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Moradi B, Hejazian SS, Tahamtan M, Ghorani H, Karami S. Imaging the post-treatment pelvis with gynecologic cancers. Abdom Radiol (NY) 2024; 49:1248-1263. [PMID: 38340181 DOI: 10.1007/s00261-023-04163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 02/12/2024]
Abstract
Gynecological malignancies, such as ovarian cancers, cervical cancers, and endometrial cancers, have a significant global impact. Women with gynecologic malignancies may receive a single or a combination of treatments, including surgery, chemotherapy, and radiation-based therapies. Radiologists utilize various diagnostic imaging modalities to provide the surgeon with relevant information about the diagnosis, prognosis, optimal surgical strategy, and prospective post-treatment imaging. Computerized Tomography (CT) and magnetic resonance imaging (MRI) may be used initially to evaluate and detect post-treatment complications. Although CT is primarily used for staging, MRI is commonly used for a more accurate evaluation of a tumor's size and detection of local invasion. Complications such as hematoma, abscess, inclusion cyst, seroma, tumor thrombosis, anorectovaginal fistula, and gossypiboma may occur after the three primary treatments, and systems such as the genitourinary, gastrointestinal, neurological, and musculoskeletal may be affected. In order to distinguish between early-onset and late-onset complications following gynecological treatment, radiological findings of the most common post-treatment complications will be presented in this review.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Women's Yas Hospital, Tehran, Iran
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Sina Hejazian
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Tahamtan
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Karami
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
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2
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Ghahremani GG. CT and MR imaging of the greater omentum: Pictorial essay. Clin Imaging 2023; 101:22-31. [PMID: 37290177 DOI: 10.1016/j.clinimag.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
The greater omentum is a unique anatomical structure that serves a critical function in the containment of inflammatory and infectious processes within the abdominal cavity. It is also a common site of involvement by metastases, as well as the primary location for various pathologic lesions of clinical significance. Its fibroadipose composition, large size, and position in the most anterior aspect of abdomen allow accurate visualization of the greater omentum on CT and MR images. Careful evaluation of the greater omentum can provide important clues to the diagnosis of the underlying abdominal disorder. The aim of this article is to present the normal appearance of the greater omentum, and the wide spectrum of its pathological features as demonstrated on CT and MRI of the abdomen.
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Affiliation(s)
- Gary G Ghahremani
- Department of Radiology, University of California-San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103, USA.
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3
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Miu K, Yousef M, Siddika A. Omental infarction mimicking acute appendicitis with negative radiological findings. BMJ Case Rep 2023; 16:e254340. [PMID: 36977509 PMCID: PMC10069514 DOI: 10.1136/bcr-2022-254340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
A male in his 30s presented to the emergency department with a 1-day history of supra-umbilical pain migrating to the right iliac fossa. On examination, his abdomen was soft but tender with localised guarding in the right iliac fossa and a positive Rovsing's sign. The patient was admitted under a presumptive diagnosis of acute appendicitis. A CT scan and ultrasound scan of the abdomen and pelvis showed no acute intra-abdominal pathology. He stayed in hospital for 2 days for observation without improvement of symptoms. A diagnostic laparoscopy was therefore performed that revealed an infarcted omentum adherent to the abdominal wall and ascending colon causing congestion of the appendix. The infarcted omentum was resected, and the appendix was removed. The CT images were reviewed by multiple consultant radiologists, but no positive findings were appreciated. This case report demonstrates the potential difficulty in diagnosing omental infarction clinically and radiologically.
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Affiliation(s)
- Kelvin Miu
- General Surgery, Homerton University Hospital, London, UK
| | | | - Arifa Siddika
- General Surgery, Homerton University Hospital, London, UK
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4
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Karaosmanoglu AD, Onder O, Kizilgoz V, Hahn PF, Kantarci M, Ozmen MN, Karcaaltincaba M, Akata D. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings. Abdom Radiol (NY) 2023; 48:2167-2195. [PMID: 36933024 PMCID: PMC10024022 DOI: 10.1007/s00261-023-03877-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Volkan Kizilgoz
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
- Department of Radiology, Atatürk University School of Medicine, 25240, Erzurum, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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5
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Roy A, Mah JJ, Ambikapathi T, Mra A, Hayati F. A challenging case of spontaneous idiopathic omental infarction in a trisomy 21 patient. Ann Med Surg (Lond) 2022; 78:103760. [PMID: 35734697 PMCID: PMC9206908 DOI: 10.1016/j.amsu.2022.103760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Omental infarction (OI) is a rare cause of acute abdominal pain that is often missed out. Due to its non-specific presentation can mimic other commoner conditions such as acute appendicitis, acute diverticulitis, and tuberculosis abdomen. Case presentation We present a 42-year-old gentleman with trisomy 21 presenting right iliac fossa pain. Examination revealed tenderness in the right lower quadrant and blood parameters showed leucocytosis. With an initial impression of acute appendicitis, the patient was subjected to surgery. Intraoperatively, there were abnormalities to the omentum suggestive of OI, resulting in partial omentectomy. Symptom resolution occurred immediately and the patient was discharged early. Conclusion OI is a rare cause of acute abdomen that can mimic other abdominal pathologies. In trisomy 21 patients who present with acute abdomen, thorough assessments including preoperative imaging are advisable. Diagnostic laparoscopy is recommended as OI can be managed via minimally invasive surgery, hence ensuring good surgical outcomes. Omental infarction (OI) is a rare cause of acute abdominal pain that is often misdiagnosed, especially among those who present with right iliac fossa pain. In trisomy 21 patients who present with acute abdomen, thorough assessments including preoperative imaging are advisable. Diagnostic laparoscopy is recommended as OI can be managed via minimally invasive surgery, hence to ensure good surgical outcomes.
