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Omental caking refers to diffuse thickening and infiltration of the omental fat by soft-tissue density material, usually due to peritoneal malignancy.

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• The omentum loses its normal fatty appearance and becomes bulky, sheet-like, or mass-like.
• The term “cake” reflects the homogeneous soft-tissue slab replacing normal omental fat.

Etiopathogenesis

• Malignant infiltration of omental fat and vessels.
• Mechanism:
  • Transcoelomic seeding of tumor cells → implants in omentum → tumor growth + desmoplastic reaction.
  • Fluid currents in peritoneal cavity deposit cells along greater omentum.

Common Causes

Malignant (most common)

• Peritoneal carcinomatosis (secondary peritoneal spread):
  • Ovarian carcinoma (most frequent).
  • Gastric adenocarcinoma.
  • Colorectal carcinoma.
  • Pancreaticobiliary tumors.
• Primary peritoneal carcinoma (rare).
• Peritoneal mesothelioma.
• Lymphoma (can mimic but tends to form bulky nodal masses too).

Benign (rare)

• Tuberculous peritonitis (may cause omental thickening).
• Sclerosing mesenteritis.
• Post-radiation or post-surgical inflammatory changes.

Radiological Features