Presentation
Lower abdominal pain.
Patient Data
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 cecum 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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