Primary omental infarction: a report of a series of cases in an Indian tertiary care hospital

Primary omental infarction is a relatively rare and often presents as right sided abdominal pain. It is often diagnosed as appendicitis and is usually picked up intra-operatively, or - as often seen nowadays - on imaging. We describe a series of four cases of primary omental infarction that presented to us with varying clinical features. Three of them had a short history of right sided abdominal pain, whereas the fourth patient had a longer history of left sided abdominal pain. All 4 were managed operatively, with the fourth having presented with an intra-abdominal abscess that required laparotomy. Primary omental infarction is a diagnosis which must be considered in any case of acute abdomen. Cases diagnosed with certainty on imaging may be managed conservatively but must be followed up closely. Need for surgical intervention should be considered in select cases.

Primary omental torsion – A rare case report

Primary omental torsion occurs when the mobile thickened segment of the omentum rotates around a proximal fixed point in the absence of any association or secondary intra abdominal pathology and is reported rarely in literature. Our patient was a 55 year old postmenopausal woman who presented with acute abdominal pain on the right side for 3 days and was diagnosed to have primary omental torsion.

Simultaneous Omental Infarction and Acute Appendicitis in A Child

It is crucial to realize that both omental infarction and acute appendicitis can occur simultaneously in the children as both diseases are managed differently. Omental infarction itself is rare in the pediatric group, and its association with acute appendicitis is even rarer. Both diseases usually present with right sided abdominal pain. Ultrasound is the choice of imaging modality in the investigation of abdominal pain in the children. It should not be content if omental infarction is detected, whilst the normal appendix is not seen. We reported a case of simultaneous omental infarction and acute appendicitis in a child who presented with 3 days history of right sided abdominal pain. It was diagnosed preoperatively by ultrasound. Prompt surgical intervention was proceeded and the child made uneventful recovery.

Secondary Omental Infarction Related to Open and Laparoscopic-Assisted Distal Gastrectomy: Report of Two Cases

Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

Omental Infarction Following Laparoscopy-assisted Gastrectomy (LAG) for Gastric Cancer

PURPOSE: Omental infarction (OI) following laparoscopy-assisted gastrectomy (LAG) for gastric cancer could become more common in the future because the indications for LAG are expected to expand. The aim of this study was to determine the clinical characteristics of OI following LAG. MATERIALS AND METHODS: Three hundred ninety patients who underwent LAG for T1 or T2 gastric cancer from April 2003 to November 2007 were enrolled. OI was diagnosed by two radiologists using the patients' abdominal 16 row-detector CT scans. The clinicopathologic characteristics were retrospectively evaluated in the omental infarction (OI) group and the non-omental infarction (non-OI) group using the gastric cancer database of Dong-A University Medical Center and the medical records. RESULTS: Nine omental infarctions (2.3%) of 390 LAGs were diagnosed. All the OIs could be discriminated from omental metastasis on the initial or follow up CT images. The location of the omental infarctions was on the epigastrium in 3 patients and in the left upper quadrant in 3 patients. The mean size of the OIs was 4.1 cm. Most patients with OI had no signs or symptoms. The body mass index of the OI group was higher than that of the non-OI group (P=0230), and OI was more common in patients who underwent total gastrectomy than in the patients who underwent subtotal gastrectomy (P=0.0011). CONCLUSION: Laparoscopy-assisted gastrectomy (LAG) with partial omentectomy for gastric cancer can be a cause of secondary OI. Omental infarction after LAG has different clinical characteristics and CT findings that those of other omental infarctions or postoperative omental metastases. Further multicenter study will be needed to evaluate in detail the clinical features of omental infarction after LAG.

Torsión omental: una causa de abdomen agudo / Omental torsion: an acute abdomen etiology

Introducción. La torsión omental es una causa poco común de abdomen agudo que usualmente semeja apendicitis aguda. La mayoría de los casos son diagnosticados durante laparotomía. Puede ser primaria o bien secundaria; la primera se presenta sin evidencia de patología intraabdominal preexistente. Material y métodos. Del primero de enero del 2001 al 31 de diciembre del 2005, se llevó a cabo un estudio descriptivo, observacional, longitudinal y retrospectivo en pacientes con diagnóstico preoperatorio de apendicitis aguda con el objetivo de conocer la incidencia de apendicitis aguda confirmada por anatomopatología y la incidencia de torsión omental. Resultados. Se incluyeron 2,135 pacientes sometidos a cirugía con el diagnóstico preoperatorio de apendicitis aguda de los cuales hubo confirmación histológica posoperatoria en el 91.71% de los casos. Se encontraron 8 casos de torsión omental, para una incidencia del 0.37%, que se diagnosticaron todos transoperatoriamente. Se detectó mayor frecuencia en las primera y cuarta décadas de la vida; el 75% se observó en adultos. El 62.5% de los casos presentó torsión secundaria. Discusión. La torsión omental es una causa poco frecuente de abdomen agudo cuyo principal diagnóstico diferencial es apendicitis aguda. En nuestra serie, encontramos una incidencia de torsión omental dos veces superior a la reportada en la literatura (0.16 contra 0.37), así como una diferencia en cuanto a su distribución por grupos de edad y por sexo.

INTRODUCTION: Omental torsion is an uncommon cause of acute abdomen, usually mimicking acute appendicitis; almost all described cases are diagnosed with laparotomy. It can be a primary or secondary condition. Primary torsion occurs without evidence of intrabdominal abnormalities. MATERIAL AND METHODS: Retrospective, observational, longitudinal, descriptive study carried out between January 2001 and December 2005. Patients diagnosed as acute appendicitis were included and we assessed diagnostic accuracy by means of anatomopathology and omental torsion incidence. RESULTS: 2135 patients were included; diagnostic accuracy was 91.71%. Eight omental torsion cases were identified, with an incidence of 0.37% and all diagnosed with laparotomy. Patients in the first and fourth decades of life were mostly affected; 75% of the cases were observed in adults, and 62.5% displayed secondary torsion. DISCUSION: Omental torsion is a rare cause of acute abdomen. Acute appendicitis is a frequent differential diagnosis that should be taken into account. In our series, we found a two-fold higher incidence of omental torsion, compared with previously reported incidence data. We also found a difference in age and sex distribution among patients with this diagnosis.