Omental infarction

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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

-<p>An<strong> omental infarction</strong> is a rare cause of acute abdomen resulting from vascular compromise of the greater <a title="omentum" href="/articles/omentum">omentum</a>. This condition has a non specific clinical presentation and is usually managed conservatively.</p>
~~-<h4>Clinical presentation</h4>~~
~~-<p>Patients may present with <sup>1</sup></p>~~
~~-<ul>~~
~~-<li>sudden onset of abdominal pain</li>~~
~~-<li>right lower quadrant pain and tenderness</li>~~
~~-<li>absence of fever and gastrointestinal symptoms</li>~~
~~-<li>encountered in healthy patients, such as marathoners, because of low omental blood flow</li>~~
~~-</ul><h4>Pathology</h4>~~
~~-<h5>Primary omental infarction</h5>~~
-<p>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.</p>
~~-<h5>Secondary omental infarction</h5>~~
~~-<ul>~~
~~-<li>post surgery</li>~~
~~-<li>abdominal trauma</li>~~
~~-<li>omental inflammation</li>~~
~~-</ul><h4>Radiographic features</h4>~~
-<p>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 <a title="Epiploic appendagitis" href="/articles/epiploic_appendagitis">epiploic appendagitis</a> <sup>1</sup>.</p>
~~-<h5>Ultrasound</h5>~~
~~-<ul><li>focal area of increased echogenicity in the omental fat</li></ul><h5>CT</h5>~~
~~-<ul>~~
~~-<li>focal area of fat stranding</li>~~
~~-<li>swirling of omental vessels in omental torsion</li>~~
~~-<li>hyperdense peripheral halo</li>~~
~~-</ul><h4>Treatment and prognosis</h4>~~
~~-<p>This condition is often self limiting and can be managed conservatively. Occasionally complications such as abscess formation occur which require surgery or radiological drainage.</p>~~
~~-<h4>Differential diagnosis</h4>~~
~~-<p>General imaging differential considerations include</p>~~
~~-<ul>~~
~~-<li><a title="acute appendicitis " href="/articles/acute-appendicitis">acute appendicitis </a></li>~~
~~-<li>~~
~~-<a title="Diverticulitis" href="/articles/diverticulitis">diverticulitis</a> </li>~~
~~-<li><a title="mesenteric panniculitis " href="/articles/sclerosing-mesentritis">mesenteric panniculitis </a></li>~~
~~-<li><a title="Epiploic appendagitis" href="/articles/epiploic_appendagitis">epiploic appendagitis</a></li>~~
+<p>An<strong> omental infarction</strong> is a rare cause of acute abdomen resulting from vascular compromise of the greater <a href="/articles/omentum">omentum</a>. This condition has a non specific clinical presentation and is usually managed conservatively.</p><h4>Clinical presentation</h4><p>Patients may present with <sup>1</sup></p><ul>
+<li>sudden onset of abdominal pain</li>
+<li>right lower quadrant pain and tenderness</li>
+<li>absence of fever and gastrointestinal symptoms</li>
+<li>encountered in healthy patients, such as marathoners, because of low omental blood flow</li>
+</ul><h4>Pathology</h4><h5>Primary omental infarction</h5><p>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.</p><h5>Secondary omental infarction</h5><ul>
+<li>post surgery</li>
+<li>abdominal trauma</li>
+<li>omental inflammation</li>
+</ul><h4>Radiographic features</h4><p>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 <a href="/articles/epiploic-appendagitis">epiploic appendagitis</a> <sup>1</sup>.</p><h5>Ultrasound</h5><ul><li>focal area of increased echogenicity in the omental fat</li></ul><h5>CT</h5><ul>
+<li>focal area of fat stranding</li>
+<li>swirling of omental vessels in omental torsion</li>
+<li>hyperdense peripheral halo</li>
+</ul><h4>Treatment and prognosis</h4><p>This condition is often self limiting and can be managed conservatively. Occasionally complications such as abscess formation occur which require surgery or radiological drainage.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include</p><ul>
+<li><a href="/articles/acute-appendicitis">acute appendicitis </a></li>
+<li>
+<a href="/articles/diverticulitis">diverticulitis</a> </li>
+<li><a href="/articles/sclerosing-mesenteritis-1">mesenteric panniculitis </a></li>
+<li><a href="/articles/epiploic-appendagitis">epiploic appendagitis</a></li>

References changed:

