omental infarction and epiploic appendagitis

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.”