Omental apoplexy: Unravelling the mystery

Abstract

Introduction To describe cases omental haemorrhage and to review the literature on this topic. Methods We describe three cases of spontaneous omental haemorrhage and discuss various management strategies, in an attempt to provide direction for similar cases in the future. Results A number of case reports of spontaneous or idiopathic omental haemorrhage exist in the literature. These cases are often attributed to an underlying vasculopathy, such as segmental arterial mediolysis (SAM). Appropriate resuscitation is paramount for best outcome. Severe bleeding may require surgery or transcatheter arterial embolisation, which is best performed early if required. Endovascular management using selective catheterisation of the bleeding vessel and embolisation is a minimally invasive alternative to emergent operative intervention. In the three cases we present, endovascular embolisation was performed in two patients, and surgical ligation in a third. Segmental arterial mediolysis is considered the likely aetiology in at least 2 of the 3 cases, based on imaging findings. No further episodes of haemorrhage occurred at follow‐up (ranging from 6 months to 2 years). Conclusions Acute omental haemorrhage is a rare condition; however, it may be associated with significant morbidity and mortality. CT angiography is the imaging of choice. Management strategies include both endovascular and surgical intervention.

Idiopathic omental hemorrhage: a case report and review of the literature

“…The cases presented in this manuscript are spontaneous, with no history of trauma, coagulopathy, or comorbidities, except for two [ 6 , 7 ]. Abdominal pain was reported by all patients.…”

“…Omental hemorrhage commonly presents in male patients with abdominal pain and occasionally with nausea, vomiting, or diarrhea. However, some of our included cases may not have had any other abdominal symptoms [ 6 , 8 – 13 ].…”

“…Ultrasonography, computed tomography scan with contrast, chest x-ray [ 5 ], angiography [ 6 ], MRI with contrast, and paracentesis [ 5 ] may be useful to establish the diagnosis.…”

Idiopathic omentum hemorrhage as a cause of hemoperitoneum

“…От селезеночной артерии отходит левая желудочно-сальниковая артерия. Правая желудочно-сальниковая артерия является одной из двух конечных ветвей гастродуоденальной артерии [1][2][3].…”

“…Кровоизлияние в большой сальник неустановленной причины, или так называемое идиопатическое сальниковое кровотечение, возникает при отсутствии морфологических изменений, которые могли бы привести к кровотечению из сосудов большого сальника [6]. Сообщается, что до 30 % случаев могут быть идиопатическими [2,7,8].…”