Maria Dimitrief, Dr1, Floryn Cherbanyk1, Hon Lai Chan1, A. Stanescu2, Daniel Roulet1, Edgardo Pezzetta1, Olivier Martinet1. 1Department of General Surgery, Riviera-Chablais Hospital, 1820 Montreux-Switzerland, 2Department of General Surgery, HFR Fribourg, 1700 Switzerland
Introduction: Idiopathic segmental infarction of the greater omentum (ISIGO) is a rare cause of acute abdomen. Patients, typically males in their fifties, present with abdominal pain located in the right quadrants, mimicking acute cholecystitis, appendicitis or gynaecological pathological conditions in females. Before the liberal use of the CT, the diagnosis was made mostly intra operatively. Actually, the conservative treatment is widely proposed unless atypical radiologic findings, failure of the medical management or unstable patient.
Case Report: 30 yo male presented in the emergency department with right para umbilical region and right iliac fossa (RIF) pain since 6 days, chills and anorexia. He was apyretic and had normal blood pressure and heart rate. The physical examination revealed tenderness and rebound in the RIF and right flank. Blood tests showed CRP 57mg/l and normal WBC count. The US examination: intra-peritoneal fluid in the RIF without visible caecal appendix. The CT scan confirmed the presence of intra-abdominal fluid in the RIF, a slightly enlarged appendix and an inflammatory mass located in the right para umbilical region, corresponding probably to an ISIGO. In these conditions, an emergency laparoscopy was undertaken for diagnostic confirmation. Bloody ascites was found with a normal appendix and a typical segmental necrosis of the right part of the omentum. We performed laparoscopic omental resection and appendectomy. The patient was discharged on post-operative day 1. The pathological examination of the specimens confirmed the diagnosis. The patient’s recovery was uneventful.
Conclusion: The management of the ISIGO is usually non-operative. Failed conservative treatment, worsening (deteriorating) condition or unclear imaging findings prompt laparoscopic abdominal exploration. Bloody ascites and segmental necrosis of the omentum are typically found. Treatment consists in the removal of the diseased omentum. The laparoscopy proved to be a diagnostic and therapeutic tool. The minimal invasive surgery offers substantial advantages compared to laparotomy, as: shorter hospital stay, reduced pain medication, lower rates of postoperative complications, less onerous and greater patient satisfaction
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80149
Program Number: P140
Presentation Session: Poster (Non CME)
Presentation Type: Poster