1. Kamaya A, Federle MP, Desser TS. Imaging manifestations of abdominal fat necrosis and its mimics. Radiographics. 31 (7): 2021-34. <a href="http://dx.doi.org/10.1148/rg.317115046">doi:10.1148/rg.317115046</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/22084185">Pubmed citation</a><div class="ref_v2"></div>
2. Singh AK, Gervais DA, Hahn PF et-al. Acute epiploic appendagitis and its mimics. Radiographics. 25 (6): 1521-34. <a href="http://dx.doi.org/10.1148/rg.256055030">doi:10.1148/rg.256055030</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/16284132">Pubmed citation</a><div class="ref_v2"></div>
3. Grattan-Smith JD, Blews DE, Brand T. Omental infarction in pediatric patients: sonographic and CT findings. AJR Am J Roentgenol. 2002;178 (6): 1537-9. <a href="http://dx.doi.org/10.2214/ajr.178.6.1781537">doi:10.2214/ajr.178.6.1781537</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12034634">Pubmed citation</a><span class="ref_v3"></span>
4. Paroz A, Halkic N, Pezzetta E et-al. Idiopathic segmental infarction of the greater omentum: a rare cause of acute abdomen. J. Gastrointest. Surg. 2004;7 (6): 805-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/13129561">Pubmed citation</a><span class="ref_v3"></span>
5. Pereira JM, Sirlin CB, Pinto PS et-al. Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics. 2004;24 (3): 703-15. <a href="http://radiographics.rsna.org/content/24/3/703.full">Radiographics (full text)</a> - <a href="http://dx.doi.org/10.1148/rg.243035084">doi:10.1148/rg.243035084</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/15143223">Pubmed citation</a><span class="ref_v3"></span>
6. van Breda Vriesman AC, Lohle PN, Coerkamp EG et-al. Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol. 2000;9 (9): 1886-92. Pubmed citationvan Breda Vriesman AC, Lohle PN, Coerkamp EG et-al. Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol. 2000;9 (9): 1886-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10602970">Pubmed citation</a><span class="ref_v3"></span>
7. Van Kerkhove F, Coenegrachts K, Steyaert L et-al. Omental infarction in childhood. JBR-BTR. 2006;89 (4): 198-200. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16999321">Pubmed citation</a><span class="ref_v3"></span>
1- Kamaya A, Federle MP, Desser TS. Imaging manifestations of abdominal fat necrosis and its mimics. Radiographics. 31 (7): 2021-34. <a href="http://dx.doi.org/10.1148/rg.317115046">doi:10.1148/rg.317115046</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/22084185">Pubmed citation</a><div class="ref_v2"></div>
2- Singh AK, Gervais DA, Hahn PF et-al. Acute epiploic appendagitis and its mimics. Radiographics. 25 (6): 1521-34. <a href="http://dx.doi.org/10.1148/rg.256055030">doi:10.1148/rg.256055030</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/16284132">Pubmed citation</a><div class="ref_v2"></div>
3- Grattan-Smith JD, Blews DE, Brand T. Omental infarction in pediatric patients: sonographic and CT findings. AJR Am J Roentgenol. 2002;178 (6): 1537-9. <a href="http://dx.doi.org/10.2214/ajr.178.6.1781537">doi:10.2214/ajr.178.6.1781537</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12034634">Pubmed citation</a><span class="ref_v3"></span>
4- Paroz A, Halkic N, Pezzetta E et-al. Idiopathic segmental infarction of the greater omentum: a rare cause of acute abdomen. J. Gastrointest. Surg. 2004;7 (6): 805-8. Pubmed citation
5- Pereira JM, Sirlin CB, Pinto PS et-al. Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics. 2004;24 (3): 703-15. <a href="http://radiographics.rsna.org/content/24/3/703.full">Radiographics (full text)</a> - <a href="http://dx.doi.org/10.1148/rg.243035084">doi:10.1148/rg.243035084</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/15143223">Pubmed citation</a><span class="ref_v3"></span>
6- van Breda Vriesman AC, Lohle PN, Coerkamp EG et-al. Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol. 2000;9 (9): 1886-92. Pubmed citationvan Breda Vriesman AC, Lohle PN, Coerkamp EG et-al. Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol. 2000;9 (9): 1886-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10602970">Pubmed citation</a><span class="ref_v3"></span>
7- Van Kerkhove F, Coenegrachts K, Steyaert L et-al. Omental infarction in childhood. JBR-BTR. 2006;89 (4): 198-200. Pubmed citation