[Pictorial essay. Infarction of the greater omentum: can US and CT findings help to avoid surgery?]

Abstract

Infarction with or without torsion of the greater omentum is an uncommon but well recognised acute abdominal condition which was seldom diagnosed preoperatively before the widespread clinical use of US and CT. The aetiology is unknown and speculative. In most cases the pathology is right sided and clinical presentation consists of an acute or subacute flank pain with mild peritonism usually evoking appendicitis or cholecystitis. Recently, US and CT have proved to provide sufficiently typical, consistent and well-recognizable features to avoid unnecessary surgery. We report on six typical -five right sided and one left sided- cases investigated with CT and US. Two patients underwent surgical treatment, one because the usually spontaneous regression of the entity was ignored and the other because of extremely severe clinical symptoms. In the other four patients, conservative medical management was preferred and successful. Even though US may be efficient if performed by a well-trained echographist, CT appears to be the procedure of choice as it is operator independent and reliable for excluding mimicking surgical conditions or associated pathology.