A rare twist in the abdomen: diagnostic and therapeutic approaches to omental infarction - a case report and literature review

Intraperitoneal focal fat infarction (IFFI) encompasses a group of rare conditions that are clinically and radiologically similar, arising from focal fatty tissue necrosis. These entities often mimic other acute abdominal conditions such as acute appendicitis or cholecystitis. We present the case of a 65-year-old female with progressive abdominal pain, ultimately diagnosed with IFFI using contrast-enhanced computed tomography (CT). Omental infarction (OI) was the leading diagnosis, though a definitive distinction from epiploic appendagitis (EA) could not be made on imaging. Conservative management with anti-inflammatory medication, analgesia, and low-molecular-weight heparins (LMWH) proved effective, resulting in complete resolution within five days. This case highlights the diagnostic value of CT-imaging in differentiating IFFI from other causes of acute abdomen, thereby avoiding unnecessary surgical interventions. The aetiology of OI will be discussed, along with a detailed focus on management strategies that may also apply to other causes of IFFI.

Keywords: abdominal infarction, omentum, ischaemia, acute abdomen, computed tomography, epiploic appendagitis.