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6
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Hofmann P, Barth BK, Bächli AE. An Uncommon Cause of Abdominal Pain: What Is Your Diagnosis? PRAXIS 2022; 111:719-720. [PMID: 36221967 DOI: 10.1024/1661-8157/a003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Patrick Hofmann
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
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7
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Rare cause of postoperative acute abdominal pain: Giant omental infarct later complicated by colonic fistulization. Radiol Case Rep 2021; 17:360-363. [PMID: 34925665 PMCID: PMC8648836 DOI: 10.1016/j.radcr.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
Omental infarction is caused by vascular obstruction with resulting tissue ischemia, representing a rare cause of abdominal pain. It has been described as a rare complication of gastric bypass. It is important to recognize omental infarction and its possible complications as The management is usually conservative with surgery deferred to specific cases. We present the case of a 56-year-old male with a history of gastric adenocarcinoma who underwent esophagogastrectomy with Roux-n-y reconstruction and 3 months later presented with severe persistent abdominal pain, due to a path proven giant omental infarction. Patient later was complicated with a colonic fistula to the omentum.
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8
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Diab J, Badiani S, Berney CR. Diagnosis and Management of Adult Omental Infarction: 10-Year Case Series. World J Surg 2021; 45:1734-1741. [PMID: 33721073 DOI: 10.1007/s00268-021-06043-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Omental infarction is a rare cause of an acute abdomen with nonspecific signs that can be easily mistaken with other more common intra-abdominal pathologies. The increased use of radiological imaging has brought this diagnosis to attention with respect to management plan. We present the experience of an Australian hospital network with the diagnosis and management of omental infarction to raise awareness of this uncommon pathology. METHODS A retrospective review of medical records of adult patients diagnosed with omental infarction from 2010 to 2020 was conducted across four major hospitals in South Western Sydney. Data relating to clinical presentation, investigations, management and outcomes were obtained. RESULTS Omental infarction was diagnosed in 61 patients (mean 51.1 years, range: 19-76 years old). All patients presented with nonspecific abdominal pain with the most common sites being the right iliac fossa followed by the right upper quadrant, respectively, over an average period of 2.7 days. Computed tomography and/or diagnostic laparoscopy identified omental infarction in all cases. Forty-two patients (68.9%) had successful conservative management, six failed conservative management and 19 patients had emergency laparoscopic omentectomy. The average hospital length of stay was 3.4 days with no significant morbidity or mortality. CONCLUSION Omental infarction generally presents with nonspecific clinical signs often masquerading as other more common abdominal diagnosis like cholecystitis or appendicitis. A trial of conservative management initially coupled with appropriate imaging should be recommended within the first 24-48 h before considering surgical treatment in refractory cases.
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Affiliation(s)
- Jason Diab
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia. .,School of Medicine, University of Sydney, Sydney, Australia. .,School of Medicine, University of Notre Dame, Sydney, Australia.
| | - Sarit Badiani
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Christophe R Berney
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
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Idiopathic omental infraction as a cause of acute abdomen: Case report. Int J Surg Case Rep 2021; 80:105321. [PMID: 33500233 PMCID: PMC7982490 DOI: 10.1016/j.ijscr.2020.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022] Open
Abstract
We presented a case of greater omentum infarction mimicking acute appendicitis.
Introduction Idiopathic omental infraction is a rare cause of acute abdominal symptoms that has been known with growing recurrence in the past ten years. It presents as right iliac fossa pain, and it’s sometimes misdiagnosed as acute appendicitis. In this study we present a case Report of idiopathic omental infraction as a cause of acute abdomen. Presentation of case A 25 year old male, presented to the casualty complaing of intermittent worsening pain in the right side of the abdomen, this symptom which mimiced the other commoner causes of acute abdomen. On further investigations he had leukocytosis, high C-reactive protein and ESR levels, A contrast computed tomography suggested acute appendicitis, In due course patient was operated after taking his consent, inside the operation 70 % of the greater omentum was necrotic with a black colour, An omentectomy was performed and he was discharged after two days with good recovery. Conclusion A right side abdominal pain is not only confined to appendeceal diseases, So other disease should be put in consideration.
