic, Francesc Pla ‘El Vigatà', 1, 08500, Vic, Spain
| | - H. Vallverdú-Cartie
- Department of General Surgery, Hospital Universitari de Vic - Consorci Hospitalari de Vic, Francesc Pla ‘El Vigatà', 1, 08500, Vic, Spain
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Coulier B. Spontaneous and rapid healing of massive symptomatic postoperative right-sided infarction of the greater omentum. Diagn Interv Imaging 2018; 99:339-340. [DOI: 10.1016/j.diii.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
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Javed AA, Bagante F, Hruban RH, Weiss MJ, Makary MA, Hirose K, Cameron JL, Wolfgang CL, Fishman EK. Postoperative Omental Infarct After Distal Pancreatectomy: Appearance, Etiology Management, and Review of Literature. J Gastrointest Surg 2015; 19:2028-37. [PMID: 26302877 DOI: 10.1007/s11605-015-2920-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/10/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The clinico-radiological characteristics and the natural history of postoperative omental infarct (OI) in patients who underwent distal pancreatectomy (DP) and splenectomy have not been defined. MATERIALS AND METHODS Twelve patients who underwent DP over a period of 2 years and were postoperatively diagnosed with OI based on computed tomography (CT) findings were identified. RESULTS A total of 12 patients were diagnosed with an OI based on their postoperative imaging. Seven (58.3 %) patients had previously undergone laparoscopic DP, one (8.3 %) had undergone a robotic DP, and in one (8.3 %), a laparoscopic DP was converted to an open procedure. The remaining three (25.1 %) were treated with open DP. In five (41.6 %) patients, the diagnosis of OI was made during routine follow-up. One patient underwent surgical resection of OI, and two had drains placed in the mass. Nine patients were managed conservatively. During the study period, on review of CT imaging, the minimum prevalence of postoperative OI after DP was found to be 22.8 %. A review of literature identified nine articles that reported a total of 34 patients who were diagnosed with OI after abdominal surgery. CONCLUSION The management of an asymptomatic postoperative OI should be conservative while an early invasive intervention should be performed in patients who are symptomatic or have infected OI.
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Affiliation(s)
- Ammar A Javed
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Fabio Bagante
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
- Department of Surgery, Chirurgia Generale e Epatobiliare, G.B. Rossi University Hospital,, University of Verona, Verona, Italy
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Matthew J Weiss
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Martin A Makary
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Kenzo Hirose
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - John L Cameron
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Christopher L Wolfgang
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Department of Radiology, The Johns Hopkins Hospital, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Chassagnon G, Metrard G, Besse H, Gauvain S. 18F-FDG PET imaging in a patient with late omental infarction after treatment of pancreatic adenocarcinoma. Clin Nucl Med 2014; 39:567-9. [PMID: 24806607 DOI: 10.1097/rlu.0000000000000424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of late omental infarction visualized by F-FDG PET/CT during follow-up for pancreatic adenocarcinoma. The 65-year-old patient was referred for imaging 8 months after pancreaticoduodenectomy and 2 months after completion of a course of chemotherapy. PET/CT showed an FDG-avid omental lesion that suggested peritoneal carcinomatosis. The appearance and evolution at follow-up studies confirmed the diagnosis of omental infarction, a rare complication of pancreatic surgery. This case revealed the possibility of late FDG uptake in omental infarction.
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Affiliation(s)
- Guillaume Chassagnon
- From the Department of Nuclear Medicine, Orléans Hospital Center, Orléans, France
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