A Case of Primary Omental Infarction in an Adult Female Presenting as Right Upper Quadrant Pain

Abstract

Background:
Primary omental infarction is a rare cause of abdominal pain that may mimic other disease entities hindering timely management. Only over 400 cases have been documented and as of this writing, there are no published local data.

Clinical Presentation:
A 55-year-old hypertensive Filipino female presented with a five-day history of epigastric pain radiating to the right upper quadrant. Examination revealed direct right upper quadrant tenderness with Murphy’s sign. Work-up revealed leukocytosis and elevated total and indirect bilirubin. Initial impression was acute cholecystitis. Abdominal ultrasound showed normal gallbladder and biliary tree. Inconclusive findings prompted a contrast-enhanced MRI of the upper abdomen with MRCP which showed a well-defined lobulated mass-like lesion with thin rim enhancement in the right upper anterior peritoneal cavity with ascites, inflammatory changes and edema of the overlying subcutaneous fatty layer, indicative of omental infarction or panniculitis.

Management and Outcome:
Exploratory laparotomy with omentectomy was done revealing a concavity between the subcostal area and segments IV/V of the liver where the omentum was trapped. The omentum was hyperemic, thickened with central fat necrosis, and adherent to the anterior abdominal wall, greater omentum and proximal transverse colon. Histopathology revealed fibro-collagenous tissue and adipose tissue with chronic inflammation, hemorrhage and congestion. She was discharged stable after three days.

Recommendations: Awareness of this disease, its mimics and diagnostic strategies are keys to early diagnosis, treatment, and prevention of complications.