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10
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Esposito F, Di Serafino M, Mauro A, Mercogliano C, Cocco C, Zenzeri L, Ferrara D, Iacobellis F, Evangelisti M, Ziparo C, Di Nardo G. Not only fat: omental infarction and its mimics in children. Clinical and ultrasound findings: a pictorial review. J Ultrasound 2020; 23:621-629. [PMID: 32623635 PMCID: PMC7588577 DOI: 10.1007/s40477-020-00492-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022] Open
Abstract
Acute abdominal pain in children is the most common cause of emergency department admissions. Omental infarction is a rare cause of acute abdominal pain in this age group, accounting for approximately 15% of cases in children and 0.024-0.1% of cases of surgery for suspected appendicitis at the same age. Its clinical presentation may mimic similar diseases such as acute appendicitis, epiploic appendagitis, and mesenteric panniculitis. Ultrasound is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients and it can be used with confidence in the diagnosis and management of omental infarction in children. In this brief review, we focus on the main ultrasound findings and their diagnostic clue for omental infarction and its mimics.
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Affiliation(s)
- Francesco Esposito
- Department of Emergency Radiology, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy.
| | - Angela Mauro
- Department of Pediatric Emergency, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Carmela Mercogliano
- Department of Pediatric 2nd Unit, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Chiara Cocco
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Letizia Zenzeri
- Department of Pediatric Emergency, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Dolores Ferrara
- Department of Emergency Radiology, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Chiara Ziparo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
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11
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Corvino A, Campanino MR, De Rosa N, Corvino F, Gisonni P. Left-sided omental infarction without torsion: report of a case with radiologic-pathologic correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00235-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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12
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Babu M, Avantsa R. Multidetector Computed Tomography Evaluation of Omental Infarct. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0039-3402631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background Omental infarction is a rare cause of acute pain abdomen and is difficult to diagnose clinically due to nonspecific clinical features. Multidetector computed tomography (MDCT) imaging of the abdomen is essential for the diagnosis of omental infarction and is also crucial to rule out appendicitis and other causes of acute pain abdomen.
Objective The main purpose of this article is to describe the MDCT features of omental infarction in clinching the diagnosis and differentiating it from its clinical mimics.
Methods CT findings of five patients with diagnosed omental infarction were retrospectively reviewed from 2014 to 2019. All patients presented with pain abdomen on the right side of the abdomen with various clinical diagnoses. MDCT was done for diagnosis and features evaluated include size of the lesion, location, relation to colon, and findings that were correlated to clinical presentation and etiology.
Results Age distribution ranged between 36 and 55 years with female predominance. Out of five cases, one was secondary omental infarction due to inguinal hernia causing omental torsion and the other four cases were of unknown etiology. Three cases were managed conservatively and the other two cases were surgically managed. Three lesions were in right iliac fossa and two lesions were in the supraumbilical region on the right side.
Conclusion Omental infarction should be considered important in the differential diagnosis of acute pain abdomen mimicking acute appendicitis and requires CT abdomen to establish diagnosis. Knowledge of typical imaging findings and application for diagnosis are important, as it is a self-limiting disease and can avoid unnecessary surgical interventions.
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Affiliation(s)
- Merin Babu
- Department of Radiodiagnosis, KS Hegde Medical Academy, Nitte deemed to be University, Mangalore, India
| | - Rohini Avantsa
- Department of Radiodiagnosis, KS Hegde Medical Academy, Nitte deemed to be University, Mangalore, India
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13
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Patil AR, Nandikoor S, Jagannath P, Bansal A. Not Just Fat: Imaging in Abdominal Fat Pathology. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1718251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractFat in abdomen has diverse distribution and function. Insult to fat due to several causes can result in infarction or necrosis and present as acute abdomen clinically. Intra-abdominal focal fat infarction is one such condition that comprises of epiploic appendagitis, perigastric appendagitis, omental infarction, and torsion of fatty appendage of falciform ligament that have characteristic imaging features. Secondary causes of fat necrosis include pancreatitis or trauma related. Metabolic or responsive fat changes, like hypertrophy and dystrophy, can be diagnosed on imaging especially on computed tomography. Mesentric fat stranding including the mesentric panniculitis spectrum poses diagnostic dilemma and the causes and imaging role are covered in this review. Some infections and neoplasms that preferably affect abdominal fat compartments may mimic benign conditions, although some have specific patterns of involvement.
