Idiopathic omental bleeding.

Area of Science:

• Gastroenterology
• Vascular Surgery
• Emergency Medicine

Background:

• Spontaneous omental bleeding, without trauma or identifiable vascular pathology, is an exceptionally rare clinical event.
• The greater omentum, a peritoneal fold, is typically involved in immune responses and fat metabolism, not primary hemorrhage.
• Patients may present with non-specific abdominal pain and hemodynamic instability, mimicking other acute abdominal conditions.

Purpose of the Study:

• To report a rare case of spontaneous omental bleeding in a young female patient.
• To highlight the diagnostic challenges and effective management strategies for this uncommon condition.
• To review the existing literature on omental hemorrhage and its potential etiologies.

Main Methods:

• A case report of a 24-year-old female presenting with acute abdominal pain and tachycardia.
• Diagnostic workup included computed tomography angiography (CTA) to identify the source of bleeding.
• Surgical intervention via exploratory laparotomy with suture ligation of the bleeding omental artery was performed.

Main Results:

• Computed tomography angiography confirmed active extravasation in the right lower quadrant, localized to the omentum.
• Exploratory laparotomy revealed a small bleeding artery within the greater omentum.
• Successful suture ligation of the bleeding vessel and evacuation of two liters of blood resulted in complete patient recovery.

Conclusions:

• Spontaneous omental bleeding, though rare, should be considered in the differential diagnosis of acute abdominal pain, especially in patients on anticoagulants or antiplatelet agents.
• Prompt diagnosis with advanced imaging like CTA and timely surgical intervention are crucial for successful management.
• This case underscores the importance of recognizing and managing this unusual cause of intra-abdominal hemorrhage.