Đau bụng cấp do nhồi máu mạc nối lớn: Thông báo ca lâm sàng

Abstract

The omentum is the largest peritoneal fold in the abdomen with many blood vessels. Omental infarction is a rare cause of acute abdominal pain with reported incidence being less than 4 per 1000 cases of appendicitis. In most cases, omental infarction were caused by rotation, torsion of the omentum or intraabdominal infection which induces obstruction of vessels and leads to omental necrosis. Clinical manifestations were nonspecific, so many patients went through surgery only with acute abdominal signs such as cholecystitis, appendicitis or peptic ulcer perforation. Historically, omental infarction was diagnosed only intraoperatively during surgery for presumed appendicitis or other causes of acute abdomen. But with the increase in the use of imaging, especially abdominal computed tomography (CT) scan, more cases of omental infarction were being diagnosed preoperatively. We report two patients who were referred to our emergency department for right lower quadrant abdominal pain. CT showed signs of infiltration, thickening of the omentum. We performed emergency laparoscopic omentectomy. These patients were discharged within 3 days. Conclusion: greater omental infarction was one of the rare causes of acute abdominal pain so difficult to accurately diagnose before surgery. Laparoscopic omentectomy was recommended to initiate  as early as possible with good outcomes.