Torsion of omentum is a rare acute condition in which the organ twists around its long axis. Omental torsion, exploratory laparotomy, acute surgical abdomen. Omental torsion means a partial or total rotation of the omentum around its main axis. In most cases, other differentials are considered before omental torsion. Ct features, abdominal radiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. In contrast, secondary omental torsion has both fixed proximal and. Omental torsion is a rare entity occurring in 4 cases of all cases of acute abdominal pain abdomen. If often mimics other acute pathologies and it is very difficult to diagnose preoperatively, which can lead to deterioration of the patient. He reported mild nausea, but no fever, chills, or changes in bowel habits. Of them, 2 patients were intraoperatively diagnosed to have omental torsion and 7 patients had segmental omental infarction. Herein, we report a case of laparoscopic omentectomy for primary torsion of the. Pdf a case report of omental torsion, which is a rare differential diagnosis of.
Omental torsion is a rare cause of acute abdominal pain that occurs in the third to fifth decade of life with slight male predominance. Omental torsion is classified as primary or secondary,3,4,6 the latter being more common. Torsion of a bifid omentum as a rare cause of acute abdomen. We report a case of omental torsion in a 7yearold girl, who presented with right iliac fossa pain. The white arrow shows the free torsion after entering the omental bursa and resecting the adhesion between the transverse colon and omentum ab. The affected segment of omentum was resected along with the appendix. Torsion of the omentum due to omental hydatid has also been reported. On ct scan a mass of fat density may be present showing whirling pattern of concentric streaks. In contrast to secondary torsion of the greater omentum, which occur with intraabdominal pathology like adhesions or tumors, primary omental torsion pot results from twisting of the greater omentum along its long axis causing vascular compromise, without any intraabdominal pathology it was first described by eitel in 1899, and since then only few case reports were. It is very difficult to make a correct diagnosis of torsion clinically because it mimics other acute pathologies. It is a mimicker of acute cholecystitis and other causes of acute abdomen. Pdf omental torsion is an infrequent cause of acute abdomen and its symptoms are nonspecific, often presenting with pain at the right iliac fossa as. Pdf eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. Greater omental torsion secondary to a right inguinal hernia.
At laparoscopy, free hemorrhagic fluid was seen and further exploration showed torsion of the right part of her omentum. Idiopathic omental torsion simulating appendicitis jama. Omental torsion is a rare cause of acute abdomen which is difficult to diagnose. Acute abdomen due to primary omental torsion and infarction. We report a case of 23yearold pregnant woman who presented to our hospital with right lower. It usually occurs between the third to fifth decade and more commonly affects male compared to female with ratio of 2. Two cases of omental torsion mimicking acute appendicitis. The widespread and increasing use of computer tomography ct in differential diagnosis of acute abdomen can be useful. Torsion of a bifid omentum as a rare cause of acute. Pdf omental torsion is a rare cause of acute abdomen. Omental torsion can be classified as primary or secondary. Primary omental torsion is a diagnostic challenge in acute. Torsion of the greater omentum is a rare cause of acute abdominal pain in adults and children. Idiopathic torsion of the omentum consists of an omental twist in the absence of any recognizable etiologic factor such as a hernia, inflammatory process, or adhesions.
A distinction between torsion of omentum and infarction has been made in the past. We describe a case of omental torsion in an adult patient who was diagnosed preoperatively by contrastenhanced computed tomography and managed by laparoscopy. It is perhaps fitting that primary omental pathology is rare, yet metastatic invasion, omental cysts, omental torsion, and omental infarction have all been reported in the literature. The twisted portion of the omentum tends to be localized to a rightside segment, thereby giving rise to the sudden onset of pain and signs of peritoneal irritation on the right side of the abdomen. A 11yearold boy presented with symptoms and signs suggestive of appendicitis.
Abstract vascular disturbances of the omentum, described variously as acute epiploitis, primary omental torsion, idiopathic segmental infarction, etc. Incidences of omental gangrene presenting as acute cholecystitis and acute appendicitis were 0. It is more common in males than females and usually occurs in the 4th and 5. Initial treatment included analgesia with intravenous fluids, nasogastric tube on free drainage and intravenous antibiotics. Differential onsiderations for omental fat infiltration. Omental torsion is defined as a twist of the omentum along its long axis with consequent impeding of its vascularity that may mimic acute abdomen 1. On laparoscopy, a 710 cm rightsided segment of greater omentum was inflamed and necrotic, without adjacent mischief or signs of omental torsion fig. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. The most common preoperative diagnosis is acute appendicitis and the proper preoperative diagnosis is important for the appropriate treatment option. Omental infarction in children misdiagnosed as acute. Abdominal ultrasound identified large amounts of hyperechoic free peritoneal fluid. Open access case report a diagnosis to keep in mind.
