Idiopathic Omental Bleeding Treated by Laparoscopic Partial Omentectomy: A Case Report and Review of the Literature

Abstract

Omental bleeding is potentially life-threatening. There are many causes of omental bleeding including trauma, neoplasia, arterial aneurysm rupture, omental torsion, vasculitis, or segmental arterial mediolysis (SAM). Without remarkable pathological features, the diagnosis of idiopathic omental bleeding is made. Omental bleeding is relatively a rare disease, and there is no established treatment strategy.A 53-year-old woman was brought to the ED for sudden onset abdominal pain. CT revealed hematoma in the omentum and was diagnosed as idiopathic omental bleeding accordingly. The patient underwent laparoscopic partial omentectomy and was discharged nine days after surgery. The pathological findings of the resected omentum were not remarkable, and the final diagnosis was made as idiopathic omental bleeding.In some case reports of omental bleeding, interventional radiology (IVR) was chosen for hemostasis, but IVR cannot resect tissue of omentum so it is difficult to make a pathological diagnosis. The surgical approach of idiopathic omental bleeding is uncommon. However, the use of the laparoscopic approach hasn't been reported in the literature. Laparoscopic partial omentectomy can provide effective hemostasis. We report laparoscopic partial omentectomy surgical procedure and review of the literature.

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

“…Early diagnosis and definitive management are of a paramount importance in achieving favourable patient’s outcome. There are many causes of omental bleeding which includes trauma, neoplasia, anticoagulant medications, spontaneous arterial aneurysmal or pseudoaneurysmal rupture, omental torsion, vasculitis, and segmental arterial mediolysis [ 5 ]. Omental artery pseudoaneurysm is scarcely documented in the literature with a higher prevalence seen in men compared to women with a ratio of 6:1 and age of onset ranging widely from 20s to 80s [ 6 ].…”

“…Given the uncommon nature of this disease there are no specific recommendations for treatment. A recent literature review [ 5 ] found only 25 cases of omental bleeding in the literature, with varied management from transcatheter arterial embolization (TAE), laparotomy, or laparoscopy with omentectomy or simple ligation of the bleeding artery.…”

“…Conservative management with regular biochemical monitoring and anticoagulation reversal is limited to stable and clinically well patient [ 12 ]. Given reported cases of re-bleeding after trialling conservative management, aggressive therapy for definitive treatment is preferred [ 5 , 6 ]. Specific management such as TAE have been reported to be effective, however for significantly unstable patients, laparotomy, or laparoscopy with omentectomy remains the mainstay for urgent surgical intervention [ 8 ].…”

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.…”

Spontaneous rupture of a left omental artery aneurysm treated by transcatheter arterial embolization: A case report

“…The treatment of omental bleeding consists of laparotomy, laparoscopy, or TAE [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ].…”