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Affiliation(s)
- Aruna R. Patil
- Department of Radiology, Apollo Hospitals, Bengaluru, Karnataka, India
| | | | - Pramod Jagannath
- Department of Gastrointestinal, HPB and Minimal Access Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Amit Bansal
- Department of Gastrointestinal, HPB and Minimal Access Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
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14
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Gaba S, Gaba N, Gupta M. Omental Infarction Imitating Acute Appendicitis. Cureus 2020; 12:e8704. [PMID: 32699700 PMCID: PMC7372225 DOI: 10.7759/cureus.8704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Saurabh Gaba
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Nayana Gaba
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
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15
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Shin CI, Kim SH. Normal and Abnormal Postoperative Imaging Findings after Gastric Oncologic and Bariatric Surgery. Korean J Radiol 2020; 21:793-811. [PMID: 32524781 PMCID: PMC7289697 DOI: 10.3348/kjr.2019.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/10/2020] [Accepted: 02/11/2020] [Indexed: 11/15/2022] Open
Abstract
Surgical resection remains the primary choice of treatment and the only potentially curative option for gastric carcinoma, and is increasingly performed laparoscopically. Gastric resection represents a challenging procedure, with a significant morbidity and non-negligible postoperative mortality. The interpretation of imaging after gastric surgery can be challenging due to significant modifications of the normal anatomy. After the surgery, the familiarity with expected imaging appearances is crucial for diagnosis and appropriate management of potentially life-threatening complications in patients who underwent gastric surgery. We review various surgical techniques used in gastric surgery and describe fluoroscopic and cross-sectional imaging appearances of normal postoperative anatomic changes as well as early and late complications after gastric surgery.
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Affiliation(s)
- Cheong Il Shin
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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16
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Multislice computed tomography evaluation of primary abdominal fat necrosis: a rare cause of acute abdominal pain. Pol J Radiol 2020; 84:e389-e396. [PMID: 31969955 PMCID: PMC6964330 DOI: 10.5114/pjr.2019.89441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Abdominal fat necrosis is a rare cause of abdominal acute pain, classified into primary or secondary according to the cause. Primary fat necrosis includes epiploic appendagitis or idiopathic infarction of the greater omentum. This retrospective study focuses on multislice computed tomography (MSCT) findings and diagnosis of primary abdominal fat necrosis as a cause of acute abdomen. Material and methods This was a retrospective study with 20 patients included, presented to emergency room with acute abdominal pain diagnosed as primary fat necrosis. Retrospective evaluation was made of the patients’ clinical data, presentation, CT studies done at the acute stage, and their primary and final diagnosis. Results Twenty patients (eight male and 12 female, mean age 45 years, age range 20-70 years) diagnosed with abdominal fat necrosis (primary omental infarct) on CT imaging between October 2014 and June 2018 were evaluated. Clinically, five patients were suspected to be cholecystitis¸ eight patients as appendicitis, and four patients as diverticulitis. In addition, three patients had renal colic and were suspected to have ureteric stones; they showed suspected areas of abnormal fat density in non-contrast CT of the urinary tract. Idiopathic omental infarctions were detected in 13 patients on CT; all were on the right side. Laparoscopic excision was done for all. The other seven patients had epiploic appendagitis, seen on the left side, treated with conservative management. Conclusions Primary fat necrosis, although rare, can be presented as acute abdomen. MSCT is the main diagnostic tool for diagnosis of omental infraction and differentiation between other causes of acute abdomen.
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17
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Nijkamp JLG, Gerretsen SC, Stassen PM. Left-sided omental infarction: a rare cause of abdominal pain, discovered by CT scan. BMJ Case Rep 2018; 2018:bcr-2017-224138. [PMID: 29739764 DOI: 10.1136/bcr-2017-224138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Omental infarction in adults is a rarely occurring phenomenon, with left-sided omental infarction being even more seldom. The importance of this case report lies in raising awareness of the diagnosis omental infarction as a cause of acute abdomen among doctors who work in the emergency department, in order to prevent unnecessary surgical interventions as conservative treatment generally solves the problem. Omental infarction is the result of vascular obstruction and ends in tissue ischaemia. Because of the rich vasculature of the greater omentum, anastomoses reorganise the vascularisation, which explains the mostly benign course of omental infarction. By adding omental infarction to the list of differential diagnoses in patients who present with acute abdominal pain, future management of patients with an acute abdomen can be adjusted for the optimal approach to not overlook any surgery-requiring diagnosis as well as to prevent overtreatment.
