Omental Infarction Imitating Acute Appendicitis

Abstract

A 26-year-old male patient with no significant past history presented with a two-day illness of nausea and abdominal pain, mimicking acute appendicitis. The appendix was poorly visualized on the ultrasound scan so a CT scan was done which revealed infarction of the omentum on the right side of the abdomen. The patient was closely monitored and managed conservatively with analgesics, fluids and antibiotics. Spontaneous improvement occurred in a day, and oral feeding was resumed. The clinical course was uncomplicated, and the patient was discharged, circumventing unnecessary surgery. Literature search has revealed that omental infarction is a rare cause of acute abdomen and it can mimic acute appendicitis or cholecystitis. The treatment needs to be individualized, and surgery may or may not be required.

Keywords: acute abdomen; acute appendicitis; omental infarction.

Figure 1. Coronal sections of contrast-enhanced CT scan of the abdomen.

There is an elongated oval-shaped mixed fat and soft tissue density (red arrows) measuring 4.4 × 2.1 × 6.0 cm in the right side of abdomen, signifying omental infarction. The lesion is extending from right iliac fossa to the subhepatic region (yellow arrows).

Figure 2. Axial sections of contrast-enhanced CT scan of the abdomen.

The lesion produced by omental infarction (red arrows) can be seen anterior to the ascending colon (yellow arrows).