PubMed Health⌕ Search

Biomedical subjects

Samuel E Wilson

Publications and source records attributed to Samuel E Wilson.

At least 37 records · Page 2Linked to original sources
PubMed2005

Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery.

HYPOTHESIS: An increase in national utilization of bariatric surgery correlates with the dissemination of laparoscopic bariatric surgery. DESIGN: Evaluation of Nationwide Inpatient Sample data from 1998 through 2002. SETTING: National database. PATIENTS: A total of 188,599 patients underwent bariatric surgery for the treatment of morbid obesity. MAIN OUTCOME MEASURES: Annual total number of bariatric operations, the proportion of Roux-en-Y gastric bypass vs gastroplasty, the proportion of laparoscopic cases, postoperative length of stay, crude in-hospital mortality, and the number of institutions that perform bariatric surgery. RESULTS: Between 1998 and 2002, the number of bariatric operations increased from 12,775 cases to 70,256 cases. The rate of bariatric surgery increased from 6.3 to 32.7 procedures per 100,000 adults. Laparoscopic bariatric surgery increased from 2.1% to 17.9%. The number of bariatric surgeons with membership in the American Society for Bariatric Surgery increased from 258 to 631, and the number of institutions that perform bariatric surgery increased from 131 to 323. During this 5-year period, the annual rate of laparoscopic bariatric surgery increased exponentially (by 44-fold) compared with a linear growth in open bariatric surgery (by 3-fold). CONCLUSIONS: Between 1998 and 2002, there was a 450% increase in the number of bariatric operations performed in the United States, a 144% increase in the number of American Society for Bariatric Surgery bariatric surgeons, and a 146% increase in the number of bariatric centers. The growth of laparoscopic bariatric surgery during this 5-year period greatly exceeds that of open bariatric surgery.

Adult↗
PubMed2005

Glycolide copolymer staple-line reinforcement reduces staple site bleeding during laparoscopic gastric bypass: a prospective randomized trial.

HYPOTHESIS: The use of staple-line reinforcement sleeves during laparoscopic gastric bypass reduces staple-line bleeding, which may translate into a reduction in the rate of gastrointestinal hemorrhage. DESIGN: Prospective randomized trial. SETTING: University hospital. PATIENTS AND INTERVENTIONS: Thirty-four patients undergoing laparoscopic gastric bypass were randomly assigned to receive either no reinforcement (control group, n = 17) or reinforcement of the staple line with glycolic copolymer sleeves (treatment group, n = 17). MAIN OUTCOME MEASURES: Demographic data, the number of stapler loads used, the number of staple-line bleeding sites, the amount of blood loss, the length of time required to obtain hemostasis of the staple lines, operative time, intraoperative and postoperative complications, and serial hemoglobin levels. RESULTS: The mean number of stapler loads used was similar between groups. The mean number of staple-line bleeding sites was significantly fewer in the treatment group for division of gastric tissue (0.4 vs 2.5 bleeding sites), jejunal tissue (0.1 vs 0.6 bleeding site), and mesenteric tissue (0 vs 0.8 bleeding site). The mean blood loss was lower in the treatment group (84 vs 129 mL). Staple misfire occurred in 1 (0.7%) of 143 stapler loads used in the treatment group compared with 0 (0%) of 138 stapler loads used in the control group. The time to obtain staple-line hemostasis was shorter in the treatment group (1.2 vs 10.1 minutes). The total operative time was similar between groups. There was no mortality or postoperative leaks. One patient in the control group had postoperative gastrointestinal hemorrhage requiring blood transfusion and reoperation. There was no significant difference in the mean hemoglobin level between groups on the first postoperative day. CONCLUSIONS: The use of glycolide copolymer staple-line reinforcement sleeves in patients undergoing laparoscopic gastric bypass is safe and significantly reduces staple-line bleeding sites and may reduce the incidence of gastrointestinal hemorrhage.

Adult↗
PubMed2005

Empiric treatment of nosocomial intra-abdominal infections: a focus on the carbapenems.

