Idiopathic Segmental Infarction of the Omentum—A Rare Cause of Abdominal Pain

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IDIOPATHIC segmental infarction of the omentum is a rare cause of acute severe abdominal pain. Various names have been given to this entity: omental infarction, acute segmental omental infarction, spontaneous infarction of the greater omentum, thrombosis of omentum, primary omental torsion, acute epiploitis, and hemorrhagic infarction of the greater omentum. This specific disease entity has been confused with other, more common types of omental infarction secondary to other conditions. In 1956 Wrzesinski, Firestone, and Walske1 proposed definite criteria for diagnosing this disease: “(l) The infarction must be spontaneous and idiopathic and not preceded by trauma, infection or other etiologic factors which could, by obvious cause and effect, initiate the process; (2) it must be segmental and not associated with massive vascular occulsions involving large areas of the omentum and/or adjacent organs; (3) it must be primary in the omentum and not the result of disease in a neighboring structure; (4) it should present the typical gross and microscopic picture excluding especially the presence of a pedicle, either twisted or untwisted, which would indicate pathology secondary to torsion.”

Bush2 in 1896, and Johnson3 in 1932, have each been credited by various authors1,4–6 for reporting the first case. Neither of the two cases, however, completely fulfills the criteria proposed by Wrzesinski, Firestone, and Walske.1 Because the above criteria for diagnosis have not been fulfilled by all cases reported before 1956, other authors who have reviewed the literature have differed in their counts of the total number of cases reported to date.



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