Korean J Radiol.  2011 Dec;12(6):757-760. 10.3348/kjr.2011.12.6.757.

Secondary Omental Infarction Related to Open and Laparoscopic-Assisted Distal Gastrectomy: Report of Two Cases

• Park KE
• Chung DJ
• Kim W
• Hahn ST
• Lee JM

• KMID: 1101933
• DOI: http://doi.org/10.3348/kjr.2011.12.6.757

Abstract

Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

Keyword

Omental infarction; Gastrectomy; CT; Carcinomatosis peritonei

MeSH Terms

Aged
Female
Gastrectomy/*adverse effects
Humans
Infarction/*etiology/radiography
Laparoscopy/*adverse effects
Middle Aged
Omentum/*blood supply/radiography/surgery
Stomach Neoplasms/surgery
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Omental infarction after open distal gastrectomy. A. Post-operative 6 months follow-up contrast enhanced abdominal CT scan shows typical area of ill-defined interspersed fatty lesion with hyperattenuating streaky infiltration in left subphrenic space which is remnant greater omentum (arrow). B. Post-operative 6 months follow-up axial F18-FDG PET-CT scan shows no abnormal FDG uptake at heterogeneous fatty lesion on contrast enhanced CT scan (arrow). C. Axial contrast enhanced CT performed 6 months later shows decrease in size and development of hyperdense rim surrounding omental infarct (arrows).

• 

  Fig. 2 Omental infarction after laparoscopic-assisted distal gastrectomy. A. Contrast enhanced abdominal CT of patient with right upper abdominal pain at postoperative day 10. Axial contrast enhanced CT shows about 4 cm sized ill-defined heterogeneous fat mass with peripheral enhancing rim and streaky infiltration in omentum, anterior to pancreas head consistent with omental infarction (arrow). This mass closely abut on duodenal stump, but no abnormal wall thickening or inflammatory change in duodenal stump. B, C. Follow-up contrast enhanced CT (B) and PET-CT (C) at 6 months later show almost regression of previous noted lesions with remained mild omental streaky infiltration and no abnormal FDG uptake at remnant greater omentum (arrows).

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