Case study: omental infarction
This article highlights a rare case of acute right upper quadrant abdominal pain because of omental infarction. A 56-year-old female patient presented to the emergency department with a 3-day history of right and epigastric abdominal pain with nausea and vomiting. There were no signs of fever and the patient was stable hemodynamically.
She was referred to the Poison Control Center for suspicion of food poisoning and digestive disorders. The patient’s medical history was not significant for abdominal surgery. Physical examination was significant for abdominal wall reaction in the upper right quadrant. Doctors further advised hematologic tests which showed a white blood cell (WBC) count of 7800/mL and elevated C-reactive protein levels. Other tests were within the normal range. An ultrasound was also done which showed high parenchymal antithesis, which is consistent with renal disease. However, no masses or stones were present in the bile tracts. X-ray and computed tomography were also normal.
Doctors further advised laparoscopic exploration which revealed a small volume of fluid inside the abdomen under the liver
There were no signs of inflammation or perforation inside the stomach or duodenum. The greater omentum was purple and black, consistent with the diagnosis of omental necrosis. Doctors advised a laparoscopic omentectomy and removed a portion of the necrosed greater omentum.
Histopathological examination confirmed necrotic inflammation of the greater omentum. The patient’s condition showed significant improvement after the emergency operation. Whereas her symptoms showed complete resolution at a 3-day follow-up.
Omental infarction is a rare condition with only 200 to 400 cases reported to date. In this condition, the omentum passes downwards and then upwards to the transverse colon. In addition, it drapes over most of the intestine and covers a large area. For this reason, the pain is not localised and may occur in many locations of the abdomen. The disease should be included in the differentials, depending on the location of the pain. Treatment includes antibiotics, painkillers and anti-inflammatories. If the clinical condition worsens, the patient should be referred to surgery. In this case, the patient was treated with treated by laparoscopic omentectomy.
Source: American Journal of Case Reports
