Omental infarction

Omental Infarction

Omental infarction is a rare cause of acute abdomen, characterized by the ischemic necrosis of the omentum. It can mimic other conditions such as acute appendicitis or cholecystitis, making its diagnosis challenging. The omentum, a large apron-like fold of visceral peritoneum that hangs down from the stomach, plays a role in immune responses and fat storage. Omental infarction can occur due to various reasons, including vascular anomalies, torsion, or less commonly, secondary to hypercoagulable states.

Etiology

The exact cause of omental infarction is not always clear, but it is often associated with torsion of the omentum, which can be primary or secondary. Primary torsion occurs without an apparent cause, while secondary torsion is associated with underlying pathology such as cysts, tumors, or hernias. Other risk factors include obesity, sudden increase in intra-abdominal pressure, and trauma.

Symptoms and Diagnosis

Patients with omental infarction typically present with acute onset of abdominal pain, which can be localized to the right or left lower quadrant, mimicking appendicitis or diverticulitis, respectively. The pain is usually constant and may be accompanied by nausea or vomiting. Physical examination may reveal localized tenderness and abdominal rigidity.

Diagnosis is primarily based on imaging studies. Ultrasound may show a hyperechoic mass, while computed tomography (CT) scan is more definitive, revealing a whorled mass of fatty tissue with streaking, indicative of omental fat stranding.

Treatment

Treatment of omental infarction has evolved from surgical intervention to conservative management in most cases. Conservative treatment includes analgesia, anti-inflammatory medications, and close observation. Surgery, typically laparoscopy, is reserved for cases where diagnosis is uncertain or when there is suspicion of other intra-abdominal pathologies.

Prognosis

The prognosis for omental infarction is generally good with conservative management. Most patients experience resolution of symptoms within a week, although complete resolution of the infarcted omentum on imaging studies may take longer.

Differential Diagnosis

Omental infarction must be differentiated from other causes of acute abdomen, such as appendicitis, cholecystitis, diverticulitis, and ectopic pregnancy in women. The distinctive imaging features and clinical presentation can aid in the diagnosis.

Prevention

There are no specific measures for the prevention of omental infarction. However, maintaining a healthy weight and avoiding activities that significantly increase intra-abdominal pressure may reduce the risk.

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