Management of Omental Infarct
Conservative management with analgesics and observation is the appropriate initial approach for patients with omental infarct diagnosed on CT imaging, as this condition is self-limited with complete resolution expected in 68-90% of cases without surgery. 1, 2
Diagnostic Confirmation
- CT abdomen and pelvis with IV contrast is the diagnostic test of choice, demonstrating characteristic findings of focal fat stranding with a heterogeneous, oval-shaped fatty mass in the omentum, typically measuring 2-5 cm. 3, 2
- The diagnosis can be made confidently on CT in the majority of cases, avoiding unnecessary surgical exploration. 2, 4
- Most cases occur on the right side (right iliac fossa or right upper quadrant), but omental infarction can occur at any location including the epigastric area and left side. 1, 5
Initial Conservative Management Protocol
Begin with conservative treatment for 24-48 hours in all patients without peritonitis, consisting of:
- NSAIDs for pain control (primary analgesic approach). 4
- Antiemetic medications as needed. 4
- Observation with serial abdominal examinations. 1
- Average hospital length of stay is 3-4 days. 1
This approach succeeds in 68.9% of patients, with complete symptom resolution typically occurring within 2 weeks. 1, 4
Indications for Surgical Intervention
Proceed to laparoscopic omentectomy only if:
- Conservative management fails after 24-48 hours with persistent or worsening pain. 1, 5
- Signs of peritonitis develop or worsen during observation. 1
- The patient cannot tolerate continued conservative management. 5
Laparoscopic omentectomy is the preferred surgical approach when intervention is required, with no significant morbidity or mortality reported. 1
Clinical Presentation Recognition
- Patients present with nonspecific abdominal pain averaging 2.7 days duration, most commonly in the right iliac fossa or right upper quadrant. 1
- The presentation frequently mimics appendicitis, cholecystitis, or diverticulitis, making clinical diagnosis unreliable without imaging. 1, 2, 6
- Elevated inflammatory markers (leukocytosis, CRP) are common but nonspecific. 6
- Regional peritonitis and fever may be present in up to 40% of cases. 2
Critical Management Pitfalls to Avoid
- Do not proceed directly to surgery based on clinical presentation alone without CT confirmation, as this leads to unnecessary operations in a self-limited condition. 2, 5
- Do not dismiss the diagnosis if pain is located outside the right lower quadrant, as omental infarction occurs throughout the abdomen. 5
- Do not continue conservative management beyond 48 hours if symptoms persist or worsen, as 10-31% of patients will require surgical intervention. 1, 5
- Avoid relying on plain radiographs, which have no diagnostic value for this condition. 7