All issues > Volume 44(6); 2001

Case Report

J Korean Pediatr Soc. 2001;44(6):694-699. Published online June 15, 2001.

Two Cases of Primary Segmental Infarction of the Greater Omentum

Do Yeon DY Kim¹, Weon W Park¹, Dong Jin DJ Lee¹, Jung Hyeok JH Kwon²

¹Departments of Pediatrics, Ulsan Dong-Kang General Hospital, Ulsan, Korea
²Departments of Radiology, Ulsan Dong-Kang General Hospital, Ulsan, Korea

Abstract

Primary segmental infarction of the greater omentum is a rare condition which usually simulates acute appendicitis or cholesystitis because of right-sided abdominal pain, tenderness, fever and leukocytosis. Its cause is unknown. Most authors believe that the condition results from an embryologic variant associated with anomalous and fragile blood supply of the right lower portion of the greater omentum, which is consequently susceptible to infarction. Because there are no characteristic clinical findings, a correct preoperative diagnosis is rare. But cross-sectional imaging by ultrasound(US) or computed tomography(CT) will demonstrate characteristic findings in a location corresponding to the patient's point of maximal tenderness. These findings consist of an ovoid or cake-like mass in the omental fat with surrounding inflammatory changes. Surgical resection of the infarcted omentum is the usual treatment when the diagnosis is not established preoperatively. If the diagnosis can be established preoperatively with cross-sectional imaging, then these patients can be managed conservatively, and laparotomy can be avoided. We report two cases of primary segmental infarction of the greater omentum. One patient underwent surgery, and the diagnosis was confirmed histologically. The other patient was treated conservatively after the diagnosis was established with clinical, US and CT findings, which were similar and consistent with the previous patient.

Keywords :Primary segmental infarction, Greater omentum, Cross-sectional imaging, Conservative treatment