Intraperitoneal focal fat infarction (IFFI) is a rare condition characterized by infarction of fatty tissue within the abdominal cavity. Lesser omental infarction, a relatively rare type of IFFI, occurs when there is an infarction of fat within the lesser omentum. Patients typically present with acute abdominal pain that can mimic more serious conditions. This case report highlights the clinical presentation, diagnostic challenges, and management strategies for patients presenting to the emergency department with lesser omental infarction. A 63-year-old female presented to the emergency department with a chief complaint of epigastric abdominal pain that had been persisting for approximately a week and a half. The pain, which initially seemed like a sore muscle, became increasingly sharp and intermittent, with tenderness upon palpation of the epigastric area. Computed tomography (CT) imaging revealed an omental infarct in the lesser sac with focal inflammation in the fat of the lesser omentum. Through conservative management with analgesics and anti-inflammatory medication, the patient experienced resolution of her symptoms within a few days and had a follow-up with the gastrointestinal team several weeks later. Lesser omental infarction typically results from compromised blood flow due to torsion or thrombosis, leading to ischemia and necrosis of the fatty tissue. CT imaging is crucial for its diagnosis and reveals fat-density lesions with surrounding inflammatory changes. Conservative management is typically effective, though in rare cases, surgical intervention may be necessary when significant vital signs and electrolyte derangements occur.

Omental infarction is an uncommon cause of abdominal pain. The condition is often misdiagnosed due to its clinical similarity to more common abdominal pathologies like appendicitis and cholecystitis. This report presents the case of a 57-year-old female with a one-week history of left-sided abdominal pain, initially aggravated by eating and defecation. The patient, a long-term smoker with a complex medical history that includes deep vein thrombosis and pulmonary embolism, was hemodynamically stable on presentation. A CT scan revealed a nodular infiltration consistent with an omental infarct. Conservative management was pursued, resulting in symptom resolution by the third day of hospitalization. This case underscores the diagnostic challenges associated with omental infarction, particularly its differentiation from other causes of acute abdominal pain. It highlights the importance of considering rare etiologies in patients with atypical presentations and emphasizes the role of imaging, particularly CT scans, in accurate diagnosis. The patient\'s successful conservative management aligns with current recommendations, which advocate for non-surgical treatment in most cases. This approach avoids unnecessary surgical interventions and ensures a favorable prognosis with low complication rates in patients with prompt and appropriate management.

UNASSIGNED: Malignant peritoneal mesothelioma (MPM) is a rare cancer that is associated with asbestos exposure. The diagnosis can be difficult given the nonspecific nature of presenting symptoms and the presence of concomitant confounding findings.
UNASSIGNED: We report a 71-year-old male who presented with right lower quadrant pain and new-onset ascites. CT imaging of the abdomen/pelvis demonstrated omental stranding concerning for a possible omental infarction. Subsequent imaging showed persistent omental edema but no identifiable soft tissue mass. A biopsy of the omentum showed atypical mesothelial proliferation, but pathology was unable to determine if proliferation was a neoplastic versus reactive process. Surgical oncology performed a diagnostic laparoscopy that showed peritoneal studding of the omentum. Subsequent immunohistochemical staining of the omentum demonstrated preservation of BAP1 expression and loss of MTAP expression, consistent with peritoneal mesothelioma.
UNASSIGNED: MPM is a rare and aggressive cancer with an overall poor prognosis. The diagnosis of MPM can be difficult based on the nonspecific clinical presentation, insufficient imaging and laboratory testing, and the presence of concomitant confounding findings, such as with this patient and his admitting diagnosis of omental infarction. This case demonstrates the importance of developing a broad differential while maintaining an awareness of heuristics that can influence clinical decision-making.

Partial infarction of the great omentum is a rare cause of abdominal pain and may present as a surgical emergency. Omental infarction might occur due to its torsion, but cases without obvious cause are reported. Risk factors related to this condition are overweight, obesity, abdominal trauma, recent abdominal surgery, hypercoagulability, postprandial vascular congestion and an increase in intra-abdominal pressure. Because of the condition\'s rarity, most patients are treated with surgery and the diagnosis is established intraoperatively. Preoperative diagnosis allows successful conservative treatment with analgesics and anti-inflammatory drugs. This case reports a young female patient with class III obesity presented with spontaneous partial infarction of the great omentum treated with laparoscopy.

Acute abdominal pain is a common presentation in emergency departments, often attributed to a myriad of potential causes. Among these, acute appendicitis remains a frequently diagnosed culprit. However, this case report presents a 32-year-old male who arrived at the emergency department with severe right lower quadrant abdominal pain, characterized by localized tenderness and guarding. The initial clinical diagnosis pointed to acute appendicitis. Before surgical intervention, a computed tomography scan was conducted and revealed a focal area of fat stranding, consistent with omental infarction, while the appendix appeared normal. The patient\'s management involved pain control and supportive care, leading to a complete resolution of abdominal pain at a two-week follow-up. This case emphasizes the significance of including omental infarction in the spectrum of diagnoses for acute abdominal pain, underlining the potential to prevent unnecessary surgical interventions.

