Necrosis of the greater omentum: A rare complication after Hartmann's pouch reversal surgery

Abstract

Omental infarction, a rare condition marked by disrupted blood flow to the omentum and subsequent tissue necrosis, is an unusual complication of colorectal surgery. Even more exceptional is its occurrence following Hartmann’s pouch reversal procedure. We present a case of a 32-year-old male patient who was operated on for perforated diverticulitis. An initial sigmoidectomy combined with the creation of a Hartmann's pouch and descending colostomy was performed. Two months later, a Hartmann's reversal procedure was conducted. Four days postoperatively, the patient developed a fever, leukocytosis (26.18 × 10 ³/µL), and foul wound discharge. Computed tomography (CT) revealed suspicion of greater omental necrosis and an omental abscess, which was confirmed during an emergency laparotomy and surgically treated. Postoperatively, the patient was managed with targeted antibiotics, and his recovery was uneventful, leading to discharge in good health. This case highlights the need to consider rare complications such as omental abscesses and necrosis following colorectal surgeries. We discuss the rarity of this complication, its pathophysiology, and review related literature to provide a comprehensive understanding of the condition.