Omental cake

Case contributed by Jose Luis Carcamo
Diagnosis certain


Patient has presented medical history of abdominal pain and bloating since the last month.

Patient Data

Age: 55 years
Gender: Male

Bilateral pleural effusion, larger on the left side.

Hypodense ill-defined liver lesions in segments 7 and 8.

Gastric wall thickening at greater curvature.

Presence of abundant fluid in the perihepatic and peri splenic spaces and in the pelvis.

Omentum thickening is seen, which suggests the omental cake sign. 

Case Discussion

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.

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