Treatment of Omental Infarction
Conservative management with supportive care is the recommended first-line treatment for omental infarction, with surgical intervention reserved for cases that fail to improve or have complications. 1
Diagnosis
Before discussing treatment, accurate diagnosis is essential:
- Omental infarction typically presents with nonspecific abdominal pain, most commonly in the right iliac fossa or right upper quadrant, mimicking more common conditions like appendicitis or cholecystitis 1, 2
- CT imaging is the diagnostic modality of choice, showing characteristic findings of inflamed omental fat 2
- Diagnostic laparoscopy may be required in unclear cases 1
Treatment Algorithm
First-Line Management: Conservative Approach
- Analgesia for pain control 1
- Anti-inflammatory medications 3
- Monitoring of clinical status for 24-48 hours 1
- No specific antibiotic therapy is required unless there are signs of infection 3
Conservative management is successful in approximately 69% of cases, with complete resolution of symptoms without surgical intervention 1.
When to Consider Surgical Management
Laparoscopic omentectomy should be considered in the following scenarios:
- Failure of conservative management with persistent pain after 48 hours 1
- Development of peritonitis or sepsis 1, 3
- Diagnostic uncertainty despite imaging 4
- Hemodynamic instability 3
Surgical Technique
- Laparoscopic approach is preferred when surgical intervention is required 1
- Complete resection of the infarcted omental segment 3
- Inspection of the abdomen to rule out other pathologies 4
Special Considerations
- Obesity is a risk factor for omental infarction and may influence management decisions 5
- Pediatric cases can also be managed conservatively with good outcomes 5
- Average hospital length of stay is approximately 3.4 days regardless of management approach 1
Outcomes
- Both conservative and surgical management have excellent outcomes with no significant mortality 1
- Complete resolution of symptoms occurs in virtually all patients 2
- Recurrence is rare after either conservative management or surgical resection 3
Common Pitfalls to Avoid
- Misdiagnosing omental infarction as appendicitis or cholecystitis, leading to unnecessary surgery 2
- Failing to consider omental infarction in the differential diagnosis of acute abdominal pain 3
- Rushing to surgery before attempting conservative management in stable patients 1
- Not recognizing that omental infarction can occur anywhere in the abdomen, not just on the right side 3
By following this approach, unnecessary operations can be avoided while ensuring appropriate care for patients with omental infarction.