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Gastrointestinal Imaging

Omental cake

form of abdominal carcinomatosis characterized by neoplastic infiltration of the greater omentum. The gastrocolic ligament and the greater omentum are an important pathway of neoplastic spread of malignant neoplasms arising in the stomach, colon and pancreas. Metastatic infiltration of the greater omentum can produce a characteristic CT pattern (Fig.1). The attenuation of the fatty tissue anterior to the colon or small intestine is increased due to the presence of nodular or strand-like structures presenting attenuation values similar to muscle. In other forms larger masses that separate the colon and the small intestine from the anterior wall and replace the omental fat are revealed by CT.

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Fig.1

CT of the upper abdomen following intravenous and oral contrast medium in a patient previously submitted to Whipple operation for pancreatic carcinoma. There are multiple nodular and streaky structures with soft tissue attenuation (arrows) located in the omentum in front of the stomach and the splenic flexure of the colon. Note also metastatic deposits (arrowhead) in the retroperitoneum dorsally to the stomach.
Omental cake, Fig.1