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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.

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Omental Infarction and Epiploic Appendagitis

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  1. Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006

  2. Epiploic Appendagitis

  3. Omental Infarction • Segment of Omentum succeptible to infarction as a result of torsion or venous thrombosis • Primary and Secondary • Predilection for Right Abdomen

  4. 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

  5. European Radiology 1999 1886-92

  6. Epiploic Appendigits J Clinical Ultrasound 2002 30:481-95

  7. Epiploic Appendagitis often misdiagnosed as Diverticulitis

  8. Omental Infarction • More often found at exploration for possible appendicitis • Higher likelihood of resection • Several reports in children, especially obese

  9. Normal Epiploic Appendices

  10. US normal epiploic appendices

  11. CT Epiploic Appendagitis

  12. Sonogram

  13. 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

  14. Epiploic Appendagitis • Rarely complications of nonoperative management • 4 cases of abscess formation • 1 case intestinal obstruction from adhesions

  15. Omental Infarct

  16. Treatment of Omental Infarction • Observation • NSAIDS • No need for antibiotics • Rarely abscess

  17. 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

  18. 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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