omental infarction and epiploic appendagitis scott nguyen md oct 10, 2006
TRANSCRIPT
![Page 1: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/1.jpg)
Omental Infarction and Epiploic Appendagitis
Scott Nguyen MD
Oct 10, 2006
![Page 2: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/2.jpg)
Epiploic Appendagitis
![Page 3: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/3.jpg)
Omental Infarction
• Segment of Omentum succeptible to infarction as a result of torsion or venous thrombosis
• Primary and Secondary
• Predilection for Right Abdomen
![Page 4: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/4.jpg)
![Page 5: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/5.jpg)
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
![Page 6: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/6.jpg)
European Radiology 1999 1886-92
![Page 7: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/7.jpg)
Epiploic Appendigits
J Clinical Ultrasound 2002 30:481-95
![Page 8: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/8.jpg)
Epiploic Appendagitis often misdiagnosed as Diverticulitis
![Page 9: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/9.jpg)
Omental Infarction
• More often found at exploration for possible appendicitis
• Higher likelihood of resection
• Several reports in children, especially obese
![Page 10: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/10.jpg)
Normal Epiploic Appendices
![Page 11: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/11.jpg)
US normal epiploic appendices
![Page 12: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/12.jpg)
CT Epiploic Appendagitis
![Page 13: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/13.jpg)
![Page 14: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/14.jpg)
![Page 15: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/15.jpg)
![Page 16: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/16.jpg)
Sonogram
![Page 17: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/17.jpg)
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
![Page 18: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/18.jpg)
![Page 19: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/19.jpg)
Epiploic Appendagitis
• Rarely complications of nonoperative management– 4 cases of abscess formation– 1 case intestinal obstruction from adhesions
![Page 20: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/20.jpg)
Omental Infarct
![Page 21: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/21.jpg)
![Page 22: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/22.jpg)
![Page 23: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/23.jpg)
![Page 24: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/24.jpg)
![Page 25: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/25.jpg)
![Page 26: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/26.jpg)
![Page 27: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/27.jpg)
Treatment of Omental Infarction
• Observation
• NSAIDS
• No need for antibiotics
• Rarely abscess
![Page 28: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/28.jpg)
• 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
![Page 29: Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006](https://reader034.vdocuments.us/reader034/viewer/2022051316/56649c9e5503460f9495e0ab/html5/thumbnails/29.jpg)
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.”