Omental infarction is a rare cause of acute abdomen resulting from vascular compromise of the greater omentum.
This condition has a non specific clinical presentation and is usually managed conservatively.
The term along with epiploic appendagitis is grouped under the broader umbrella term intraperitoneal focal fat infarction.
Clinical presentation
Patients may present with :
sudden onset of abdominal pain right lower quadrant pain and tenderness absence of fever and gastrointestinal symptoms encountered in healthy patients, such as marathoners, because of low omental blood flow
Pathology
Primary omental infarction
The classic location of primary omental infraction is in the right lower quadrant. The vascular compromise occurs along the right edge of the greater momentum where the arterial supply is usually tenuous.
Sometimes it is the result from kinking of venous channels in the inferior part of the greater omentum in the pelvis. Occasionally omentum twists on itself resulting in omental torsion leading to both arterial and venous compromise. The omentum may infarct without torsion, this is called as primary idiopathic segmental infarction.
Secondary omental infarction
post surgery
abdominal trauma
omental inflammation
Radiographic features
Primary omental infraction is usually seen in the right lower quadrant. Secondary omental infarction is located at the site of initial insult. It is usually larger than 5 cm, which helps distinguishing it from epiploic appendagitis.
Ultrasound
focal area of increased echogenicity in the omental fat
CT
focal area of fat stranding swirling of omental vessels in omental torsion hyperdense peripheral halo
Treatment and prognosis
This condition is often self limiting and can be managed conservatively. Occasionally complications such as abscess formation occur which require surgery or radiological drainage.
Differential diagnosis
General imaging differential considerations include:
acute appendicitis
diverticulitis
mesenteric panniculiti
sepiploic appendagitis
This condition has a non specific clinical presentation and is usually managed conservatively.
The term along with epiploic appendagitis is grouped under the broader umbrella term intraperitoneal focal fat infarction.
Clinical presentation
Patients may present with :
sudden onset of abdominal pain right lower quadrant pain and tenderness absence of fever and gastrointestinal symptoms encountered in healthy patients, such as marathoners, because of low omental blood flow
Pathology
Primary omental infarction
The classic location of primary omental infraction is in the right lower quadrant. The vascular compromise occurs along the right edge of the greater momentum where the arterial supply is usually tenuous.
Sometimes it is the result from kinking of venous channels in the inferior part of the greater omentum in the pelvis. Occasionally omentum twists on itself resulting in omental torsion leading to both arterial and venous compromise. The omentum may infarct without torsion, this is called as primary idiopathic segmental infarction.
Secondary omental infarction
post surgery
abdominal trauma
omental inflammation
Radiographic features
Primary omental infraction is usually seen in the right lower quadrant. Secondary omental infarction is located at the site of initial insult. It is usually larger than 5 cm, which helps distinguishing it from epiploic appendagitis.
Ultrasound
focal area of increased echogenicity in the omental fat
CT
focal area of fat stranding swirling of omental vessels in omental torsion hyperdense peripheral halo
Treatment and prognosis
This condition is often self limiting and can be managed conservatively. Occasionally complications such as abscess formation occur which require surgery or radiological drainage.
Differential diagnosis
General imaging differential considerations include:
acute appendicitis
diverticulitis
mesenteric panniculiti
sepiploic appendagitis
