A rare diagnosis of abdominal pain presentation in the emergency department

Abstract

Rationale:Idiopathic omental bleeding is a rare cause of acute abdomen, with only a few reported cases. It usually presents with abdominal pain and may be life-threatening. As it rarely occurs, it may not be considered initially during patient presentation.Patient concerns:A 35-year-old male came to our emergency department with abdominal pain present for around 5 to 6 hours. The patient complained of left upper quadrant abdominal pain after eating breakfast. The only associated symptom was 3 episodes of vomiting up food. Physical examination revealed mild left upper quadrant abdominal tenderness without muscle guarding or rebounding pain. Blood examination showed leukocytosis with neutrophil predominance and C reactive protein elevation. The pain was persistent and relief was not obtained by medication.Diagnoses:Computed tomography showed a large lobular-contour homogenous slightly hyperdense lesion without enhancement along the greater curvature of the stomach in the lesser sac. A surgeon was consulted and laparotomy was suggested. Hematoma was found at Morrison pouch, subsplenic fossa, and lesser sac under operation.Intervention:Laparotomy and ligation for hemostasis.Outcomes:The patient was discharged with stable condition after 7 days of hospitalization.Lessons:This diagnosis should be considered in patients presenting with epigastric pain and vomiting after eating while in the emergency department because this disease might be life-threatening. This case highlights 2 important learning points. First, idiopathic omental bleeding could occur after eating in patients without underlying disease or trauma history, and this disease should be taken into consideration when acute abdomen occurs. Second, emergent laparotomy is indicated if the cause of acute abdomen is not clear.

Idiopathic pseudoaneurysmal omental bleeding, a rare cause of life-threatening acute abdomen

“…Omental bleeding often presents as abdominal pain, especially over the epigastric area, and is accompanied with nausea, vomiting, diarrhoea, but can present with haemorrhagic shock and in severe cases, with abdominal compartment syndrome. Omental pseudoaneurysm can mimic other presentations of the acute abdomen with some case series mistakenly assessing omental bleeding as possible appendicitis or viscus perforation pre-operatively [ 4 , 7 ].…”

Hidden hemorrhage: A case of idiopathic omental hemorrhage causing spontaneous hemoperitoneum

“…A brief review on PubMed yields 14 pertinent English‐language publications containing “idiopathic omental hemorrhage,” all of which are case reports. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 The majority of patients are male, aged 20–65, presenting with abdominal pain of varied locations and duration ranging from hours to days. Few patients had predisposing conditions.…”

Omental apoplexy: Unravelling the mystery

“…Hypertension and coagulopathy due to either haematological disorder or anticoagulants/ antiplatelet agents may also contributed to episodes of spontaneous intra‐abdominal haemorrhage. Rarer causes of omental haemorrhage include reports of those secondary to rupture of omental varices 5‐9 . It is reported that up to 30% of cases may be idiopathic 10…”