Omental Infarction: A Rare Cause of Acute Abdomen

Abstract

INTRODUCTION: Omental infarct is a rare cause of acute abdominal pain resulting from vascular compromise of the greater omentum. This condition usually has a nonspecific clinical presentation with right lower quadrant being the most common location and is usually managed conservatively. We present a rare case of idiopathic omental infarct. CASE DESCRIPTION/METHODS: 35-year-old obese caucasian male with past medical history significant for hypertension and GERD presented to the emergency department with chief complaint of right lower quadrant pain which started 3 days ago without any precipitating event. Initial labs were unremarkable with vital signs only significant for elevated blood pressure. CT of the abdomen and pelvis with contrast showed significant inflammation in the right side of the abdomen most likely representing omental infarct. On call general surgeon was consulted who suggested no acute surgical intervention and patient to be managed medically with ciprofloxacin and metronidazole. On call vascular surgeon was consulted; advised there was no immediate need for anticoagulation as there was no evidence of acute vascular issues such as embolization and/or dissection involving the celiac or the superior mesenteric arteries. Following day, the patient improved clinically and was discharged with total of 10 days of antibiotic treatment and to followup outpatient with general surgeon. DISCUSSION: Omental infarct is a rare cause of acute abdominal pain. Clinical presentation includes sudden onset of acute abdominal pain located mostly in the right lower quadrant with tenderness and absence of any other GI symptoms. Omental Infarction can be isolated event or in succession to omental torsion. A diagnosis of primary/idiopathic omental infarct is made when no identifiable etiology is determined. Secondary causes of omental infarction include hypercoagulability, vasculitis, abdominal adhesions, cysts, and tumors. Other contributing factors include obesity, local trauma, heavy food intake, coughing, sudden body movements, laxative use, and hyperperistalsis. CT of the abdomen may show focal area of fat stranding, swirling of omental vessels, omental torsion, and/or hyperdense peripheral halo. The disease is often self-limiting and managed conservatively. Complications such as abscess can occur which may require surgical or radiologicallyguided drainage. (Figure Presented).