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Chirurgia 2011 August;24(4):215-7

language: English

Segmental infarction of the lesser omentum and acute abdomen

Bohlmann I., De Lorenzi D.

Department of Surgery and Orthopedics, Kantonales Spital Grabs, Grabs, Switzerland


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Segmental infarction of the lesser omentum is an extremely rare cause of acute abdomen and is often neglected as a differential diagnosis. The patients present with various symptoms, the localization of pain mostly suggests appendicitis or cholecystitis. Therefore, preoperative diagnosis can be difficult, although recently, extensive use of computed tomography and ultrasound examination to prevent unnecessary surgery, have been favored. We present a case of intraperitoneal fat focal infarction of the lesser omentum in a 65- year- old female. She was admitted with increasing colicky abdominal pain of the right upper quadrant, accompanied by nausea. The patient was admitted with increasing colicky abdominal pain of the right upper quadrant and rebound tenderness. Ultrasound suggested cholecystolithiasis, there were no other suspicious findings detected. During the subsequently performed laparoscopic cholecystectomy the segmental necrosis of the lesser omentum was found and resected, additionally. Postoperatively, the patient recovered well and could be discharged after four days. As imaging techniques advance, conservative therapy has recently gained more interest. Patients with non- complicated omentum torsion diagnosis can be safely treated by conservative means. However, extensive use of computed tomography in younger patients and its diagnostic reliability concerning this particular matter, is still dicussed controversial. In the majority of the cases, surgical resection remains treatment of choice.

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