BACKGROUND: Serious nosocomial intra-abdominal infections are associated with high morbidity and mortality and represent a substantial drain on healthcare resources. Effective management of this type of infection requires the early use of appropriate, broad-spectrum empiric antimicrobial therapy. The consequences of delayed or inappropriate antimicrobial treatment can be severe-leading to an increased risk of death, re-operation, or prolonged hospitalization. Therefore, it is necessary to begin treatment as soon as possible with the most appropriate regimen, in terms of spectrum, timing, and duration. METHODS: Review of pertinent English-language literature. RESULTS: Serious nosocomial intra-abdominal infections require broad-spectrum coverage because of the wide range of possible pathogens, which include difficult-to-treat organisms such as Pseudomonas aeruginosa and Bacteroides spp., and resistant strains of Klebsiella spp., Escherichia coli, and methicillin-resistant Staphylococcus aureus acquired from the hospital flora. The early use of appropriate, broad-spectrum empiric antimicrobial therapy for treating high-risk patients with intra-abdominal infections is considered, and appropriate use of the carbapenems, meropenem, and imipenem/cilastatin, is described. CONCLUSION: The carbapenems meropenem and imipenem/cilastatin have a spectrum of antimicrobial activity that covers the majority of expected pathogens, including anaerobes, as well as difficult-to-treat and resistant gram-negative strains. Early and appropriate use can reduce mortality and morbidity. Data from published clinical trials support the clinical effectiveness of these two carbapenems in intra-abdominal infections.

Abdominal Cavity↗
PubMed2005

Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver.

In a subset of super-obese patients, the one-stage laparoscopic Roux-en-Y gastric bypass (RYGBP) can be associated with significant morbidity and mortality. In a previous effort to reduce the perioperative risks associated with the super-obese, a two-stage operation was devised. This two-stage operation consisted of a sleeve gastrectomy (1st stage) followed by a RYGBP or duodenal switch procedure (2nd stage). We find that the primary limiting factor making laparoscopic gastric bypass challenging in the super-obese is the volume of the left lobe of the liver. A greatly thickened left lobe of the liver obscures visualization of the gastroesophageal junction and angle of His so that a sleeve gastrectomy is difficult to construct. In this report, we describe a novel method utilizing a staged Roux-en-Y procedure. Instead of performing a restrictive operation (sleeve gastrectomy) as the initial procedure, we fashion a modified Roux-en-Y with a low gastrojejunal anastomosis and a larger gastric pouch encompassing the gastric fundus. The low anastomosis obviates the need for exposure of the gastro-esophageal junction and angle of His. At the 2nd stage procedure, completion sleeve gastrectomy of the gastric fundus is performed at an interval of 6-12 months after the 1st stage operation.

Anastomosis, Roux-en-Y↗
PubMed2005

Systemic upregulation of leukocyte integrins in response to lower body ischemia-reperfusion during abdominal aortic aneurysm repair.

Ischemia and reperfusion in myocardial infarction and stroke are associated with upregulation of leukocyte adhesion molecules, which contributes to tissue injury by facilitating leukocyte adhesion and infiltration in the affected tissues. Surgical repair of the abdominal aortic aneurysm involves clamping and declamping of the aorta, which necessarily results in ischemia and reperfusion of the lower half of the body. Given the large volume of the affected tissues and unimpeded venous return during reperfusion, we hypothesized that the procedure may result in upregulation of leukocyte integrins in the systemic circulation. To test this hypothesis, we studied neutrophil and monocyte surface densities of CD11b and CD18 in patients undergoing elective infrarenal abdominal aortic aneurysm repair. Serial blood samples were collected from the radial artery and femoral vein during the operation and leukocyte CD11b and CD18 surface densities were quantified by flow cytometry. Following reperfusion, CD11b expression in neutrophils and monocytes increased significantly in femoral venous and arterial blood. The mean time to peak expression of CD11 b in neutrophils and monocytes during reperfusion was 34.4 and 31.4 minutes in venous and 38.5 and 36.4 minutes in arterial blood, respectively. Similar rises in CD18 expression on neutrophils and monocytes were observed in venous and arterial blood. The mean time to peak expression of CD18 in neutrophils and monocytes during reperfusion was 34.0 and 40.0 minutes in venous and 47.5 and 50.0 minutes in arterial blood, respectively.

Aged↗
PubMed2005

Bioabsorbable staple line reinforcement for laparoscopic gastrointestinal surgery.

