Focal infarction of the greater omentum

Case contributed by Vikas Shah

Presentation

Known Crohn's disease and paramedian anterior abdominal wall hernia. Severe upper abdominal pain, tender over hernia site. ?incarceration, ?complication of Crohn's disease

Patient Data

Age: 55 years
Gender: Female

Focal area of fat inflammation involving the greater omentum adjacent to the transverse colon. This lies close to the anterior abdominal wall hernia, but the fat within the hernia sac is clean. Some areas of mucosal and submucosal thickening of the large bowel, particularly the transverse colon. No free fluid or free air.

Case Discussion

Focal inflammation of the omentum falls under the general umbrella term of 'intraperitoneal focal fat infarction' (IFFI). Primary omental infarction is usually located along the cecum and proximal ascending colon. It is plausible that the inflammation commenced as a result of omental fat being trapped within the hernia sac, and then reducing back into the abdominal cavity just before imaging (secondary omental infarction). Whilst there are features of mucosal and submucosal abnormalities involving the large bowel, due to Crohn's disease, there is no transmural inflammation and as such, the omental inflammation is not considered to be due to Crohn's disease. The size of the abnormality is larger than that encountered with epiploic appendagitis

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