Primary Infarction of Greater Omentum Report of a Case

原發性大網膜梗塞：一病例報告

許博翔(Bor-Shyang Sheu) ； 張定宗(Ting-Tsung Chang) ； 辛政憲(Jeng-Shiann Shin) ； 林炳文(Pin-Wen Lin) ； 曾慶誠(Ching-Cherng Tzeng) ； 蔡宏名(Hong-Ming Tsai) ； 林錫璋(Xi-Zhang Lin) ； 林勤益(Ching-Yih Lin)

《中華民國消化系醫學會雜誌》 11卷3期 (1994/09) Pp. 213-218

https://doi.org/10.6557/GJTa.199409_11(3).0006

摘要

三十八歲男性過去有酒精成癮及切除盲腸之病史。自覺上腹悶痛約三日，但在飽餐及飲酒後，急速惡化為嚴重之右側陣發性痙攣腹痛，臨床表現酷似急性膽囊炎。由於病程伴有持續輕度發燒、腹脹及腹痛加劇為腹膜徵象(peritoneal sign)，腹部電腦斷層顯示為網膜梗塞併有扭曲(omentum infarction with torsion)，後經外科術中配合病理確認為原發性大網膜梗塞併扭曲(primary infarction of greater omentum with torsion)。
網膜梗塞為罕見之右側腹痛原因，散發在各個年齡層，常伴有特定之好發原因：如先天性網膜缺陷、腹部手術、心衰竭、凝血疾病、肥胖、飽餐及運動之後等等。臨床表現並無專一性，故術前診斷不易，近年來腹部電腦斷層配合臨床之高度警覺，已使術前診斷率提高，值得臨床醫師引為借鏡。

關鍵字

網膜梗塞 ； 大網膜 ； 電腦斷層掃描

並列摘要

A 38-year-old alcoholic male, who had had an appendectomy at 17 years of age, suffered from indolent epigastralgia for 3 days, which rapidly progressed into severe cramping abdominal pain on the right side after a heavy meal with alcohol. His symptoms initially simulated acute cholecystitis but this was later found negative by sonography. Due to progressive abdominal distention, low grade fever, and right upper quadrant pain with peritoneal sign, abdominal CT scan was arranged through a small bowel lesion. The CT scan disclosed a heterogenic wedge-shaped area with intervening fibrous bands and hyperattentulated fatty necrosis over the RUQ. The patient was subsequently operated on, and both the surgical and pathologic findings confirmed primary infarction of greater omentum with torsion.
Omental infarction is a rare cause of right-side abdominal pain and occurs at any age sporadically with certain predisposing factors. Clinically, it presents as right-side abdominal pain that simulates acute cholecystitis or appendicitis. Therefore, preoperative diagnosis is not common. Specific findings of abdominal CT scan as shown in this case is a good tool for early diagnosis.

並列關鍵字

omental infarction ； greater omentum ； CT scan