Abstract Introduction Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. It affects predominantly young and middle aged women. Case presentation This is a case report of a 26-year-old Caucasian woman with spontaneous omental infarction two weeks after normal vaginal delivery. Conclusion Omental infarction is a differential diagnosis in the postpartum acute abdomen. As some cases of omental infarction, which are caused by torsion, can be adequately diagnosed via computed tomography, a conservative treatment strategy for patients without complications should be considered in order to avoid any unnecessary surgical intervention.</p

AC van Breda Vriesman

AH James

Andreas H Marx

B Coulier

B Guerquin

CP Kimber

EJ Balthazar

Florian Gebauer

Jakob R Izbicki

JB Puylaert

Jussuf T Kaifi

L Ceuterick

LN Naffaa

M Knoop

M Maternini

Michael Tachezy

R Leung

Rainer Grotelüschen

RK Tompkins

RW Phillips

SE Basson

English

PubMed

Springer - Publisher Connector

CASE REPORT Open Access
Omental infarction in the postpartum period:
a case report and a review of the literature
Michael Tachezy1*, Rainer Grotelüschen1, Florian Gebauer1, Andreas H Marx2, Jakob R Izbicki1, Jussuf T Kaifi1
Abstract
Introduction: Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. It
affects predominantly young and middle aged women.
Case presentation: This is a case report of a 26-year-old Caucasian woman with spontaneous omental infarction
two weeks after normal vaginal delivery.
Conclusion: Omental infarction is a differential diagnosis in the postpartum acute abdomen. As some cases of
omental infarction, which are caused by torsion, can be adequately diagnosed via computed tomography, a
conservative treatment strategy for patients without complications should be considered in order to avoid any
unnecessary surgical intervention.
Introduction
Omental infarction is a rare clinical event that affects
predominantly young and middle aged women [1]. It is
usually caused by omental torsion, but the reasons for
this remains poorly understood. Omental infarction was
first reported in 1882 by Oberst [2]. Patients present
symptoms of an acute abdomen. The clinical findings
are very unspecific and, therefore, in most cases it is
surgical exploration that leads to the diagnosis.
This report highlights the case of a spontaneous
omental infarction in a young woman in the postpartum
period.
Case presentation
A 26-year-old Caucasian woman presented with a five
day history of increasing epigastric pain and nausea two
weeks after the vaginal delivery of a healthy child of
normal weight and size.
Physical examination revealed a normal peristalsis and
supraumbilical tenderness. A small umbilical hernia
(<1 cm diameter), with no signs of incarceration, was
described by the initial examining physician. Pulse and
blood pressure were normal (85 beats/min, 123/83
mmHg). She was apyrexial but adynamic, with pale and
clammy skin. In summary, the general status of the
patient was impaired on admission (American Society of
Anesthesiologists score 2-3).
Blood tests revealed an elevated white blood cell count
(14.7/nL) and serum C-reactive protein (120 mg/dL).
A coagulation study (international normalised ratio, par-
tial thromboplastin time, fibrinogen and platelet count)
revealed no abnormalities.
Abdominal ultrasound showed no specific pathological
findings and, for further clarification, a contrast-enhanced
abdominal computed tomography (CT) was performed.
The morphologic findings of the CT were interpreted as
an incarcerated umbilical hernia by the radiologist. How-
ever, due to the clinical presentation of an acute abdomen
and the elevated inflammatory blood parameters, the
patient was asked to consent to an exploratory laparot-
omy. A small laparotomy (5 cm long midline incision
around the umbilicus) was performed. Contrary to the CT
findings, and in accordance to the clinical examination, no
umbilical hernia could be detected intraoperatively. Sur-
prisingly, a hemorrhagic greater omentum measuring 11 ×
7.5 × 2.5 cm was discovered and resected. A small amount
of sanguinous ascites was also found. On further explora-
tion we found no adhesions or other underlying causes for
the infarction, such as an external or internal hernia or a
vascular pedicle.
In a retrospective repeat analysis of the CT scan, a
hypoperfused mass of fatty appearance in the anterior
* Correspondence: mtachezy@uke.uni-hamburg.de
1Department of General, Visceral and Thoracic Surgery, University Medical
Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg
Full list of author information is available at the end of the article
Tachezy et al. Journal of Medical Case Reports 2010, 4:368
http://www.jmedicalcasereports.com/content/4/1/368 JOURNAL OF MEDICAL
CASE REPORTS
© 2010 Tachezy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
portion of the midabdomen and small amounts of free
fluid surrounding the liver were observed (Figure 1).
Histopathological findings of the resected omental
specimen confirmed fresh hemorrhagic infiltrations of
the tissue, partial thrombosis of the small vessels and, in
some parts, necrotic fatty tissues with an acute inflam-
matory cellular infiltrate (Figure 2). Further laboratory
testing excluded potentially underlying coagulopathy or
rheumatic disease.
The patient was discharged after an uneventful recov-
ery three days after surgery.
Discussion
Omental infarction was first described in the late 19th
century and, since then, only a few hundred cases have
been published in the English literature [3]. This is one
of the first cases showing spontaneous omental infarc-
tion in the puerperium after a vaginal birth. Two pre-
viously published cases describe omental infarction in
the postpartum period - one after caesarean section and
another after vaginal delivery [4,5]. Torsion of the
omentum is the main reason for infarction and two dif-
ferent forms have been described: primary torsions
(without other pathologic intraabdominal findings) and
secondary torsions (tumors, cysts, inflammatory changes,
adhesions, hernias). Predisposing factors for torsion are
anomalies of the omentum, such as a small root, irregu-
lar vascular anatomy, abdominal trauma, cough and
physical strain [2].
The etiology of omental infarction without torsion
remains uncertain but several mechanisms have been
proposed, such as an anomaly of venous vessels [6].
Other possible causes for primary infarctions could be
disorders of hemostasis or vascular diseases. It is known
that hematologic changes occur during pregnancy and
the puerperium and that hypercoagulability leads to an
increased risk of thromboembolic events [7]. The exact
mechanism leading to infarction in this case remains
unclear. Possible changes during the return of the
mother’s body to the pre-pregnancy physiological condi-
tion may have provoked the infarction. Usually the clini-
cal symptoms of an infarction of the omentum are
localized peritoneal irritation on the right side of the
abdomen, sometimes associated with low-grade fever.
As in the present case, the C-reactive protein and white
blood count may be elevated. The clinical picture
often misleads physicians to assume an incorrect preo-
perative diagnosis such as acute cholecystitis, appendici-
tis, diverticulitis, appendicitis epiploica or umbilical
hernia [3,8,9].
As most patients show symptoms of an acute abdo-
men, CT of the abdomen and pelvis should be the diag-
nostic imaging of choice [10]. If omental infarction is
caused by torsion, characteristic CT-findings might be
detectable. The torsion leads to the presence of con-
centric linear strands in the fatty mass, a so-called ‘fat
spiral pattern’ [11]. In our case no omental torsion was
present and, consequently, the radiologist was unable to
identify this diagnostic radiologic sign. Therefore, differ-
entiating the omental infarction from other abdominal
or omental diseases was challenging and the radiological
findings were misinterpreted as a small incarcerated
umbilical hernia.
Diagnosis of an omental infarction has traditionally
been made intraoperatively during an exploratory lapar-
otomy or laparoscopy and the treatment has been partial
or total omentectomy. Recent reports highlight cases of
patients with CT diagnosed omental torsions who have
been successfully treated conservatively without any
Figure 1 Computed tomography scan of the abdomen
showing a hypoperfused mass in the anterior portion of the
median epigastrium with fatty density (®) and a thin layer of
free fluid surrounding the liver.
Figure 2 Histological findings of omentum majus show fresh
hemorrhagic circulation disorders (arrows), partial necrosis of
fatty tissue with acute inflammatory cell infiltrate (hematoxylin
staining, original magnification × 100).
Tachezy et al. Journal of Medical Case Reports 2010, 4:368
http://www.jmedicalcasereports.com/content/4/1/368
Page 2 of 3
other complications (such as bacterial superinfections)
[12-15]. Whenever conservative treatment fails, or the
clinical status of the patient worsens, a surgical interven-
tion should be quickly implemented.
Conclusion
Omental infarctions are often not initially considered in
the differential diagnosis of a post partum acute abdo-
men. When omental infarction is caused by torsion, a
correct preoperative diagnosis by contrast-enhanced CT
scanning can avoid surgery. Recently published case ser-
ies have reported successful conservative management.
Consent
Written informed consent was obtained from the patient
for publication of this case report and any accompany-
ing images. A copy of the written consent is available
for review by the Editor-in-Chief of this journal.
Acknowledgements
The authors would like to thank Shazia Hussain and Katharina Tornow for
their help in proofreading and editing the manuscript.
Author details
1Department of General, Visceral and Thoracic Surgery, University Medical
Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg. 2Institute of
Pathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52,
20246 Hamburg, Germany.
Authors’ contributions
MT, RG and JTK managed the patient and reviewed the literature. MT and
RG were the main authors of the manuscript. AHM analyzed the
histopathological specimen. FG, JTK and JRI made modifications to the
manuscript. All authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 30 November 2009 Accepted: 17 November 2010
Published: 17 November 2010
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doi:10.1186/1752-1947-4-368
Cite this article as: Tachezy et al.: Omental infarction in the postpartum
period: a case report and a review of the literature. Journal of Medical
Case Reports 2010 4:368.
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Tachezy et al. Journal of Medical Case Reports 2010, 4:368
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Page 3 of 3

