Surgical Complication of Omental Infarction in Ulcerative Colitis Following Laparoscopic Colectomy

Omental infarction is a rare cause of acute abdomen, often mimicking more common abdominal emergencies such as appendicitis and cholecystitis, presenting significant diagnostic challenges. A 47-year-old male with a history of ulcerative colitis underwent laparoscopic total colectomy with end ileostomy. Postoperatively, he developed severe abdominal pain, chills, nausea, and increased abdominal distension. Despite having output from his ileostomy, his symptoms persisted. A CT scan revealed free intraperitoneal air and significant intra-abdominal fluid, indicating potential intra-abdominal injury. Diagnostic laparoscopy identified an infarcted omentum and 850 mL of hemoperitoneum. An omentectomy was performed, and the patient received supportive care postoperatively, leading to gradual improvement in symptoms and recovery. In this case, surgical intervention was required due to severe symptoms, diagnostic uncertainty, and associated hemoperitoneum. While conservative management has been described in stable cases, this approach was not appropriate for our patient. Advanced imaging techniques, particularly CT, remain crucial for identifying omental infarction, but clinical judgment and individual patient factors ultimately guide management decisions.