Evaluating Conservative Versus Surgical Management Strategies in Omental Infarction: A Case Report and Literature Review

TL;DR

This paper compares conservative and surgical treatments for omental infarction using a case report and literature review, finding that surgery is often needed for severe cases.

Contribution

The study provides a comprehensive analysis of treatment outcomes for omental infarction based on a large case review.

Findings

Surgical intervention was used in 68.1% of cases, while conservative management succeeded in 25.3%.

Conservative treatment failure was more common in cases of omental torsion.

CT imaging improved preoperative diagnosis but did not eliminate the need for surgery in many cases.

Abstract

Omental infarction was first described in 1896 mimics other causes of acute abdomen. Improved imaging modalities such as ultrasound and CT scans, have enhanced preoperative diagnosis with conservative management emerging as a treatment option. We report the case of a 51-year-old man presenting with epigastric pain migrating to the right iliac fossa, fever, nausea and anorexia. Examination revealed a stable patient with a right lumbar mass (5 cm × 6 cm) and rebound tenderness. CT imaging identified fat stranding near the ascending colon and hepatic flexure (6 cm ×10 cm ×10 cm) with peritoneal thickening. He underwent exploratory laparotomy, omentectomy and peritoneal washout, which revealed an infarcted omentum (8 cm × 8 cm) and 200 ml of haemoserous fluid. The patient recovered well postoperatively. A systematic search of the literature identified 237 articles reporting 479 cases of omental infarction, with clinical data extracted for analysis. Male predominance was observed (2:1) and 326 patients (68.1%) underwent surgical intervention. Conservative management was successful in 121 patients (25.3%), while 32 (6.7%) required surgery following failed conservative treatment. Among those managed surgically, the most common preoperative diagnosis was appendicitis. CT imaging was performed in 245 cases (51.1%), of which 103 (42.0%) within this group were successfully managed conservatively, while 26 (10.6%) required surgical intervention after conservative failure. Omental torsion was diagnosed preoperatively in 220 patients (45.9%); in this subset, 21 (9.5%) underwent surgery after failed conservative management and only 5 (2.3%) were successfully treated conservatively. While omental infarction can often be managed conservatively, surgery remains a key treatment for intractable pain or omental torsion, where conservative management failure rates are high.

Figures