Omental cakes: colonic involvement by omental metastases

The authors describe 7 cases of pelvic malignancy (4 ovarian, 1 bladder, 1 cervical, and 1 endometrial) in which pathological examination demonstrated involvement of the transverse colon by contiguous spread from the greater omentum. Most patients had a pelvic mass at the time of presentation. All also had evidence of intraperitoneal seeding in the anterior rectosigmoid, the superior border of the sigmoid, or the medial border of the cecum, ascending colon, or ileum. Barium-enema examination showed predominant involvement of the superior border of the transverse colon with a mass effect, nodularity, and tethered mucosal folds, although focal or diffuse areas of circumferential narrowing were also identified. This appearance may be indistinguishable from direct extension of gastric carcinoma via the gastrocolic ligament; however, a pelvic mass or intraperitoneal colonic seeding should alert the radiologist to possible malignant spread from the greater omentum.