EVALUATING CONSERVATIVE VERSUS SURGICAL MANAGEMENT STRATEGIES IN OMENTAL INFARCTION: A CASE REPORT AND LITERATURE REVIEW yukijulius@gmail.com

PE015

EVALUATING CONSERVATIVE VERSUS SURGICAL MANAGEMENT STRATEGIES IN OMENTAL INFARCTION: A CASE REPORT AND LITERATURE REVIEW

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Malaysia

Oral or Poster

Omental infarction was first described in 1896 mimics other causes of acute abdomen. Improved imaging modalities have enhanced preoperative diagnosis with conservative management emerging as a treatment option.

We report a 51-year-old man with epigastric pain migrating to the right iliac fossa, fever, nausea and anorexia. Examination showed a stable patient with a right lumbar mass (5 × 6 cm) and rebound tenderness. CT revealed fat stranding near the ascending colon and hepatic flexure (6 × 10 × 10 cm) with peritoneal thickening. He underwent exploratory laparotomy, omentectomy and peritoneal washout, revealing an infarcted omentum (8 × 8 cm) and 200 ml haemoserous fluid. The patient recovered well postoperatively. A literature search identified 237 articles with 479 omental infarction cases, clinical data extracted for analysis.

Male predominance was observed (2:1) and 326 patients (68.1%) underwent surgical intervention. Conservative management was successful in 121 patients (25.3%), while 32 (6.7%) required surgery following failed conservative treatment. Among those managed surgically, the most common preoperative diagnosis was appendicitis. CT imaging was performed in 245 cases (51.1%), of which 103 (42.0%) within this group were successfully managed conservatively, while 26 (10.6%) required surgical intervention after conservative failure. Omental torsion was diagnosed preoperatively in 220 patients (45.9%); in this subset, 21 (9.5%) underwent surgery after failed conservative management and only 5 (2.3%) were successfully treated conservatively.

While omental infarction can often be managed conservatively, surgery remains a key treatment for intractable pain or omental torsion, where conservative management failure rates are high.