What is the management for a possible omental infarct?

Management of Omental Infarction

Initial Management Recommendation

Conservative management with analgesics and observation for 24-48 hours is the recommended first-line approach for omental infarction, with surgical intervention reserved for patients who fail conservative treatment or have persistent symptoms. 1, 2

Diagnostic Confirmation

• CT imaging is essential to confirm the diagnosis and avoid unnecessary surgery, as omental infarction produces characteristic radiological findings including a focal area of fat stranding, often with a "whirl sign" in cases of torsion 1, 3, 4
• The diagnosis can occur at any abdominal location (right iliac fossa, right upper quadrant, epigastric area, or even left-sided), though right-sided presentation is most common 1, 2

Conservative Management Protocol

Initial conservative management should include:

• Analgesics for pain control (NSAIDs or opioids as needed) 1, 2
• Observation period of 24-48 hours with serial abdominal examinations 1
• NPO or clear liquids initially, advancing diet as tolerated 2
• Average hospital stay of 3-4 days for successful conservative management 1

Success rate: Approximately 69% of patients respond successfully to conservative management without requiring surgery 1

Indications for Surgical Intervention

Proceed to laparoscopic omentectomy if:

• Symptoms persist or worsen despite 24-48 hours of conservative management 1, 2
• Patient develops peritoneal signs suggesting complications 3
• Severe, refractory pain that significantly impacts quality of life 1

Surgical Approach When Indicated

• Laparoscopic omentectomy is the preferred surgical technique when intervention is necessary, offering diagnostic confirmation and definitive treatment 1, 3
• Resection of the infarcted omental segment should be performed to prevent ongoing symptoms and potential complications 3
• Even if omental infarction is discovered incidentally during laparoscopy for presumed appendicitis, resection can be considered to expedite symptom resolution 5, 3

Clinical Outcomes

• No significant morbidity or mortality reported with either conservative or surgical management 1
• The condition is generally self-limited when managed conservatively 2, 4
• Surgical management may expedite symptom resolution in refractory cases 5, 3

Key Clinical Pitfalls to Avoid

• Do not rush to surgery without adequate imaging - omental infarction frequently mimics appendicitis, cholecystitis, or diverticulitis, and unnecessary operations can be avoided with proper CT diagnosis 2, 4
• Do not dismiss the diagnosis based on location alone - while right-sided pain is most common, omental infarction can occur anywhere in the abdomen 2
• Do not continue conservative management beyond 48 hours if symptoms are worsening - persistent or progressive pain warrants surgical intervention 1