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Affiliation(s)
- Jamie L G Nijkamp
- Internal Medicine, Maastricht Universitair Medisch Centrum+ Interne Geneeskunde, Maastricht, The Netherlands
| | - Suzanne C Gerretsen
- Radiology, Maastricht Universitair Medisch Centrum +, Maastricht, The Netherlands
| | - Patricia M Stassen
- Internal Medicine, Maastricht Universitair Medisch Centrum+ Interne Geneeskunde, Maastricht, The Netherlands
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18
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Udechukwu NS, D'Souza RS, Abdulkareem A, Shogbesan O. Computed tomography diagnosis of omental infarction presenting as an acute abdomen. Radiol Case Rep 2018; 13:583-585. [PMID: 30008978 PMCID: PMC6043633 DOI: 10.1016/j.radcr.2018.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/11/2018] [Indexed: 11/30/2022] Open
Abstract
Omental infarction is a rare cause of acute abdominal pain. Without the support of radiological evidence, diagnosis is difficult to attain owing to its infrequent incidence, low awareness among clinicians, and its nonspecific presentation that mimics other causes of acute abdomen, namely, acute appendicitis and cholecystitis. Incorrect diagnosis may lead to unnecessary invasive surgery in patients with omental infarction, a disorder that is typically managed conservatively without exposing the patient to intraoperative risks and postoperative morbidity. We report a case of a 61-year-old man who presented to the emergency department with signs of peritonitis. He was eventually diagnosed with omental infarction through computed tomography of the abdomen. He was successfully managed medically with nonsteroidal anti-inflammatory and antiemetic medications, with complete resolution of his symptoms within 2 weeks.
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Affiliation(s)
- Nneka S Udechukwu
- Department of Internal Medicine, Reading Hospital and Medical Center, K-Building, 420 S 5th Ave, Reading, PA 19611, USA
| | - Ryan S D'Souza
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Abdullateef Abdulkareem
- Department of Internal Medicine, Reading Hospital and Medical Center, K-Building, 420 S 5th Ave, Reading, PA 19611, USA
| | - Oluwaseun Shogbesan
- Department of Internal Medicine, Reading Hospital and Medical Center, K-Building, 420 S 5th Ave, Reading, PA 19611, USA
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Alshehri M, Khalifa H, Alqahtani A, Aburahmah M. Secondary Omental Infarction in a Patient with a Hypercoagulable State. BMJ Case Rep 2018; 2018:bcr-2017-223212. [PMID: 29374648 DOI: 10.1136/bcr-2017-223212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Omental infarction is a rare cause of acute and non-specific abdominal pain. We report a case of a 46-year-old man who presented to the emergency room with right upper quadrant cramping pain that was of sudden onset. The patient's presentation was later diagnosed as an omental infarction, by an abdominal CT. After extensive work-up, it was revealed that the cause of the patient's omental infarction was secondary to a hypercoagulable state caused by antiphospholipid syndrome, based on his thrombophilia work-up. The patient was successfully managed conservatively and was started on lifelong anticoagulation. The patient was followed up with an abdominal CT after 2 months into therapy, which showed a decrease in the size of the omental infarction and a significant improvement in his state.
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Affiliation(s)
- Mohammed Alshehri
- Department of Surgery, Alfaisal University College of Medicine, Riyadh, Saudi Arabia.,Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hisham Khalifa
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Department of Surgery, National Cancer Institute (NCI) - Cairo University, Cairo, Egypt
| | - Abdulhadi Alqahtani
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammad Aburahmah
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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20
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Singh A, Mansouri M. Imaging of Acute Colonic Disorders. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Souza RRDM, Faria IM, Luz JHM. Omental Infarction after Transarterial Chemoembolization due to Nontarget Embolization of an Extrahepatic Branch from the Right Hepatic Artery. J Vasc Interv Radiol 2017; 28:1605-1607. [PMID: 29056195 DOI: 10.1016/j.jvir.2017.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/24/2017] [Accepted: 03/08/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Roberto Rômulo de Medeiros Souza
- Department of Interventional Radiology, Radiology Division, Instituto Nacional de Câncer-INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro CEP 20230-130, Brazil
| | - Igor Murad Faria
- Department of Interventional Radiology, Radiology Division, Instituto Nacional de Câncer-INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro CEP 20230-130, Brazil
| | - José Hugo Mendes Luz
- Department of Interventional Radiology, Radiology Division, Instituto Nacional de Câncer-INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro CEP 20230-130, Brazil
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Abstract
Primary omental infarction (POI) is a rare cause of acute abdomen. Most patients have aggravating abdominal pain without gastrointestinal symptoms. Here, we report a case of omental infarction in a 50-year-old woman, who had left abdominal pain and intestinal obstruction. Preoperative computed tomography (CT) of the abdomen showed a left ovarian cyst measuring 6.0 cm × 4.5 cm but otherwise seemed normal initially. The white blood cell count was 9.71 × 109/L, and D-dimer was 1.58 mg/L. Laparoscopic exploration was performed 1 day after admission because of peritonitis and intestinal obstruction. During the exploration, a segment of congested necrotic omentum was found adhering to the abdominal wall with a segment of small intestine. Bloody ascites was also observed in the abdominal cavity. We resected the nonviable segmental omentum, and the ovarian cyst was removed by the gynecologist using laparoscopic procedures. Final pathological findings confirmed POI. While reanalyzing the preoperative CT, a segmental fat mass with an increased density was noted in the left lower quadrant, which was consistent with the intraoperative view 6 days after surgery. The patient recovered uneventfully and was discharged.
