Idiopathic Omental Infarction - A Case Report and Review of the Literature

特發性大網膜梗塞：病例報告及文獻回顧

張慧傑(Huai-Jie Zhang) ； 陳瑞灝(Jui-Hao Chen) ； 吳金珠(Chin-Chu Wu)

《內科學誌》 31卷4期 (2020/08) Pp. 293-297

https://doi.org/10.6314/JIMT.202008_31(4).10

摘要

The idiopathic omental infarction (IOI) is a rare cause of acute abdomen. It is usually a self-limited disorder presenting with nonspecific abdominal pain that may mimic several acute abdominal conditions, such as appendicitis, cholecystitis, diverticulitis, epiploic appendagitis, and mesenteric panniculitis. In the present era, more cases of IOI are being diagnosed preoperatively by computed tomography (CT scan).If the diagnosis was made in the initial period of patient's visit, the conservative treatment is feasible and surgery can be avoided. Surgical treatment is indicated only in cases of secondary infection. Here we report a case of 28-year-old obese male (height :177.5 cm, body weight: 96 Kg, BMI 30.5kg/m^2) who represented with pain at right upper quadrant of abdomen for 3 days and it got worse upon movement of body or sitting up from the bed. Initial lab data were normal, no significant findings in abdominal ultrasound except severe fatty liver, but abdominal CT revealed omental infarction at right upper quadrant. He was discharged uneventfully after 6 days of hospitalization after conservative management with pain control and empiric antibiotics. The aim of this report is to emphasize the importance of a differential diagnosis of the acute abdomen and to discuss the management of omental infarction. In this report, we present a review of current literature on omental infarction and highlight the importance of imaging study especially abdominal CT scan in the nonoperative diagnosis and conservative management.

關鍵字

Computed tomography ； Idiopathic omental infarction ； Fat necrosis

並列摘要

特發性大網膜梗塞（Idiopathic Omental Infarction, IOI）是急性腹痛的罕見原因。它通常是一種自限性疾病，以非特異性腹痛為初始表現，與其他幾種急性腹痛疾病的症狀類似，例如闌尾炎，膽囊炎，大腸憩室炎，腸脂垂炎和腸系膜脂肪炎。目前因為電腦斷層掃描的廣泛使用，大網膜壞死在發病的早期就得到正確的診斷，因此避免了不必要的外科手術。此疾病目前絕大部分只要保守治療就可完全康復，只有少數病人因併發次發性感染而必須行外科治療。本文報告一例28歲的肥胖男性（BMI 30.4kg / m^2），病患主訴右上腹痛3天，腹痛隨著運動而惡化。初始的各種抽血檢查結果（包含肝腎胰功能及白血球、紅血球、血小板）均正常。腹部超音波檢查顯示嚴重脂肪肝，其他無異常發現，但腹部電腦斷層顯示右上腹大網膜梗塞。經入院保守治療（疼痛控制和經驗性抗生素治療），6天後穩定出院。本報告的目的是為了強調大網膜梗塞在急性腹痛進行鑑別診斷時的重要性及討論大網膜梗塞的處理方式。本文亦針對有關大網膜梗塞的文獻進行匯整，並強調腹部影像學檢查（比如電腦斷層）在早期診斷和保守治療的重要性。