A CASE OF IDIOPATHIC OMENTAL HEMORRHAGE

Abstract

A 51-year-old man was seen at the emergency clinic in our hospital because of gradually enhancing epigastralgia which suddenly appeared in the evening. There were no abnormal physical findings except tenderness from the epigastric region to right lower quadrant of the abdomen. An abdominal CT scan showed retention of ascites covered in a wide range from around the liver and the pancreas to the Douglas' pouch. Also a localized low density area just under the right abdominal wall compressed the intestine dorsad and a high density area detected within it, which was suggestive of leakage of contrast medium. Abdominal puncture disclosed bloody ascites, and abdominal angiography showed leakage of contrast medium from peripheral branches of the omental artery. Hence intraabdominal hemorrhage due to omental bleeding was diagnosed. An emergency operation was done on the same day, when laparoscopic observation of the entire abdominal cavity revealed massive hematoma on the greater omentum at the right lower abdomen. After a small incision was made on the midline in the vicinity of the bleeding site, the greater omentum was pulled out outside the body, and the bleeding site was identified, and was stopped by sutures.
Idiopathic omental hemorrhage of unknown origin is a rare entity. This disease must be kept in mind as a probable differential diagnosis for sudden onset of intraabdominal hemorrhage.