A Case of Laparoscopic Surgery for Idiopathic Segmental Infarction That Was Difficult to Diagnose Preoperatively

Abstract

A 14-year-old female patient visited a local clinic with the chief complaints of nausea and abdominal pain. She was treated with antibiotics for suspected appendicitis, but her condition did not improve and she was referred to our hospital 2 days later. The patient complained of localized pain and examination revealed muscular guarding in the right lower abdomen. Abdominal CT showed no obvious enlargement of the appendix, but a localized low density mass around the appendix and pelvis. The patient was suspected as having acute appendicitis with abscess formation, and we performed laparoscopic surgery. Laparoscopic observation revealed only mild redness of the appendix, whereas the right caudal side of the greater omentum showed a band of dark red discoloration and was adherent to the appendix. The appendix was removed and the discolored greater omentum was resected. The patient showed a good postoperative course and was discharged the day after surgery. The patient was diagnosed as having idiopathic segmental omental infarction. Although this disease is rare, most cases reported in recent years have been diagnosed preoperatively based on CT findings. Conservative treatment is becoming more common. In this case, we were unable to make a correct diagnosis preoperatively and performed an unnecessary appendectomy, which was thought to be mainly due to insufficient awareness about the disease.