Omental infarction

Causes

Omental infarction is an uncommon source of acute abdominal pain, occurring in fewer than 4 out of every 1000 cases of appendicitis. While it typically causes pain on the right side of the abdomen, it can also produce left-sided or upper abdominal discomfort. The right side is affected more often because the blood vessels there are fragile, and the right portion of the omentum is longer and more mobile than the left, making it prone to twisting. Obesity raises the risk, likely because extra fat in the omentum can block blood flow to its far ends and also makes torsion more likely. Other contributing factors include polycythemia, hypercoagulability, vasculitides, and conditions that encourage twisting, such as trauma, sudden movements, coughing, heavy meals, and hyperperistalsis. In the past, omental infarction was only found during surgery for suspected appendicitis or other abdominal emergencies. With the wider use of imaging, particularly CT scans, it is now often identified before surgery. This has revealed that the condition usually resolves on its own and can be managed without surgery. Today, both conservative care and surgery are used, but there is no agreement on which approach is best. It is extremely rare for someone to have both omental infarction and acute appendicitis at the same time, with only three such cases documented.