Idiopathic omental infarction cured by conservative treatment without hospitalization

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  • KUSHIMOTO Airi
    Shonan Kamakura General Hospital, Department of Emergency Medicine
  • SEKINE Ichiro
    Shonan Kamakura General Hospital, Department of Emergency Medicine
  • TSUJIYAMA Minako
    Shonan Kamakura General Hospital, Department of Emergency Medicine
  • FUKAGUCHI Kiyomitsu
    Shonan Kamakura General Hospital, Department of Emergency Medicine
  • FUKUI Hiroyuki
    Shonan Kamakura General Hospital, Department of Emergency Medicine
  • YAMAGAMI Hiroshi
    Shonan Kamakura General Hospital, Department of Emergency Medicine

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  • 外来保存的治療で治癒した特発性大網梗塞
  • ガイライ ホゾンテキ チリョウ デ チユ シタ トクハツセイ ダイモウ コウソク

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Abstract

<p>Idiopathic omental infarction is rare and clinically manifests as acute abdomen. Patients usually present to the outpatient emergency department; however, no guidelines are available for acute management of this condition. Computed tomography(CT)-based preoperative diagnosis facilitates prompt initiation of conservative treatment, although omentectomy is required in some patients. This condition usually occurs in young patients with good prognosis; however, outpatient treatment has not been reported in Japan. A 44-year-old man with a 2-day history of laxative use presented with sudden abdominal pain, 4 hours prior to his visit. Physical examination at the time of admission showed tenderness localized to the umbilical region and a right inguinal mass. CT revealed a right inguinal hernia and localized elevation of fat tissue density in the greater omentum, which coincided with the site of abdominal pain. The inguinal hernia was not incarcerated, and we observed no findings suggestive of omental torsion. Therefore, the patient was diagnosed with idiopathic segmental omental infarction and was successfully treated with outpatient conservative therapy using orally administered analgesics and discontinuation of oral laxatives. We conclude that outpatient conservative treatment following diagnostic confirmation within 24-48 hours is a useful option for patients with controllable pain. Patients should be instructed to seek immediate medical attention for any exacerbation of symptoms. </p>

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