Omental Infarction Imitating Acute Appendicitis

Abstract

A 26-year-old male patient with no significant past history presented with a two-day illness of nausea and abdominal pain, mimicking acute appendicitis. The appendix was poorly visualized on the ultrasound scan so a CT scan was done which revealed infarction of the omentum on the right side of the abdomen. The patient was closely monitored and managed conservatively with analgesics, fluids and antibiotics. Spontaneous improvement occurred in a day, and oral feeding was resumed. The clinical course was uncomplicated, and the patient was discharged, circumventing unnecessary surgery. Literature search has revealed that omental infarction is a rare cause of acute abdomen and it can mimic acute appendicitis or cholecystitis. The treatment needs to be individualized, and surgery may or may not be required.

Omental infarction found incidentally during metastatic workup: A report of 2 cases

“…On a CT scan, omental infarction can be easily differentiated from acute appendicitis [10] and cholecystitis by showing a normal appearing, uninflamed appendix and gallbladder, respectively. CT findings suggestive of diverticulitis that include the visualization of inflamed diverticula, marked bowel wall thickening, and paracolic abscess are usually not found in omentum infarction.…”

“…No definite guidelines exist for management [10] , there are 2 approaches to managing omental infarction: conservative medical treatment and early laparoscopic surgical intervention [ 5 , 6 , 11 ]. Conservative treatment for omental infarction varies among physicians and includes all or part of the following: oral analgesics, anti-inflammatory drugs, and prophylactic antibiotics.…”

Torsion of the omentum: A rare cause of acute abdomen.

“…Treatment of omental torsion in literature is reported as both conservative and surgical. 6,8,15,16,17 Conservative treatment although is only reported in a few cases of acute abdomen without obstruction and should be reserved for unambiguous radiological diagnosis. [16][17] Surgical procedure is the treatment of choice in order to prevent complications.…”