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Affiliation(s)
- Xiao-Wen Sun
- Department of General Surgery, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Bin Luo
- Department of General Surgery, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Hong-Wei Lin
- Department of General Surgery, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
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23
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Tannoury J, Yaghi C, Gharios J, Abboud B. Omental ischemia. Presse Med 2016; 45:824-828. [PMID: 27614536 DOI: 10.1016/j.lpm.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022] Open
Abstract
Omental ischemia is a rare cause of acute abdomen. Clinical diagnosis is usually difficult because clinical signs and symptoms are similar to other common causes of abdominal pain. The most common differential diagnosis is acute appendicitis. Diagnosis is mainly based on ultrasound, and especially computed tomography scan analysis. There is, at present, no standard treatment modality for omental ischemia. When diagnosed by radiological imaging, omental ischemia can be managed conservatively. We hereby review incidence, etiology, pathology, clinical presentation, differential diagnosis, biological anomalies, radiological features, and treatment options of omental ischemia.
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Affiliation(s)
- Jenny Tannoury
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of Gastroenterology and Hepatology, Beirut, Lebanon
| | - Cesar Yaghi
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of Gastroenterology and Hepatology, Beirut, Lebanon
| | - Joseph Gharios
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of General Surgery, Beirut, Lebanon
| | - Bassam Abboud
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of General Surgery, Beirut, Lebanon.
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24
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Wongwaisayawan S, Kaewlai R, Dattwyler M, Abujudeh HH, Singh AK. Magnetic Resonance of Pelvic and Gastrointestinal Emergencies. Magn Reson Imaging Clin N Am 2016; 24:419-31. [DOI: 10.1016/j.mric.2015.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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25
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Omental infarct mimicking acute pancreatitis. Indian J Surg 2016; 77:1393-4. [PMID: 27011573 DOI: 10.1007/s12262-013-1028-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022] Open
Abstract
Omental infarction is a rare condition which is being increasingly reported in the literature due to the advancement in imaging techniques and its typical computed tomography appearance. Accurate diagnosis of omental infarct can be made on computed tomography, thereby avoiding exploratory surgery. We report a case of conservatively managed primary omental infarct which was clinically thought to be acute pancreatitis.
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26
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Rusgo A, Carraro MN, Niehaus MT, Reynolds SC, Jacoby JL. An unusual cause of abdominal pain in pregnancy: omental infarction. Am J Emerg Med 2015; 34:1184.e3-4. [PMID: 26704771 DOI: 10.1016/j.ajem.2015.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/07/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Allison Rusgo
- Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PA
| | - Michelle N Carraro
- Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PA
| | - Matthew T Niehaus
- Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PA
| | - Shawn C Reynolds
- Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PA
| | - Jeanne L Jacoby
- Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PA.
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27
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Primary and secondary disease of the peritoneum and mesentery: review of anatomy and imaging features. ACTA ACUST UNITED AC 2015; 40:626-42. [PMID: 25189130 DOI: 10.1007/s00261-014-0232-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The largest and most complex serosal membrane in the body, the peritoneum, lines the abdominal cavity, and the abdominopelvic viscera. It is frequently involved in a variety of benign and malignant processes. While secondary involvement of the peritoneum is more common, primary tumors can be a diagnostic challenge. Knowledge of the anatomy is crucial in understanding the various pathologic processes. Cross-sectional imaging plays an important role in diagnosing and evaluating the extent of the disease processes. This article reviews the imaging anatomy of the peritoneum and mesentery and the common pathologies involving it.
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28
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Abstract
Right lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important imaging findings associated with acute appendicitis as well as major differential considerations including: mesenteric adenitis, Meckel diverticulum, neutropenic colitis, right-sided diverticulitis, epiploic appendagitis, omental infarction, and inflammatory bowel diseaseRight lower quadrant pain is one of the most common indications for imaging evaluation of the abdomen in the emergency department setting. This article reviews important imaging findings associated with acute appendicitis as well as major differential considerations including: mesenteric adenitis, Meckel diverticulum, neutropenic colitis, right-sided diverticulitis, epiploic appendagitis, omental infarction, and inflammatory bowel disease.