BACKGROUND: Omental torsion is due to the twisting of the omentum along its axis and is observed in young male patients. The first description of omental torsion was first made by Eitel in 1899.
METHODS: A 35-year-old male presented with right iliac fossa pain, nausea, occasional vomiting and loss of appetite for four days. His clinical and radiological findings were suggestive of acute appendicitis. However, he was diagnosed with greater omental torsion intraoperatively and successfully managed with laparoscopic omentectomy.
CONCLUSIONS: Omental torsion is a rare condition with a low incidence. Preoperative diagnosis of omental torsion continues to be a challenge as the symptoms reported in the literature are usually confused with other abdominal pathologies such as appendicitis or cholecystitis etc. Preoperative US or CT scans are mandatory, and these procedures can accurately accomplish the pre-operative diagnosis. In search for the treatment of choice, laparoscopy proved its effectiveness as a diagnostic tool since it allows for confirming the diagnosis, evaluating the severity of the ischemia, and ruling out other surgical pathologies and therapeutic tools. At the same time, the open surgery approach can be described in many cases as being too invasive.
CONCLUSIONS: Greater omental torsion should be considered a differential diagnosis in all patients with acute abdominal emergencies.

Omental infarction (OI) is a rare cause of acute abdominal pain, which is benign and self-limited. It is diagnosed by imaging. The etiology of OI is either idiopathic or secondary and due to torsion, trauma, hypercoagulability, vasculitis, or pancreatitis.
Here, we present a case of OI in a child with acute severe right upper quadrant pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Correct diagnosis of OI via imaging can prevent unnecessary surgery.

BACKGROUND: Omental infarction (OI) is a surgical abdominal disease that is not common in adults and is very rare in children. Similar to various acute abdominal pain diseases including appendicitis, diagnosis was previously achieved by diagnostic laparotomy but more recently, ultrasonography or computed tomography (CT) examination has been used.
METHODS: A 6-year-old healthy boy with no specific medical history visited the emergency room with right lower abdominal pain. He underwent abdominal ultrasonography by a radiologist to rule out acute appendicitis. He was discharged with no significant sonographic finding and symptom relief. However, the symptoms persisted for 2 more days and an outpatient visit was made. An outpatient abdominal CT was used to make a diagnosis of OI. After laparoscopic operation, his symptoms resolved.
CONCLUSIONS: In children\'s acute abdominal pain, imaging studies should be performed for appendicitis and OI.

Acute appendicitis is considered one of the most common surgical emergencies with low morbidity and mortality. However, delay in the diagnosis may lead to perforation of the appendix. Hence, complications may arise, including necrotizing fasciitis, a rare complication of a perforated appendix. We present a case of perforated appendicitis complicated by necrotizing fasciitis leading to rapid deterioration. A 75-year-old male patient presented to our emergency room with a three-day history of right lower quadrant abdominal pain and abdominal distention. On admission, computed tomography (CT) scan showed a perforated appendix and peri-appendicular abscess. An exploratory laparotomy was performed. The appendix was resected and the wound closed. The patient was recovering well and tolerating food after the procedure. However, the patient developed progressive erythema/swelling over the right flank with new-onset leukocytosis. The diagnosis of necrotizing fasciitis was suspected and confirmed by careful evaluation and laboratory/radiological tests. Antibiotics were changed to clindamycin and piperacillin/tazobactam, and the patient was taken back to the operation room (OR) for surgical debridement. Postoperatively, the patient was shifted to the intensive care unit (ICU). He developed hearing impairment, which improved after the cessation of clindamycin. He was discharged in good condition after three weeks of hospital stay. This case report highlights the importance of maintaining a high index of suspicion for necrotizing soft tissue infection in immunocompromised patients with perforated appendicitis and being cautious when prescribing clindamycin to patients at risk of hearing loss.

Postsurgical fat necrosis is a frequent finding in abdominal cross-sectional imaging. Epiploic appendagitis and omental infarction are a result of torsion or vascular occlusion. Surgery or pancreatitis are conditions that can have a traumatic and ischemic effect on fatty tissue. The imaging appearances may raise concerns for recurrent malignancy, but percutaneous biopsy and diagnostic follow-up assist in the accurate diagnosis of omental infarction. Herein we describe a case of encapsulated omental necrosis temporally related to gastric surgery. Preoperative CT and MRI findings showed the characteristics of encapsulated, postcontrast nonviable tumefaction in the epigastrium without clear imaging features of malignancy. Due to the size of the lesion and the patient\'s primary disease, tumor recurrence could not be completely ruled out, and the patient underwent surgery. Histopathological analysis confirmed the diagnosis of steatonecrosis of the omentum.