Omental infarct with inguinal hernia

Case contributed by Dr Craig Hacking

Presentation

Lower abdominal pain.

Patient Data

Age: 27
Gender: Male
Modality: CT

A large volume of inflamed stranded intraperitoneal fat extends into the right iliac fossa and into the right inguinal canal, lateral to the inferior epigastric vessels (ie indirect inguinal hernia). This is associated with twisting of the omental vessels which is best appreciated on the axial images. No 'halo sign' evident.

The caecum is normally positioned however appears marginally thick walled and the terminal ileum similarly appears marginally thick walled.

The liver, spleen, pancreas, adrenal glands and kidneys are unremarkable. There is no free gas. There is minimal free fluid.

Conclusion

Appearances are in keeping with omental infarction with an associated fat containing right inguinal hernia.

Case Discussion

Segmental omental infarct is a DDx of misty mesentery.

It just so happens this patient also has an inguinal hernia containing the infarcting / infarcted ometum. Go figure.

Apart from affecting the omentum rather than the small bowel mesentery, absence of the 'halo sign' make mesenteric panniculitis unlikely.

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Case Information

rID: 34714
Case created: 6th Mar 2015
Last edited: 15th Jan 2017
Inclusion in quiz mode: Included

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