Idiopathic segmental infarction of the greater omentum diagnosed by unenhanced multidetector-row CT and treated successfully by laparoscopy

Abstract

Idiopathic segmental infarction of the greater omentum is a rare disorder presenting with nonspecific clinical symptoms that may mimic a variety of acute abdominal conditions. We describe the diagnosis and treatment of two patients who had idiopathic infarction of the greater omentum and presented with localized abdominal pain, mimicking acute cholecystitis and acute diverticulitis, respectively. Patients underwent unenhanced multidetector-row computed tomography (CT) examination, which demonstrated the characteristic features of omental infarction, consisting of a heterogeneous density fatty mass, containing hyperattenuating streaks, located in the greater omentum, between the anterior abdominal wall and the colon; a moderate amount of free peritoneal fluid was also present. There were no other pathological abdominal findings. Giving persisting and worsening symptoms, both patients underwent laparoscopy with resection of the necrotic portion of the omentum. Pathology confirmed the preoperative diagnosis. Unenhanced CT allows us to obtain a reliable diagnosis of omental infarction in patients with acute abdominal pain and may help in selecting the appropriate medical or surgical therapy.

Idiopathic Segmental Infarction of the Greater Omentum

“…Unenhanced CT features of omental infarction consist of a heterogeneous density fatty mass containing hyperattenuating streaks located in the greater omentum between the anterior abdominal wall and the colon. Free peritoneal fluid may also be seen [6]. A classic finding at laparotomy is sanguineous/ serosanguineous peritoneal fluid which was also seen in our case.…”

“…The index case is unusual in that the patient was young and non-obese. The condition commonly mimics acute appendicitis, cholecystitis [3] or diverticulitis [6]. Segmental omental infarction should be considered in the differential diagnosis of acute abdomen especially when the presentation is atypical and all other causes have been excluded [7].…”

Omental Infarction: Case Series and Review of the Literature

“…For this reason, abdominal pain can develop at different sites according to the site of omental infarction. It should be differentiated from cholecystitis, appendicitis, diverticulitis, epiploic appendagitis, and gynecological problems, based on the occurrence site of abdominal pain (1). We report 4 patients with omental infarction who presented to the Emergency Department (ED) with various clinical symptoms.…”

Laparoscopic omentectomy for preoperative diagnosis of torsion of the greater omentum

“…The advantages of the use of laparoscopy include the following: (1) complete examination of the abdominal cavity under visualization to confirm the diagnosis; (2) facilitation of aspiration and washing of the peritoneum; and (3) minimization of surgical invasiveness, postoperative pain, and complications related to the laparotomy wound. 15 …”

“…14 When the diagnosis is not made preoperatively, laparoscopy is useful for the diagnosis, as well as treatment. 15 The specimen might easily be removed because of the flexibility of the omentum, allowing it to adapt to the hole of a 12-mm trocar, although the incision can be extended if required. The advantages of the use of laparoscopy include the following: (1) complete examination of the abdominal cavity under visualization to confirm the diagnosis; (2) facilitation of aspiration and washing of the peritoneum; and (3) minimization of surgical invasiveness, postoperative pain, and complications related to the laparotomy wound.…”