Laparoscopic gastrointestinal (GI) surgery often requires transection and reconstruction of the GI tract and division of vascular pedicles. Intraoperative staple line bleeding and postoperative GI hemorrhage are reported complications. Prevention of staple line bleeding includes oversewing of the staple line or more recently the use of staple line reinforcement sleeves as an adjunct on the stapler. The results of bioabsorbable glycolide copolymer sleeves (Seamguard, W.L. Gore & Associates, Inc., Flagstaff, AZ, USA) as staple line reinforcement during 44 laparoscopic GI operations were reviewed. The charts were analyzed retrospectively for demographics, quantity of staple line reinforcement material used, operative time, blood loss, intraoperative complications, postoperative bleeding or leak, and serial hemoglobin. The study group of 44 patients included 17 males and 27 females, with a median age of 44 years. The laparoscopic GI operations performed were laparoscopic cystgastrostomy (n=1), esophagus cancer staging (n=2), esophagectomy (n=2), colectomy (n=3), gastrectomy (n=5), appendectomy (n=9), and Roux-en-Y gastric bypass (n=22). The median number of staple line reinforcement sleeves used per operation was one for appendectomy and laparoscopic cancer staging, five for gastrectomy and esophagectomy, and seven for gastric bypass and colectomy. The mean blood loss was 86 +/- 22 mL. No intraoperative staple line disruptions occurred. Intraoperative staple line bleeding was minimal and few staple lines required oversewing. One patient developed GI hemorrhage on postoperative day five after being involved in a motor vehicle accident. The mean hemoglobin decreased from 13.9 +/- 1.6 g/dL at baseline to 12.6 +/-1.4 g/dL on the first postoperative day. No postoperative leaks or abscesses occurred. This study demonstrates that bioabsorbable glycolide copolymer staple line sleeves is safe and effective in prevention of intraoperative staple line bleeding and postoperative GI hemorrhage in 44 intra-abdominal GI operations.

Absorbable Implants↗
PubMed2004

Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions.

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF K/DOQI) guidelines have advocated autogenous arteriovenous fistulae as a primary procedure for hemodialysis access. This study compared the clinical outcomes between autogenous and prosthetic arteriovenous hemodialysis accesses, determining factors contributing to primary and secondary patency and function. Associated risk factors and number of interventions required to maintain secondary patency in each cohort were also assessed. A vascular database review of consecutive hemodialysis access procedures performed during a 36-month period (January 1999 to December 2001) at an academic institution was conducted. Life-table and log-rank analyses were used to analyze patency rates. Univariate and multivariate analysis was used to analyze risk factor influence on patency and function. A total of 231 upper extremity arteriovenous access procedures were performed in 209 patients during this period. One hundred autogenous accesses were created in 100 patients, 68 being forearm Brescia-Cimino arteriovenous fistulae. A total of 131 prosthetic accesses (ePTFE) grafts were also placed during this period in 109 patients. The demographic profiles of both cohorts were similar. Primary patency at 1 and 2 years was 56% (CI 45-76%) and 39% (CI 28-50%), respectively, in the autogenous group, and 36% (CI 26-45%) and 9% (CI 3-14%), respectively, in the prosthetic group. Differences in secondary patency at 1 year and 2 years were not significant (64% [CI 54-74%] and 53% [CI 42-65%] in the autogenous group vs. 65% [CI 55-73%] and 46% [CI 36-55%] in the prosthetic group). Secondary interventions were required in 87% of the prosthetic cohort (average 0.92 procedures/patient/year) and 57% of the autogenous cohort (average 0.53 procedures/patient/year). Multivariate analysis of associated risk factors demonstrated no significant effects on either primary or secondary patency in both groups. Autogenous accesses have superior primary patency and maintain equal secondary patency with significantly fewer interventions. These data strongly support the NKF K/DOQI guidelines recommending creation of autogenous access whenever possible. These outcomes can provide significant health-care cost benefits when using an algorithm favoring primary creation of autogenous access for hemodialysis.

Adult↗
PubMed2004

Duodenocaval fistula: a late complication of retroperitoneal irradiation and vena cava replacement.

