Idiopathic omental hemorrhage is a rare cause of an acute abdomen, which is potentially life threatening. Here, we report a case of a 34-year-old male who presented to the emergency department with sudden, severe pain abdomen and abdominal distension for 1 day. There was no history of trauma, abdominal surgeries or any significant past medical history. The diagnosis was suspected on contrast computed tomography, which revealed hyperdense areas of blood in the peritoneal cavity with contrast extravasation from the omentum. The patient underwent successful emergency laparotomy, peritoneal lavage and greater omentectomy to achieve hemostasis.

BACKGROUND: Omental hemorrhage results from rupture of the omental vessels. There are many causes of omental hemorrhage including trauma, aneurysm, and vasculitis. Idiopathic omental hemorrhage is a rare cause of an acute abdomen, which is potentially life-threatening. We report a patient with idiopathic omental hemorrhage, which may have been caused by overeating.
METHODS: A 29-year-old man without a history of trauma, bleeding disorders, or other significant medical history, presented with left upper quadrant pain, which began after overeating the previous evening. The pain worsened and he presented to the emergency department. On physical examination, his BP was 111/69mmHg and pulse 71 and he reported tenderness and involuntary guarding in the left upper quadrant on palpation. Contrast enhanced computed tomography scan revealed intraperitoneal fluid collection with intra-omental extravasation. Significant intraperitoneal hemorrhage was suspected and emergency laparotomy was performed. On exploring the abdominal cavity, a hematoma was found in the greater omentum, adjacent to the right gastroepiploic artery. No active bleeding was seen, and partial omentectomy was performed. There were no obvious lesions suggestive of malignancy or aneurysm, supporting the diagnosis of idiopathic omental hemorrhage. On postoperative day six, the patient developed a wound dehiscence, which was surgically closed. The subsequent postoperative course was uneventful and he was discharged on fifth day after the second operation.
CONCLUSIONS: Idiopathic omental hemorrhage is a rare cause of an acute abdomen, which may develop after eating. Omentectomy is preferred to ligation or transcatheter arterial embolization to rule out an underlying malignancy or aneurysm.