Omental Cake

Abdominal bloating and pain of 3 months’ duration prompted a 70-year-old woman to seek medical evaluation. She also reported minimal weight loss and fatigue, but she denied any bowel symptoms.

The physical examination suggested a vague nontender mass in the upper abdomen. The pelvic examination revealed a left adnexal mass.

A CT scan of the abdomen showed abnormal thickening and fullness of the greater omentum. The patient underwent laparotomy and had evidence of ovarian cancer and omental peritoneal metastasis. The omentum was hard and plaque-like because of malignant infiltration from ovarian cancer. Omentectomy, debulking of the ovarian tumor, and hysterectomy were performed. The patient is undergoing chemotherapy.

Omental cake is a description given to thickening of the greater omentum secondary to omental peritoneal metastasis. Bulky metastatic deposits in the greater omentum, the so-called omental cake, most often result from ovarian carcinoma or less frequently gastic, pancreatic, or colonic malignancies. Omental cake may also be caused by extra-abdominal tumors, most commonly breast carcinoma. On a CT scan, omental cake appears as multiple nodular streaky structures with soft tissue attenuation located in the omentum in front of the stomach and colon. This condition may coexist with malignant ascites.