Omental Infarction Presenting as Right Iliac Fossa Pain: A Rare Radiological Diagnosis

Omental infarction is a rare, benign cause of acute abdominal pain that frequently mimics appendicitis. Its recognition via imaging is essential to avoid unnecessary surgical intervention and guide evidence-based conservative management. This report aims to emphasize the diagnostic role of contrast-enhanced computed tomography (CT) in differentiating omental infarction from appendicitis, which is essential to avoid unnecessary surgical intervention and guide management. We report a case of a 40-year-old obese man who presented with acute right iliac fossa pain, clinically suggestive of appendicitis. Laboratory tests revealed normal inflammatory markers (white cell count = 5.6 × 10⁹/L; C-reactive protein = 9 mg/L). Contrast-enhanced CT demonstrated a 5 × 4 cm heterogeneous fatty lesion with surrounding inflammatory fat stranding, peritoneal thickening, and mild vessel engorgement in the right iliac fossa, with a normal appendix, findings consistent with primary omental infarction. The patient was managed conservatively with analgesics and anti-inflammatory medication, resulting in complete symptom resolution within five days. CT remains the diagnostic gold standard for omental infarction, typically showing an ovoid fatty mass with hyperattenuating streaks and a preserved appendix. Differentiation from appendicitis is crucial to guide non-operative management. This case highlights the importance of prompt CT evaluation in patients with atypical right iliac fossa pain. Recognizing the radiological features of omental infarction allows evidence-based conservative treatment, prevents unnecessary appendectomy, and reinforces the value of imaging-guided decision-making in acute abdomen.