Omental infarction (OI) is a condition where the greater omentum is subjected to ischemic damage due to interrupted blood flow. It is rare and often characterized by right lower quadrant abdominal pain [1]. One in one thousand laparotomies performed is secondary to acute abdomen arising from OI.

OI can be classified into primary and secondary [2]. In primary disease, the exact pathogenesis is unknown. There is a greater incidence of OI on the right hand side, and literature suggests that the reason lies in abnormal vasculature, stemming from embryonic factors, making it particularly vulnerable to congestion and decreased blood flow [3]. This is often referred to as primary idiopathic segmental OI [4]. In some cases the omentum first twists around itself, which then leads to OI. Conditions that predispose to omental torsion are obesity, adhesions, increased peristalsis, intra abdominal masses, and increased abdominal pressure [5]. Obesity is thought to increase the risk of torsion because of the additional fat tissue that disrupts the arterial blood supply and increases the weight of the omentum [6]. Males are more affected by idiopathic OI than females. OI has been known to occur in children as well, notably those who are obese. Secondary OI results from various medical conditions such as trauma, surgery, vascular disease and hypercoagulable states.

Because of its uncommon occurrence and non specific presentation, OI is frequently misdiagnosed, as clinicians suspect more common causes of acute abdomen, namely appendicitis, acute cholecystitis, peptic ulcer disease and so on [7]. Constitutional symptoms such as fever, as well as gastrointestinal upset (nausea, vomiting, diarrhea) are usually absent. Right sided guarding may be elicited [3].

As the clinical picture is unreliable in diagnosis, more emphasis has been placed on imaging modalities. Because of their improved availability, accuracy, and thus detection rate, fewer exploratory laparotomies are being done [2] [8]. Furthermore, this may explain the apparent increased incidence of omental infarction, added to more awareness of the condition by physicians [9]. Radiology is thus paramount, as it confirms the diagnosis and influences management.

In primary omental OI, abnormalities are likely to be present in the right lower quadrant, whereas secondary OI mostly appears at the site of the causative injury. The distinction between idiopathic omental infarction, and infarction secondary to torsion can only be definitively made intra-operatively.

Imaging:

• Abdominal ultrasound: This may show a focused hyper-echoic accumulation of fat that is not compressible.
• Computerized tomography (CT): This may show a well demarcated lesion with fat stranding, between the anterior abdominal wall and the bowel [10]. Omental torsion may be indicated by twisted blood vessels, which is known as the swirl sign [8]. The whole lesion may have a hyperdense rim around it. Pelvic and abdominal CT scanning is the imaging modality of choice [11].

Treatment for omental infarction is usually conservative, meaning it often resolves without surgery. Management includes pain relief with analgesics and anti-inflammatory medications. In some cases, if symptoms persist or complications arise, surgical intervention may be necessary to remove the affected tissue.

The prognosis for omental infarction is generally good, especially with early diagnosis and appropriate management. Most patients recover fully with conservative treatment. Complications are rare but can include infection or abscess formation if the infarcted tissue is not resolved.

The exact cause of omental infarction is not always clear. It can occur due to torsion (twisting) of the omentum, which cuts off its blood supply. Other potential causes include trauma, post-surgical changes, or vascular issues that affect blood flow to the omentum.

Omental infarction is a rare condition, with a higher incidence in adults than in children. It is more commonly reported in males and is often seen in individuals with a higher body mass index (BMI). Due to its rarity, it is often underdiagnosed or misdiagnosed.

The pathophysiology of omental infarction involves the interruption of blood flow to the omentum, leading to tissue ischemia and necrosis. This can result from mechanical factors like torsion or from vascular issues that impair blood supply. The resulting inflammation and tissue death cause the characteristic abdominal pain.

There are no specific measures to prevent omental infarction due to its unpredictable nature. Maintaining a healthy weight and managing risk factors for vascular disease may help reduce the risk. Awareness and early recognition of symptoms can aid in prompt diagnosis and treatment.

Omental infarction is a rare but important condition to consider in patients with acute abdominal pain. It mimics other more common abdominal conditions, making diagnosis challenging. A CT scan is essential for accurate diagnosis, and treatment is typically conservative. With appropriate management, the prognosis is excellent.

If you experience sudden, severe abdominal pain, it is important to seek medical attention. Omental infarction is a rare cause of such pain but can be effectively managed with proper diagnosis and treatment. Understanding the symptoms and seeking timely care can lead to a full recovery.

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