Spontaneous segmental infarction of the greater omentum.

Spontaneous segmental infarction of the greater omentum, although rare, is probably more common than the 112 reported cases suggest, but its sporadic occurrence has lent itself more to isolated case reports than to an extensive overview of the disease. Despite the frequent preoperative diagnosis of appendicitis, the presentation and course are seldom typical of appendicitis. Progressive peritoneal signs finally dictate surgical exploration. A vertical incision provides the best access to the involved organs and should be used whenever the diagnosis of appendicitis is in doubt. A surgeon who encounters free serosanguineous peritoneal fluid and a normal appendix should suspect omental disease. No convincing etiology has yet been advanced although blunt trauma, whether substantial or trivial, may account for some cases. The close temporal and geographic relation of two of these cases has raised the question of infectious etiology; however there was no microbiologic or pathologic evidence of bacterial or viral infection.