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Omental infarction

An 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.

Clinical presentation

Patients may present with 1

  • 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.

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 1.

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

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