Diagnosis of Primary Omental Infarction and Epiploic Appendagitis Using Computed Tomography

Omental infarction and epiploic appendagitis are rare conditions characterized by fat tissue necrosis and clinically presenting with acute abdominal pain. Omental infarction and epiploic appendagitis can mimic various acute urological, surgical, and obstetric-gynecological diseases depending on pain localization. These conditions can be classified as primary or secondary, i.e. those of unknown origin or those resulting from a definite cause. It is generally believed that primary appendagitis is more common than primary omental infarction. Currently, there is no evidence-based consensus on the most optimal treatment approach for omental infarction and epiploic appendagitis. However, most experts agree that these conditions are self-limiting and tend to resolve spontaneously. Consequently, accurate detection and differentiation from other acute abdominal conditions requiring urgent surgery are crucial. For omental infarction and epiploic appendagitis, computed tomography remains the primary imaging modality in emergency diagnostics, as it is superior to clinical examination and blood chemistry in terms of sensitivity and specificity. The article reviews predisposing factors and anatomical prerequisites for primary omental infarction and epiploic appendagitis. It also details characteristic computed tomography signs that may be used to differentiate omental infarction and epiploic appendagitis between each other and from other acute abdominal conditions. Although computed tomography may identify typical signs of these conditions, the differentiation between primary omental infarction and epiploic appendagitis can sometimes be challenging. Therefore, the term “intra-abdominal focal fat infarction” is recommended.