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Omental Infarction and Epiploic Appendagitis
Scott Nguyen MD
Oct 10, 2006
Epiploic Appendagitis
Omental Infarction
• Segment of Omentum succeptible to infarction as a result of torsion or venous thrombosis
• Primary and Secondary
• Predilection for Right Abdomen
Risk Factors for Torsion or Infarction
• OBESITY– Fat accumulation in appendices –
pedunculated nature and mobility increase chances of torsion
– Fat deposition may outgrow the bloody supply predisposing to ischemia
– Heavy exercise and excessive stretching – excess movement of omentum
European Radiology 1999 1886-92
Epiploic Appendigits
J Clinical Ultrasound 2002 30:481-95
Epiploic Appendagitis often misdiagnosed as Diverticulitis
Omental Infarction
• More often found at exploration for possible appendicitis
• Higher likelihood of resection
• Several reports in children, especially obese
Normal Epiploic Appendices
US normal epiploic appendices
CT Epiploic Appendagitis
Sonogram
Treatment Epiploic Appendagits
• Conservative• No surgery necessary• Symptoms treated with analgesics• No antibiotics necessary• Most literature support Imaging saves patient
from exploratory laparotomy• Repeat imaging often shows complete resolution
of inflammation – Occasionally fibrous band or calcified appendage may
remain
Epiploic Appendagitis
• Rarely complications of nonoperative management– 4 cases of abscess formation– 1 case intestinal obstruction from adhesions
Omental Infarct
Treatment of Omental Infarction
• Observation
• NSAIDS
• No need for antibiotics
• Rarely abscess
• Largest Series in Literature• 40 patients, 1988-1997
– 20 epiploic appendagitis– 11 Omental infarction– 9 Unspecified abdominal focal fat infarction
• All had CT or US• No patients had to undergo exploration• No antibiotics• Most had symptoms resolve w/in 7 days
Appendices Epiploicae
“They rarely excite much notice, except to be cursed as an impediment to precise anastomosis of the colon or gratefully acknowledged as an added measure of protection when used to reinforce a precarious suture line.”
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