Laparoscopic Management of Primary Omental Infarction – 2 Case Reports

A. C Stanescu*, MD, M. Nedelcu**, MD, A. Andreica ***, MD, Gilbert Weill *, MD

* Hopital Saint Jean de Maurienne, France ** Institute Mutualiste Montouris, Paris, France *** Hopital Necker, Paris, France

Introduction : Omental Infarction(OI) is an unusual and infrequently encountered cause of acute abdominal pain and is often mistaken preoperatively for: appendicitis, cholecystitis or similar abdominal emergency. Clinical presentation and imaging findings are atypical and of limited value in the diagnosis. As for other emergency situations, laparoscopy has been shown to be both a diagnostic and a therapeutic tool of this rare pathology.

Methods: We report 2 cases of acute abdomen for which the clinical presentation and US results were relevant for ovarian cyst torsion and cholecystitis, but the intraoperative findings established the final diagnosis of OI.

Results: The first patient is a 27 years old female with 21 week pregnancy who presented with right lower quadrant pain for the last 12 hours, nausea with no fever. Abdominal and intravaginal ultrasound showed a normal intrauterine pregnancy and a right ovarian cystic mass.
The second case, a 70 years old male had a 2-days hystory of worsening right upper quadrant pain. The abdominal US examination revealed an inflamatory mass with high suspicion of acute cholecystitis. Diagnostic laparoscopy was undertaken, the diagnosis of OI confirmed and the diseased omentum resected. Laparoscopic resection of the diseased omentum has been performed. No postoperative morbidity was recorded and the patients were discharged after 24h and respectively 48 h. At 1 month follow up both patients have had an uncomplicated recovery with no recurrence of symptoms.

Conclusions: In the literature the debate for the best management of omental infarction remains with strong support for both nonoperative management and definitive laparoscopic surgery. In our department the laparoscopic omentectomy resulted in prompt resolution of symptoms and rapid discharge of the patients. Inspection of the omentum should be a routine part of exploration in any laparoscopy for suspicion of acute abdomen.

Session: Poster Presentation

Program Number: P548

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