Omental infarction as an unusual manifestation of decompensated chronic left heart failure: a rare case report.

Introduction and importance: Omental infarction (OI) is a rare cause of acute abdominal pain, frequently misidentified as appendicitis or diverticulitis. It generally originates from vascular compromise, torsion, or thrombosis and is infrequently associated with left-sided heart failure. This appears to be the inaugural documented instance of OI linked to left-sided heart failure. Case presentation: A 43-year-old man with a history of coronary artery disease and heart failure with reduced ejection fraction (35%) presented with right lower quadrant abdominal pain initially localized to the periumbilical region. CT imaging demonstrated distinctive fat stranding and haziness indicative of OI. The patient exhibited hemodynamic stability and was treated conservatively with symptomatic and supportive care, including medications for heart failure. He exhibited clinical improvement and was discharged in satisfactory condition. Clinical discussion: This case underscores the possible association between heart failure and OI. Hemodynamic instability and prothrombotic conditions in chronic heart failure may lead to diminished omental perfusion. CT imaging is essential for diagnosis, allowing for differentiation from surgical emergencies like appendicitis. Conservative treatment is efficacious in the majority of instances and may avert superfluous surgical procedures. Conclusion: Clinicians must include OI in the differential diagnosis of acute abdominal pain, even in patients lacking conventional risk factors. In individuals with cardiac comorbidities, identifying this uncommon association may facilitate suitable nonoperative management and diminish morbidity.