Duodenocaval fistula (DCF), an unusual pathology, is associated with a 40% mortality rate in the 36 patients previously reported. Although migrating or ingested foreign bodies, trauma, and peptic ulcer disease are often described etiologies, 11 patients have been described who developed DCF after resection of retroperitoneal tumors, 9 of whom also had postoperative radiotherapy. We report two patients who developed DCF after resection of retroperitoneal tumors followed by radiation therapy. The first patient, a 56-year-old female, presented with upper gastrointestinal hemorrhage requiring transfusion caused by a duodenoprosthetic caval fistula 7 years after successful resection of a retroperitoneal leiomyosarcoma and replacement of the inferior vena cava followed by radiation and chemotherapy. The second patient, a 37-year-old male who had previously undergone resection of a retroperitoneal sarcoma followed by external radiotherapy, developed massive upper and lower gastrointestinal bleeding secondary to a duodenocaval fistula. The etiology, diagnosis, and treatment of DCF are analyzed with an emphasis on DCF following resection and irradiation of retroperitoneal tumors. In most patients, "spontaneous" DCF have occurred as a late complication of high-dose radiation for carcinoma of the right kidney or retroperitoneal structures.

Adult↗
PubMed2004

Significant correlation of trauma epidemiology with the economic conditions of a community.

HYPOTHESIS: Depressed economic conditions are associated with increased trauma and violent crime. DESIGN: Retrospective cohort study of prospectively collected data. SETTING AND INTERVENTIONS: Population and labor force data from 1992 to 2002 were obtained from the state Employment Development Department and the US Census Bureau. County data regarding the total number of trauma activations and mechanism of trauma were recorded. Crime statistics were obtained from the state Department of Justice and the Federal Bureau of Investigation. Correlation statistics were performed. Health care coverage for victims of penetrating trauma was also analyzed. MAIN OUTCOME MEASURES: Correlation between unemployment rate, trauma epidemiology, and crime indexes. RESULTS: The correlation between the percentage penetrating trauma and the unemployment rate was R = 0.92 (Orange County, California) and R = 0.95 (Los Angeles County, California) (P<.001). The unemployment rate was also tightly correlated with Federal Bureau of Investigation crime indexes in both counties and in the state (P<.001). The overall county population was positively correlated with the total number of trauma occurrences in both counties (P<.001) but was negatively correlated with the number of penetrating traumas and crime indexes (P<.001). Seventy-five percent of penetrating trauma victims had no health care coverage or had state or county aid only. CONCLUSIONS: The proportion of violent crime in a community is closely associated with the unemployment rate of that community and will vary longitudinally over time. The overall county population is less important. These data may be used for public policy initiatives regarding resource allocation to trauma centers, law enforcement planning, and programs aimed at crime prevention.

California↗
PubMed2004

Effect of the 80-hour workweek on resident burnout.

HYPOTHESIS: With the introduction of the newly mandated restrictions on resident work hours, we expected improvement in subjective feelings of personal accomplishment and lessened emotional exhaustion and depersonalization. DESIGN: Residents and faculty members completed an anonymous online Maslach Burnout Inventory Human Services Survey (3rd ed; Consulting Psychologist Press Inc, Palo Alto, Calif) and work-hour registry before and after implementation of new restrictions. SETTING: Urban, university-based department of surgery. PARTICIPANTS: All house staff (n = 37) and faculty (n = 27). INTERVENTION: Introduction of new Institutional Standards for Resident Duty Hours 2003. Main Outcome Measure Resident work hours and levels of emotional exhaustion, perceived degree of depersonalization, and personal accomplishment. RESULTS: Resident work hours per week decreased from 100.7 to 82.6 (P < .05) with introduction of the new schedule. Home call and formal educational activity time within working hours (eg, clinical conferences) significantly (P < .05) decreased from 11.5 and 4.8 hours to 4.6 and 2.5 hours per week, respectively. Operating room hours, clinic time, and duration of rounds did not show a significant change. Changes in parameters of resident and faculty emotional exhaustion, depersonalization, and personal accomplishment did not show statistical significance (P > .05). CONCLUSIONS: Despite successful reductions in resident work hours, measures of burnout were not significantly affected. However, important clinical activities such as time spent in the operating room, clinic, and making rounds were maintained. Formal in-hospital education time was reduced.

Burnout, Professional↗
PubMed2004

Dose-dependent inhibition of myointimal hyperplasia by orally administered rapamycin.