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Affiliation(s)
- Neel B Patel
- Jupiter Imaging Associates, Sheridan Healthcorp, Jupiter, FL, USA.
| | - Daniel R Wenzke
- NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, 2650 Ridge Avenue, Evanston, IL 60201, USA
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29
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Robert B, Chivot C, Yzet T. Appendagitis of the lesser omentum - an uncommon cause of acute abdominal pain. Presse Med 2015; 44:954-6. [PMID: 26049915 DOI: 10.1016/j.lpm.2015.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Brice Robert
- University of Picardy, Amiens North hospital, department of digestive radiology, diagnostic imaging, place Victor-Pauchet, 80054 Amiens cedex 01, France.
| | - Cyril Chivot
- University of Picardy, Amiens North hospital, department of digestive radiology, diagnostic imaging, place Victor-Pauchet, 80054 Amiens cedex 01, France
| | - Thierry Yzet
- University of Picardy, Amiens North hospital, department of digestive radiology, diagnostic imaging, place Victor-Pauchet, 80054 Amiens cedex 01, France
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30
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Diagnostic value of multidetector computed tomography in differentiation of benign and malignant omental lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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31
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Omental infarction mimicking cholecystitis. Case Rep Surg 2015; 2015:687584. [PMID: 25737796 PMCID: PMC4337263 DOI: 10.1155/2015/687584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 11/22/2022] Open
Abstract
Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction.
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32
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Sánchez Fuentes PA, López López V, Febrero B, Ramírez P, Parrilla Paricio P. Omental infarction: Surgical or conservative management? Cir Esp 2015; 93:475-7. [PMID: 25649332 DOI: 10.1016/j.ciresp.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/23/2014] [Accepted: 09/07/2014] [Indexed: 11/24/2022]
Affiliation(s)
| | - Víctor López López
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Beatriz Febrero
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Pablo Ramírez
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Pascual Parrilla Paricio
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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33
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Litzau M, Lall MD. Idiopathic left upper quadrant omental infarction: diagnosed and managed conservatively in the ED. Am J Emerg Med 2014; 33:741.e1-2. [PMID: 25537141 DOI: 10.1016/j.ajem.2014.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Megan Litzau
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Michelle D Lall
- Department of Emergency Medicine, Emory University School of Medicine
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34
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Abstract
OBJECTIVE This article will discuss the most common forms of torsion encountered in the emergency department. CONCLUSION Torsion refers to the twisting of an object about its axis and represents the pathophysiologic mechanism underlying an important group of disorders affecting both the bowel and the solid organs of the abdomen and pelvis. Although these disorders typically present with the acute onset of pain, clinical findings are often nonspecific, with imaging playing a key role in diagnosis. Missed or delayed diagnosis may result in complications, such as ischemia; end-organ loss; and, in some cases, death. Therefore, it is critical to have a thorough understanding of the pathophysiology and imaging findings of these entities to avoid the morbidity and mortality associated with a missed or delayed diagnosis.
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35
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Chassagnon G, Metrard G, Besse H, Gauvain S. 18F-FDG PET imaging in a patient with late omental infarction after treatment of pancreatic adenocarcinoma. Clin Nucl Med 2014; 39:567-9. [PMID: 24806607 DOI: 10.1097/rlu.0000000000000424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of late omental infarction visualized by F-FDG PET/CT during follow-up for pancreatic adenocarcinoma. The 65-year-old patient was referred for imaging 8 months after pancreaticoduodenectomy and 2 months after completion of a course of chemotherapy. PET/CT showed an FDG-avid omental lesion that suggested peritoneal carcinomatosis. The appearance and evolution at follow-up studies confirmed the diagnosis of omental infarction, a rare complication of pancreatic surgery. This case revealed the possibility of late FDG uptake in omental infarction.
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Affiliation(s)
- Guillaume Chassagnon
- From the Department of Nuclear Medicine, Orléans Hospital Center, Orléans, France
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36
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Omental infarction complicated by internal hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2013.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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37
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Wang W, Wang ZJ, Webb EM, Westphalen AC, Gross AJ, Yeh BM. Omental infarction preceded by anatomically upturned omentum. Clin Imaging 2013; 37:1125-7. [PMID: 23932388 DOI: 10.1016/j.clinimag.2013.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 11/20/2022]
Abstract
We report the case of a 49-year-old man who presented with acute abdominal pain. Contrast-enhanced computed tomography of the abdomen revealed spontaneous omental torsion with no other noticeable findings. Notably, a computed tomography exam 6 months prior demonstrated the omentum located within the anterior hepatic space, suggesting that the patient had a hypermobile, upturned omentum. To our knowledge, this is the first case report illustrating an anatomically upturned omentum as precursor to omental infarction.
