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Omental
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Historically, omental infarction was diagnosed only intraoperatively during surgery for presumed appendicitis or other causes of acute abdomen. But with the increase in the use of imaging, especially abdominal computed tomography (CT) scan in the work-up for acute abdomen, more cases of omental infarction are being diagnosed preoperatively. This has also led to the observation that omental infarction is a self-limiting condition which can be managed conservatively. Currently, conservative management and surgery are the only treatment options for omental infarction with no consensus as to the best treatment modality. Having both acute appendicitis and omental infarction is extremely rare with only two cases reported in the literature: one in an adult female and the other in a 7-year-old girl.
infarction
Infarction is tissue death (necrosis) due to inadequate blood supply to the affected area. It may be caused by artery blockages, rupture, mechanical compression, or vasoconstriction. The resulting lesion is referred to as an infarct
(from the ...
, or omental torsion, is an acute vascular
Blood vessels are the structures of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away from ...
disorder which compromises tissue of the greater omentum
The greater omentum (also the great omentum, omentum majus, gastrocolic omentum, epiploon, or, especially in animals, caul) is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It extends from the greater curvature ...
—the largest peritoneal fold in the abdomen
The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the tors ...
.
Signs and symptoms
Patients will present with a sudden onset of cramps/abdominal pain or a 'stitch
Stitch, Stitches or Stitched may refer to:
Medical uses
*Stitch, a surgical suture, a medical device used to hold body tissues together after an injury or surgery
** Cervical cerclage, also known as a cervical stitch
*Husband stitch, a purported ...
'. The pain localises in the area of the umbilicus
Umbilicus may refer to:
*The navel or belly button
*Umbilicus (mollusc), a feature of gastropod, Nautilus and Ammonite shell anatomy
* ''Umbilicus'' (plant), a genus of over ninety species of perennial flowering plants
*Umbilicus urbis Romae
The ...
and can radiate to the lumbar
In tetrapod anatomy, lumbar is an adjective that means ''of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum.''
The lumbar region is sometimes referred to as the lower spine, or as an area of the back i ...
and surrounding regions.
Causes
Omental infarction is a rare cause of acute abdomen pain with reported incidence being less than 4 per 1000 cases of appendicitis. Omental infarction usually presents as right-sided abdominal pain although seldom causing left-sided abdominal pain and even epigastric pain. The dominion of right-sided abdominal pain in omental infarction has been attributed to right segmental infarction as a result of the tenuous blood vessels in this part of the omentum as well as its longer size and higher mobility in comparison to the left side which subjects it to torsion. Obesity is a known risk factor for omental infarction. The theory behind this is that fat accumulation within the omentum occludes blood supply to the distal parts of the omentum in addition to making it more susceptible to torsion. Other risk factors for omental infarction are polycythemia, hypercoagulability, and vasculitides plus other conditions which predispose to torsion such as trauma, sudden body movements, coughing, heavy food intake, and hyperperistalsis. Text was copied from this source, which is available under Creative Commons Attribution 4.0 International License
Historically, omental infarction was diagnosed only intraoperatively during surgery for presumed appendicitis or other causes of acute abdomen. But with the increase in the use of imaging, especially abdominal computed tomography (CT) scan in the work-up for acute abdomen, more cases of omental infarction are being diagnosed preoperatively. This has also led to the observation that omental infarction is a self-limiting condition which can be managed conservatively. Currently, conservative management and surgery are the only treatment options for omental infarction with no consensus as to the best treatment modality. Having both acute appendicitis and omental infarction is extremely rare with only two cases reported in the literature: one in an adult female and the other in a 7-year-old girl.
Diagnosis
The diagnosis is usually inferred from abdominal CT scan which shows a localised inflammatory-appearing mass of omentum .Treatment
Conservative treatment may include antibiotics, anti-inflammatory medication, and pain medication.See also
*Greater omentum
The greater omentum (also the great omentum, omentum majus, gastrocolic omentum, epiploon, or, especially in animals, caul) is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It extends from the greater curvature ...
References
External links
{{Medical resources , DiseasesDB = 12938 , ICD10 = {{ICD10, K, 55, 0 , ICD9 = {{ICD9, 557.0 , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeshID = D015436 Symptoms and signs: Digestive system and abdomen