title: Idiopathic omental hemorrhage: A case report and review of the literature.
abstract: BACKGROUND
  Omental hemorrhage results from rupture of the omental vessels. There are many causes of omental hemorrhage including trauma, aneurysm, and vasculitis. Idiopathic omental hemorrhage is a rare cause of an acute abdomen, which is potentially life-threatening. We report a patient with idiopathic omental hemorrhage, which may have been caused by overeating.
  
  
  METHODS
  A 29-year-old man without a history of trauma, bleeding disorders, or other significant medical history, presented with left upper quadrant pain, which began after overeating the previous evening. The pain worsened and he presented to the emergency department. On physical examination, his BP was 111/69mmHg and pulse 71 and he reported tenderness and involuntary guarding in the left upper quadrant on palpation. Contrast enhanced computed tomography scan revealed intraperitoneal fluid collection with intra-omental extravasation. Significant intraperitoneal hemorrhage was suspected and emergency laparotomy was performed. On exploring the abdominal cavity, a hematoma was found in the greater omentum, adjacent to the right gastroepiploic artery. No active bleeding was seen, and partial omentectomy was performed. There were no obvious lesions suggestive of malignancy or aneurysm, supporting the diagnosis of idiopathic omental hemorrhage. On postoperative day six, the patient developed a wound dehiscence, which was surgically closed. The subsequent postoperative course was uneventful and he was discharged on fifth day after the second operation.
  
  
  CONCLUSIONS
  Idiopathic omental hemorrhage is a rare cause of an acute abdomen, which may develop after eating. Omentectomy is preferred to ligation or transcatheter arterial embolization to rule out an underlying malignancy or aneurysm.
authors.affiliation: Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. Electronic address: me17022@s.okadai.jp.
authors.forename: Jiro
authors.initials: J
authors.lastname: Kimura
authors.affiliation: Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. Electronic address: kenjioku620@gmail.com.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okumura
authors.affiliation: Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. Electronic address: x62h20k38@yahoo.co.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Katagiri
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan. Electronic address: alefor@jichi.ac.jp.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. Electronic address: kenmi@jadecom.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Mizokami
authors.affiliation: Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. Electronic address: tadaokubota@me.com.
authors.forename: Tadao
authors.initials: T
authors.lastname: Kubota
keywords: Acute abdomen; Idiopathic omental hemorrhage; Laparotomy; Omentectomy