Myointimal hyperplasia (MIH) after vascular intervention is a major problem. Recent reports describing elimination of within-stent restenosis by means of rapamycin-eluting stents prompted us to examine the effect of systemic oral rapamycin on MIH induced by arterial trauma. We studied the effect of oral rapamycin on MIH after rabbit aorta balloon injury. Thirty-five New Zealand white rabbits (2.5-3 kg) had aortic injury and were given either no rapamycin (control), 0.1 (low dose) rapamycin mg/kg/day, or 0.4 mg/kg/day (high dose). Rapamycin was started 1 week before injury and continued for 3 (4 weeks total) or 6 weeks (7 weeks total) post-injury. Sections were analyzed to measure aortic intima/media area ratios (I:M) at either 3 or 6 weeks. At 3 weeks, the I:M (mean +/- SD) for controls was 0.53 +/- 0.1; for low dose, 0.17 +/- 0.13; and for high dose, 0.24 +/- 0.07 (p < 0.001 vs. control). At 6 weeks, the I:M for controls was 0.52 +/- 0.12; for low dose-4 weeks, 0.29 +/- 0.15; low dose-7 weeks, 0.33 +/- 0.07; and high dose-4 weeks, 0.47 +/- 0.16. At 6 weeks only the difference between the low dose-4 weeks and control I:M ratios was significant (p = 0.018). The results confirm earlier studies showing that systemic rapamycin inhibits MIH after arterial injury when drug therapy is started before injury. Therapy for 3 or 6 weeks after injury yields similar inhibition, indicating that exposure to the drug early in the response to injury is more important than prolonged exposure. We observed a paradoxical relation between dose and degree of MIH inhibition, with the low dose being more effective than the high dose at both time intervals studied. Overall, the results suggest that oral rapamycin therapy might be a useful adjunct to clinical interventions at risk for development of MIH.

Administration, Oral↗
PubMed2004

Trends in utilization and outcomes of laparoscopic versus open appendectomy.

BACKGROUND: Although a number of trials have analyzed the outcomes of laparoscopic versus open appendectomy, the clinical advantages, and cost-effectiveness of laparoscopic appendectomy in the management of acute and perforated appendicitis are still not clearly defined. The aim of this study was to examine utilization and outcomes of laparoscopic versus open appendectomy using a national administrative database of academic medical centers and teaching hospitals. METHODS: Using ICD-9 diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all patients who underwent appendectomy for acute and perforated appendicitis between 1999 and 2003 (n = 60,236). Trends in utilization of laparoscopic appendectomy were examined over the 5-year period. The outcomes of laparoscopic and open appendectomy were compared including length of hospital stay, 30-day readmission, complications, observed and expected (risk-adjusted) in-hospital mortality, and costs. RESULTS: Overall, 41,085 patients underwent open appendectomy and 19,151 patients underwent laparoscopic appendectomy. The percentage of appendectomy performed by laparoscopy increased from 20% in 1999 to 43% in 2003 (P <0.01). Compared with patients who underwent open appendectomy, patients who underwent laparoscopic appendectomy were more likely female, more likely white, had a lower severity of illness, and were less likely to have perforated appendicitis. Laparoscopic appendectomy was associated with a shorter length of hospital stay (2.5 days vs 3.4 days), lower rate of 30-day readmission (1.0% vs 1.3%), and lower rate of overall complications (6.1% vs 9.6%). There was no significant difference in the observed to expected mortality ratio between laparoscopic and open appendectomy (0.5 vs 0.6, respectively). The mean cost per case was similar between the two groups (US$ 6,242 vs US$ 6,260). CONCLUSIONS: Utilization of laparoscopic appendectomy at academic centers has increased more than two-fold between 1999 and 2003. Patients selected for laparoscopic appendectomy have less advanced appendicitis and have a shorter length of stay and fewer complications without increasing the inpatient care cost.

Adolescent↗
PubMed2004

The practice of bariatric surgery at academic medical centers.

The growing demand for laparoscopic bariatric surgery has led to an increase in the development of new bariatric surgical practices. Proper hospital facilities and an experienced bariatric surgical team are necessary to ensure optimal patient results. We surveyed academic centers participating in the University HealthSystem Consortium to examine the current practice of bariatric surgery. The survey questioned (1) availability of resources and equipment designed for the morbidly obese, (2) accidents, equipment problems, and workers' compensation relating to the care of bariatric surgical patients, (3) credentialing of bariatric surgeons, and (4) suggestions for improvements in the bariatric surgery program. Twenty-five institutions that perform bariatric surgery responded. Although the majority of institutions noted that they had basic bariatric equipment, some organizations did not have facility resources such as high-weight operating room tables and computed tomography scanners or transfer devices. Twenty-eight percent of institutions reported having accidents or equipment problems and 40% of institutions had workers' compensation claims relating to the care of bariatric patients. With regard to credentialing, 60% of institutions required the surgeons to have performed a minimum number of procedures prior to granting privileges. Suggested improvements included the need for more specialized bariatric equipment, enhancement of the education of all members of the bariatric surgical team, and designation of a bariatric physician who would coordinate care. This survey of bariatric surgery practices at academic medical centers demonstrates that the practice of bariatric surgery could be improved with regard to availability of bariatric equipment and resources and credentialing of surgeons.

