Omental torsion: a diagnostic challenge
DOI:
https://doi.org/10.18203/2349-2902.isj20151104Keywords:
Omental torsion, Inguinal hernia, Acute abdomen, Exploratory laparotomyAbstract
Torsion of the greater omentum is a rare acute abdominal condition that is seldom diagnosed preoperatively. We report a case of surgically proved right-sided torsion of the greater omentum that occurred secondary to recurrent inguinal hernia. A 39-year-old man presented to our hospital with abdominal pain.He had been diagnosed with right indirect inguinal hernia many years back for which herniorrhaphy was done. Contrast-enhanced Computed Tomography (CT) of the abdomen showed omental torsion with extension in the right inguinal hernia, mild ascites with subtle layering of blood. Exploratory laparotomy revealed torsion and gangrene of the greater omentum with small bloody ascites. An omentectomy was performed. Post-operative period was uneventful. Omental torsion is a rare cause of acute abdominal pain but should be included in the differential diagnosis of acute abdomen, especially in patients with untreated inguinal hernia. Knowledge of this pathology is important to the surgeon as it mimics common acute surgical abdomen. For this reason, in the absence of diagnosed preexisting abdominal pathology including cysts, tumors, foci of intra-abdominal inflammation, post-surgical wounds or scarring, omental torsion can present a surprise. Exploratory laparotomy represents the diagnostic and definitive therapeutic procedure.Presently laparoscopy is the first choice procedure. A rare and unique case of omental torsion with gangrene presenting with abdominal signs of peritonism without leucocytic reaction is being reported.
References
Theriot JA, Sayat J, Franco S, Buchino JJ. Childhood obesity: a risk factor for omental torsion. Pediatrics. 2003;112(6 Pt 1):e460.
Saber A, La Raja R. Omental torsion, 2007. Available at: http://emedicine.medscape.com/. Accessed 14 December 2011.
Eitel GG. Rare omental torsion. NY Med Rec. 1899;55:715.
Parr NJ, Crosbie RB. Intermittent omental torsion--an unusual cause of recurrent abdominal pain? Postgrad Med J. 1989;65:114-5.
Tsironis A, Zikos N, Bali C, Pappas-Gogos G, Koulas S, Katsamakis N. Primary torsion of the greater omentum: report of two cases and review of the literature. Internet J Surg. 2008;17(2):239-46.
Al-Jaberi T, Gharaibeh K, Yaghan R. Torsion of abdominal appendages presenting with acute abdominal pain. Ann Saudi Med. 2000;20(3-4):211-3.
Jeganathan R, Epanomeritakis E, Diamond T. Primary torsion of the omentum. Ulster Med J. 2002;71(1):76-7.
Aoun N, Haddad-Zebouni S, Slaba S, Noun R, Ghossain M. Left-sided omental torsion: CT appearance. Eur Radiol. 2001;11:96-8.
Karayiannakis AJ, Polychronidis A, Chatzigianni E, Simopoulos C. Primary torsion of the greater omentum: report of a case. Surg Today. 2002;32:913-5.
Atar E, Herskovitz P, Powsner E, Katz M. Primary greater omental torsion: CT diagnosis in an elderly woman. Isr Med Assoc J. 2004;6(1):57-8.
Parr NJ, Crosbie RB. Intermittent omental torsion--an unusual cause of recurrent abdominal pain? Postgrad Med J. 1989,65(760):114-5.
Abdennasser el K, Driss B, Abdellatif D, Mehci A, Souad C, Mohamed B. Omental torsion and infarction: CT appearance. Intern Med. 2008;47(1):73-4.
Chand M, Moore PJ, Nash GF. A simple case of appendicitis? An increasingly recognised pitfall. Ann R Coll Surg Engl. 2007;89(7):W1-3.
Al-Bader I, Ali A, Al-Sharraf Abdulla Behbehani K. Primary omental torsion: two case reports. Med Princ Pract. 2007;16:158-60.
Kepertis C, Koutsoumis G. Primary torsion of the greater omentum. Indian Pediatr. 2005;42(6):613-4.
Yager A, Carmeci C. Torsion of the greater omentum: CT findings. AJR Am J Roentgenol. 1999;173(4):1139-40.