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We report a case of a 33-year-old, 28-week pregnant woman who presented to our suburban emergency department twice with symptoms of upper abdominal pain. She had a benign examination result, which elicited only mild tenderness and fullness in the right upper quadrant. Complete laboratory and radiographic studies, including computed tomographic scan of the chest, revealed only herniation of the left lobe of the liver through a divarication of the abdominal wall. At laparoscopic surgery, she was noted to have omental infarction, apparently secondary to entrapment and vascular compromise from postoperative adhesions. Omental infarction is a rare condition, which has been associated with obesity, blunt trauma, heavy lifting, occupational vibration, and laxative use. Pregnancy has not been considered a risk factor. Emergency physicians should be aware of this rare entity, which mimics a variety of more common causes of abdominal pain.
A 33-year-old, 28-week pregnant woman with a medical history of ectopic pregnancy (treated with left salpingectomy) and endometriosis presented to our suburban emergency department complaining of right upper quadrant abdominal pain that began several days prior. She described her symptoms as a constant "gnawing" 4/10 pain with occasional radiation to her left upper quadrant. The pain was alleviated by standing and exacerbated by sitting and laying supine. The patient also reported intermittent shortness of breath, pleuritic chest pain, and dizziness but denied any recent history of trauma, gastrointestinal illnesses, or prior similar symptoms. She had been evaluated in the emergency department for identical symptoms 2 days prior and discharged home after complete blood count, basic metabolic panel, troponin, and chest x-ray were unremarkable. A chest computed tomographic (CT) revealed subxiphoid ventral abdominal wall divarication with a portion of the left lobe of liver herniating through the defect; there was a suggestion of a small area of arteriovenous shunting in...