Diagnosis of Primary Omental Infarction and Epiploic Appendagitis Using Computed Tomography

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Abstract

Omental infarction and epiploic appendagitis are rare conditions characterized by fat tissue necrosis and clinically presenting with acute abdominal pain. Omental infarction and epiploic appendagitis can mimic various acute urological, surgical, and obstetric-gynecological diseases depending on pain localization. These conditions can be classified as primary or secondary, i.e. those of unknown origin or those resulting from a definite cause. It is generally believed that primary appendagitis is more common than primary omental infarction. Currently, there is no evidence-based consensus on the most optimal treatment approach for omental infarction and epiploic appendagitis. However, most experts agree that these conditions are self-limiting and tend to resolve spontaneously. Consequently, accurate detection and differentiation from other acute abdominal conditions requiring urgent surgery are crucial. For omental infarction and epiploic appendagitis, computed tomography remains the primary imaging modality in emergency diagnostics, as it is superior to clinical examination and blood chemistry in terms of sensitivity and specificity. The article reviews predisposing factors and anatomical prerequisites for primary omental infarction and epiploic appendagitis. It also details characteristic computed tomography signs that may be used to differentiate omental infarction and epiploic appendagitis between each other and from other acute abdominal conditions. Although computed tomography may identify typical signs of these conditions, the differentiation between primary omental infarction and epiploic appendagitis can sometimes be challenging. Therefore, the term “intra-abdominal focal fat infarction” is recommended.

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About the authors

Vladimir V. Ryazanov

Military Saint Petersburg State Pediatric Medical University

Email: 79219501454@yandex.ru
ORCID iD: 0000-0002-0037-2854
SPIN-code: 2794-6820
Scopus Author ID: 57204629827

MD, Dr. Sci. (Medicine), Professor, Department of Modern Diagnostic Methods and Radiotherapy named after Professor S. A. Reinberg

Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100

Gulnaz K. Sadykova

Military Saint Petersburg State Pediatric Medical University

Email: kokonya1980@mail.ru
ORCID iD: 0000-0002-6791-518X
SPIN-code: 3115-7430
Scopus Author ID: 57204633567

MD, Dr. Sci. (Medicine), Department of Modern Diagnostic Methods and Radiotherapy named after Professor S. A. Reinberg

Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100

Valery P. Kutsenko

Military Saint Petersburg State Pediatric Medical University

Email: val9126@mail.ru
ORCID iD: 0000-0001-9755-1906
SPIN-code: 5760-0218
Scopus Author ID: 57221996886

MD, Dr. Sci. (Medicine), Department of Modern Diagnostic Methods and Radiotherapy named after Professor S. A. Reinberg

Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100

Olesya A. Zaika

Military Saint Petersburg State Pediatric Medical University

Email: olesyazaika2001@mail.ru
ORCID iD: 0009-0009-6834-1155

resident, Department of Modern Diagnostic Methods and Radiotherapy named after Professor S. A. Reinberg

Russian Federation, 2 Litovskaya st., Saint Petersburg, 194100

Marat R. Gafiatulin

Military Saint Petersburg State Pediatric Medical University; North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: Gafiatulin_2000@mail.ru
ORCID iD: 0000-0002-5224-1717
SPIN-code: 5832-4224

Postgraduate student of the Department of Human Morphology

Russian Federation, 2, Litovskaya st., Saint Petersburg, 194100; 41, Kirochnaya str., Saint Petersburg, 191015

References

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  2. Öztaş M, Türkoğlu B, Öztas B, et al. Rare causes of acute abdomen and review of literature: Primary/secondary omental torsion, isolated segmental omental necrosis, and epiploic appendagitis. Ulus Travma Acil Cerrahi Derg. 2023;29(2):193–202. doi: 10.14744/tjtes.2022.28430
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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Appendagitis in the left lower quadrant. Native CT images. In the sagittal (a), frontal (b) and axial (c) planes, an oval formation of fat density with a peripheral hyperdense rim (arrows) is visualized, with compaction of the surrounding tissue, the adjacent colonic wall is not thickened.

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3. Fig. 2. Appendagitis in the left lower quadrant. Native CT images. Serial sections in the axial plane (a–c, arrows) show an oval fat-dense lesion with a peripheral hyperdense rim and a hyperdense dot in the region of the appendicular pedicle.

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4. Fig. 3. Native CT image in the axial plane. Extraorgan located totally homogeneously calcified rounded formation (arrow).

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5. Fig. 4. Omental infarction. Native CT images. In the sagittal (a), frontal (b) and axial (c) planes, an area of compaction of fatty tissue is visualized at the lower surface of the transverse colon as a formation with fuzzy contours (arrows).

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6. Fig. 5. Appendagitis. Native CT images. On successive sections in the axial plane (a–d), an oval formation of fat density is visualized, with a peripheral hyperdense rim and a central hyperdense linear inclusion, with reactive thickening of the adjacent wall of the descending colon (arrows), and stringy compaction of the surrounding tissue.

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7. Fig. 6. Appendagitis in the left lower quadrant. Native CT images. In the sagittal (a), frontal (b) and axial (c) planes, an oval formation of fat density with a peripheral hyperdense rim and a centrally located linear inclusion is visualized. Marked changes in the surrounding adipose tissue with edema of the visceral and parietal peritoneum, the adjacent wall of the colon is not thickened.

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8. Fig. 7. Appendagitis in the right lower quadrant. Native CT images in the axial plane. During the initial examination (a) and in dynamics after 25 days (b), the oval formation of fat density has decreased in size, the peripheral hyperdense rim and centrally located hyperdense linear inclusions remain, and compaction of the surrounding fat tissue is not determined. During the initial and repeated examination, the adjacent intestinal wall is unchanged. During the ultrasound examination after 25 days in the grayscale mode (c) and in the color Doppler mode (d), an avascular hyperechoic oval formation with a hyperechoic rim is visualized.

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