Omental infarction in the postpartum period: a case report and a review of the literature

Abstract Introduction Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. It affects predominantly young and middle aged women. Case presentation This is a case report of a 26-year-old Caucasian woman with spontaneous omental infarction two weeks after normal vaginal delivery. Conclusion Omental infarction is a differential diagnosis in the postpartum acute abdomen. As some cases of omental infarction, which are caused by torsion, can be adequately diagnosed via computed tomography, a conservative treatment strategy for patients without complications should be considered in order to avoid any unnecessary surgical intervention.</p

Izbicki Jakob R

Marx Andreas H

Gebauer Florian

Grotelüschen Rainer

Tachezy Michael

Kaifi Jussuf T

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Crossref

[Pictorial essay. Infarction of the greater omentum: can US and CT findings help to avoid surgery?]. JBR-BTR

Geboes K: CT diagnosis of primary torsion of greater omentum.

JH: Primary omental torsion in children.

Kreis DJ Jr: Infarction of the omentum in pregnancy.

Laparoscopic approach for idiopathic segmental infarction of the greater omentum. Minerva Chir

Legoulme C: [Tumor syndrome of omental origin in the post-partum period].

MC: CT findings of omental torsion and infarction: case report and review of the literature. Clin Imaging

PA: Primary torsion of the omentum.

Peterson CM: Infarction of the omentum after cesarean section. A case report.

Pregnancy-associated thrombosis. Hematology Am Soc Hematol Educ Program

Puylaert JB: Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol

Right-sided segmental infarction of the omentum: clinical, US and CT findings. Radiology

Sparks FC: Primary torsion of the omentum - mimic of appendicitis: review of six cases. Am Surg

Vorwerk T: [Inflammatory alterations of the greater omentum– a difficult preoperative diagnosis]. Zentralbl Chir

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Omental infarction in the postpartum period: a case report and a review of the literature

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