Omental cake

A 48-year-old woman without systemic disease presented to the emergency department with a 2-month history of abdominal pain and distension. General malaise, anorexia, alternating constipation and diarrhea, and intractable hiccups were also noted. Physical examinations revealed a soft and distended abdomen without an obvious tender point. Routine laboratory tests were unremarkable except for mild anemia with a hemoglobin level of 11.7 g/dl. Focused abdominal ultrasound was performed by the emergency physician revealed ascites and multiple echogenic implants over the parietal peritoneum (Fig. 1). Computed tomography of the abdomen was arranged and showed diffuse peritoneal infiltration and ascites (Fig. 2).

Fig. 1

Ultrasound revealing ascites formation and presence of multiple echogenic lesions over the parietal peritoneum

Fig. 2

Computed tomography of the abdomen revealed diffuse peritoneal infiltration and ascites

Diffuse peritoneal infiltration (omental cake) occurs most commonly as secondary to intraperitoneal tumor spread. Other less common causes of the peritoneal infiltration include inflammatory conditions such as tuberculosis, Crohn’s disease, phlegmonous pancreatitis, granulomatous enterocolitis, benign disease (desmoid fibroma, extramedullary hematopoiesis, and hemoperitoneum), and malignant disease entities [1]. An omental cake is classically associated with ovarian carcinoma, but it may also be seen with carcinomatosis and lymphomatosis, mesothelioma, primary peritoneal serous carcinoma, tubal carcinoma, and rarely, cholangiocarcinoma [2]. A computed tomography (CT) scan is an effective method for detection of peritoneal disease. CT images along with CT-guided or laparoscopically assisted biopsy of the peritoneal core is required for a definite diagnosis of the disease entities.