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Affiliation(s)
- Wilbur Wang
- Department of Radiology, University of California San Francisco, Box 0628, M-372, 505 Parnassus Avenue, San Francisco, CA 94143-0628
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39
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Sibileau E, Boulay-Coletta I, Jullès MC, Benadjaoud S, Oberlin O, Zins M. Appendicitis and diverticulitis of the colon: Misleading forms. Diagn Interv Imaging 2013; 94:771-92. [PMID: 23759294 DOI: 10.1016/j.diii.2013.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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40
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High FDG activity in focal fat necrosis: a pitfall in interpretation of posttreatment PET/CT in patients with non-Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2013; 40:1330-6. [DOI: 10.1007/s00259-013-2429-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 04/09/2013] [Indexed: 12/31/2022]
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41
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Imaging of Acute Colonic Disorders. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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42
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Lubner MG, Simard ML, Peterson CM, Bhalla S, Pickhardt PJ, Menias CO. Emergent and Nonemergent Nonbowel Torsion: Spectrum of Imaging and Clinical Findings. Radiographics 2013; 33:155-73. [DOI: 10.1148/rg.331125016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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43
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Aguilar-García J, Alcaide-León P, Vargas-Serrano B. Necrosis grasa intraabdominal. RADIOLOGIA 2012; 54:449-56. [DOI: 10.1016/j.rx.2011.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 12/27/2022]
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44
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Bouilland O, Le Goudeveze S, Barbe O, Moncade F, Ann X. Infarctus du grand épiploon. Presse Med 2012; 41:881-2. [DOI: 10.1016/j.lpm.2011.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 11/30/2022] Open
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45
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Kani KK, Moshiri M, Bhargava P, Kolokythas O. Extrahepatic, Nonneoplastic, Fat-Containing Lesions of the Abdominopelvic Cavity: Spectrum of Lesions, Significance, and Typical Appearance on Multidetector Computed Tomography. Curr Probl Diagn Radiol 2012; 41:56-72. [DOI: 10.1067/j.cpradiol.2011.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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46
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Park TU, Oh JH, Chang IT, Lee SJ, Kim SE, Kim CW, Choe JW, Lee KJ. Omental Infarction: Case Series and Review of the Literature. J Emerg Med 2012; 42:149-54. [DOI: 10.1016/j.jemermed.2008.07.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 05/16/2008] [Accepted: 07/12/2008] [Indexed: 11/29/2022]
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47
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Kerr S, Hyland R, Rowbotham E, Chalmers A. Postoperative omental infarction following colonic resection. Clin Radiol 2012; 67:134-9. [DOI: 10.1016/j.crad.2011.07.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/13/2011] [Accepted: 07/27/2011] [Indexed: 11/26/2022]
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48
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Barai KP, Knight BC. Diagnosis and management of idiopathic omental infarction: A case report. Int J Surg Case Rep 2011; 2:138-40. [PMID: 22096707 DOI: 10.1016/j.ijscr.2011.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 02/21/2011] [Indexed: 10/18/2022] Open
Abstract
A 32 year old man presented to casualty on three occasions in the space of four days, with intermittent, worsening abdominal pain. These symptoms imitated other commoner causes of acute abdomen and the site of onset changed, both factors delaying diagnosis. In due course, computer tomography imaging established findings indicative of omental infarction. Patient was discharged from hospital nine days later, having made a satisfactory recovery following successful conservative treatment. In this report, we evaluate the merits of a similar approach in future instances.
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Affiliation(s)
- Kushal P Barai
- Department of General Surgery, Royal Blackburn Hospital, East Lancashire Hospitals Trust, Blackburn, Lancashire, United Kingdom
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49
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Omental infarction caused by laparoscopy-assisted gastrectomy for gastric cancer: CT findings. Clin Radiol 2011; 66:966-73. [PMID: 21684534 DOI: 10.1016/j.crad.2011.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 04/05/2011] [Accepted: 05/05/2011] [Indexed: 11/21/2022]
Abstract
AIM To investigate the computed tomography (CT) imaging features of omental infarction in patients who underwent laparoscopy-assisted gastrectomy (LAG) for gastric cancer. MATERIALS AND METHODS A retrospective study was performed on 390 patients who underwent LAG for gastric cancer. Two radiologists evaluated the CT images for the presence of omental infarction. The CT pattern was characterized at initial presentation and the evolutional changes were evaluated. The initial CT appearance of omental infarctions were categorized into the following four types: type 1 (ill-defined, heterogeneous, fat density lesion); type 2 (well-defined fat density lesion with rim enhancement); type 3 (well-defined heterogeneous lesion with fat component); and type 4 (well-defined heterogeneous lesion without a fat component). RESULTS Of the 390 patients involved, nine patients (2.3%; six male and three female with a mean age of 57 years) were diagnosed with omental infarction. Infarctions averaged 4.1 cm (range 2-7.3 cm) in diameter. Among nine patients with omental infarction, two patients had type 1 lesions, two had type 2, two had type 3, and three type 4. All infarctions became smaller and better defined with evolution. In two patients who presented with type 1 lesions on initial CT, each lesion was progressed to type 2 and type 3 on follow-up CT. In two patients with type 3 lesions on initial CT, the lesions changed to type 4 on follow-up CT. CONCLUSION An awareness of the various CT features and evolutional changes in omental infarction after LAG for gastric cancer can help ensure the correct diagnosis and to avoid misdiagnosis for omental implants.
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