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Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006.

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Presentation on theme: "Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006."— Presentation transcript:

1 Omental Infarction and Epiploic Appendagitis Scott Nguyen MD Oct 10, 2006

2 Epiploic Appendagitis

3 Omental Infarction Segment of Omentum succeptible to infarction as a result of torsion or venous thrombosis Primary and Secondary Predilection for Right Abdomen

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5 Risk Factors for Torsion or Infarction OBESITY –Fat accumulation in appendices – pedunculated nature and mobility increase chances of torsion –Fat deposition may outgrow the bloody supply predisposing to ischemia –Heavy exercise and excessive stretching – excess movement of omentum

6 European Radiology

7 Epiploic Appendigits J Clinical Ultrasound :481-95

8 Epiploic Appendagitis often misdiagnosed as Diverticulitis

9 Omental Infarction More often found at exploration for possible appendicitis Higher likelihood of resection Several reports in children, especially obese

10 Normal Epiploic Appendices

11 US normal epiploic appendices

12 CT Epiploic Appendagitis

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16 Sonogram

17 Treatment Epiploic Appendagits Conservative No surgery necessary Symptoms treated with analgesics No antibiotics necessary Most literature support Imaging saves patient from exploratory laparotomy Repeat imaging often shows complete resolution of inflammation –Occasionally fibrous band or calcified appendage may remain

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19 Epiploic Appendagitis Rarely complications of nonoperative management –4 cases of abscess formation –1 case intestinal obstruction from adhesions

20 Omental Infarct

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27 Treatment of Omental Infarction Observation NSAIDS No need for antibiotics Rarely abscess

28 Largest Series in Literature 40 patients, –20 epiploic appendagitis –11 Omental infarction –9 Unspecified abdominal focal fat infarction All had CT or US No patients had to undergo exploration No antibiotics Most had symptoms resolve w/in 7 days

29 Appendices Epiploicae “They rarely excite much notice, except to be cursed as an impediment to precise anastomosis of the colon or gratefully acknowledged as an added measure of protection when used to reinforce a precarious suture line.”


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