This patient had a medical history of gastric carcinoma and refused treatment, he arrived at the emergency room with abdominal pain and bloating. After a physical examination a distended abdomen was noticed with tenderness, pain and rigidity when palpating. A complete abdominal CT scan was performed, demonstrating the omental cake sign.

The omentum is a predominantly fat-containing intra-abdominal structure, its inherent contrast on CT makes inflammatory, infectious, and neoplastic processes more apparent.

This sign is called ¨omental cake¨ due to the appearance of the contiguous omental mass simulating the top of a cake.

Depending on the cause of the omental cake and the extent of intraperitoneal disease, ascites may be an accompanying feature. Thick caking is an indicator of advanced stage of any disease.