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Laparoscopic Surgery for Diagnosis and Treatment of Acute Right Upper-Quadrant Abdominal Pain Due to Omental Infarction: A Report of a Rare Case in a Single Vietnamese Hospital

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease

Tran Que Son, Tran Hieu Hoc, Vu Duc Long, Tran Thanh Tung, Pham Van Tuyen, Nguyen Toan Thang, Tran Thu Huong

Vietnam Department of Surgery, Hanoi Medical University, Hanoi, Vietnam

Am J Case Rep 2021; 22:e931098

DOI: 10.12659/AJCR.931098

Available online: 2021-06-18

Published: 2021-07-27


#931098

BACKGROUND: Omental infarction (OI) is an infrequent cause of acute abdominal pain, and there is no consensus on whether conservative or surgical treatment should be performed. The clinical manifestations are nonspecific, so many patients are referred for surgery because of acute abdominal signs that may indicate other diseases such as cholecystitis, appendicitis, or peptic ulcer perforation. In most cases, infarction of the greater omentum is diagnosed only during emergency surgery for other diseases of the abdomen. Currently, multisequence computed tomography is performed for acute abdomen, and this disease is increasingly diagnosed preoperatively.
CASE REPORT: We report on 2 patients who were referred to our Emergency Department for acute abdominal pain. Both were female and middle-aged. The first patient presented with vomiting and right upper-quadrant pain with thickened and right subcostal omental infiltration on computed tomography (CT). The second patient presented with right subcostal pain and fever. CT showed signs of infiltration, thickening of the omentum, and a right upper subcostal mass measuring 22×60 mm. We performed emergency laparoscopic surgery to explore the abdominal cavity. Both patients were discharged after 3 days.
CONCLUSIONS: Omentum infarction is a rare disease that causes a diagnostic dilemma, as there is a wide spectrum of causes of acute abdomen. Many patients are diagnosed only during surgery. Laparoscopic surgery should be performed as soon as possible.

Keywords: Emergency Medical Services, Laparoscopy, Omentum, Infarction, Abdominal Pain



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