Academic Medical Centers↗
PubMed2004

The relationship between hospital volume and outcome in bariatric surgery at academic medical centers.

OBJECTIVE: To examine the effect of hospital volume of bariatric surgery on morbidity, mortality, and costs at academic centers. SUMMARY BACKGROUND DATA: The American Society for Bariatric Surgery recently proposed categorization of certain bariatric surgery centers as "Centers of Excellence." Some of the proposed inclusion criteria were hospital volume and operative outcomes. The volume-outcome relationship has been well established in several complex abdominal operations; however, few studies have examined this relationship in patients undergoing bariatric surgery. METHODS: Using the International Classification of Diseases, 9th edition, diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all patients who underwent Roux-en-Y gastric bypass for the treatment of morbid obesity between 1999 and 2002 (n = 24,166). Outcomes of bariatric surgery, including length of hospital stay, 30-day readmission, morbidity, observed and expected (risk-adjusted) mortality, and costs were compared between high-volume (>100 cases/year), medium-volume (50-100 cases/year), and low-volume hospitals (<50 cases/year). RESULTS: There were 22 high-volume (n = 13,810), 27 medium-volume (n = 7634), and 44 low-volume (n = 2722) hospitals included in our study. Compared with low-volume hospitals, patients who underwent gastric bypass at high-volume hospitals had a shorter length of hospital stay (3.8 versus 5.1 days, P < 0.01), lower overall complications (10.2% versus 14.5%, P < 0.01), lower complications of medical care (7.8% versus 10.8%, P < 0.01), and lower costs ($10,292 versus $13,908, P < 0.01). The expected mortality rate was similar between high- and low-volume hospitals (0.6% versus 0.6%), demonstrating similarities in characteristics and severity of illness between groups. The observed mortality, however, was significantly lower at high-volume hospitals (0.3% versus 1.2%, P < 0.01). In a subset of patients older than 55 years, the observed mortality was 0.9% at high-volume centers compared with 3.1% at low-volume centers (P < 0.01). CONCLUSIONS: Bariatric surgery performed at hospitals with more than 100 cases annually is associated with a shorter length of stay, lower morbidity and mortality, and decreased costs. This volume-outcome relationship is even more pronounced for a subset of patients older than 55 years, for whom in-hospital mortality was 3-fold higher at low-volume compared with high-volume hospitals. High-volume hospitals also have a lower rate of overall postoperative and medical care complications, which may be related in part to formalization of the structures and processes of care.

Academic Medical Centers↗
PubMed2004

Accurate diagnosis of infarction of omentum and appendices epiploicae by computed tomography.

Segmental infarction of the omentum and epiploic appendages presents with acute abdominal findings that may be confused with a surgical illness. Computed tomography, however, demonstrates a consistent and well-recognized pattern that allows safe, nonoperative treatment. Infarction of omental or mesenteric fat may present clinically as localized peritonitis, mimicking appendicitis, diverticulitis, or cholecystitis. Spontaneous recovery without operation is to be expected if an accurate diagnosis is established. We describe the diagnosis, treatment, and outcome of 15 patients who had infarction of the greater omentum (eight) and epiploic appendage (seven) and presented with localized abdominal pain and tenderness, with six demonstrating regional peritonitis and fever. All underwent CT imaging during their initial evaluation, and 12 of the 15 patients were diagnosed with focal omental or mesenteric fat infarction radiographically and managed nonoperatively. Three patients who had characteristic CT findings nevertheless underwent operation. All patients had complete resolution of their abdominal pain regardless of treatment. The clinical presentation of infarction of the omental or epiploic appendages may be difficult to differentiate from surgical causes of acute abdominal pain. The characteristic findings on computed tomography are diagnostic and allow safe, conservative management in the majority of patients.

Adolescent↗