Omental infarction oi is a rare cause of acute abdomen in children. Omental bleeding with spontaneously derotated torsion. Primary omental torsion is less common than secondary torsion 11. This report, and others which followed, were concerned with what is currently classified as a secondary type of torsion related to preexisting intraabdominal adhesions, herniasespecially inguinaland other inflammatory foci.
Laparoscopic omentectomy in primary torsion of the greater. In case of epiploic appendagitis, the fatty mass is typically located as in the cases of omental torsion, but it is surrounded by a highattenuation ring which is interrupted within the intestinal wall 1,5. Anatomical malformations, such as a bifid or accessory omentum consisting of an abnormal embryological position of the right part of the omentum with secondary fragile vascularity and abnormal deposits of fat, are predisposed for omental torsion. Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. Primary torsion is unipolar with one end of the omentum free and it is generally associated with. Histological examination of the resected specimen showed hemorrhage without any venous. Omental torsion is a rare cause of acute abdomen which is frequently diagnosed intraoperatively. Omental torsion develops with a set of turns around its own axis that compress the distal right epiploic artery. The caecum and ascending colon were entirely normal fig. Although it is rarely diagnosed preoperatively, knowledge of this entity is important to the surgeon because it mimics the common causes of acute surgical abdomen.
The syndrome is clinically indistinguishable from acute appendicitis when the infarcted segment lies in the right lower abdominal quadrant. Primary omental torsion pot occurs because a mobile, thicken segment. Eitel first described primary omental torsion in 1899. The omentum is a double fold of peritoneum joining the stomach to the posterior abdominal wall, anterior to the transverse colon. Abdominal pain in the right lower quadrant suddenly developed just after the patient twisted his waist and an emergency laparotomy revealed a hemorrhagic mass at the edge of the right omentum, which was excised.
This is the first case report of an omental torsion in a polar bear ursus maritimus. Omental definition of omental by medical dictionary. A computed tomography of abdomen revealed findings suggestive of omental torsion. Torsion of the greater omentum can be either primary or secondary. Acute abdominal pain is a common surgical presentation, and most often, the first line of consideration is to rule out acute appendicitis.
Omental torsion is a cause of acute abdominal pain and sometimes mimics acute appendicitis in its. A case of omental torsion seen in a 16 year old male is reported herein. Torsion of the omentum is a benign selflimiting disorder, which is difficult to diagnose because the main symptoms are similar to those of other abdominal diseases. It predominates in the latter because it is longer, so that it is more likely to turn towards. The importance of this case report lies in raising awareness of the diagnosis omental infarction as a cause of acute abdomen among doctors who work in the emergency department, in order to prevent unnecessary surgical interventions as conservative treatment generally. Omental torsion is a rare and very unusual cause of acute abdominal pain. The patient underwent an open appendicectomy, during which a normal appendix was identified and a diagnosis of omental torsion was made. Intraoperative diagnosis and treatment by resection are the current management of choice, however with increasing use of preoperative imaging this may need to be reconsidered. Most of the published cases had been diagnosed during operation via direct eye view. No identifiable cause but may be related to local omental anatomical variations that allow a movable segment of omentum to twist around the proximal.
A 33yearold male presented to the emergency department complaining of right upper quadrant pain and was initially diagnosed with acute cholecystitis. The more common secondary torsion is associated with adhesion of the free end of the greater omentum to a cyst, tumor, surgical scar, sac of a hernia or an inflammatory focus 12. The more common type of the secondary torsion of the greater omentum is associated with adhesion of the free end of the omentum to the intraabdominal cyst, tumor, inflammatory foci, surgical scar, or hernial sack. Ct findings of primary torsion of the greater omentum with. Omental torsion is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Case report of primary omental torsion shinde j, pandit s. Symptoms are unspecific and preoperative diagnosis is difficult.
The presence of free serosanguineous fluid within the peritoneum cavity with normal appendix should raise the possibility of primary omental torsion. Radiologic and clinical features of omental torsion. This causes right abdominal pain in up to 90% of cases. Omental infarction may be primary or may occur after surgery secondary omental. Primary omental torsion is unipolar, where one end of the omentum remains fixed while the other end is free, whereas secondary omental torsion is bipolar with the free end attached either to adhesions or to some other pathological condition 4, 5. Omental infarction in adults is a rarely occurring phenomenon, with leftsided omental infarction being even more seldom. Omental torsion is an infrequent cause of acute abdomen and its symptoms are. Omental torsion is a rare cause of acute abdominal pain, which can present in two ways. Omental torsion is a rare cause of acute abdominal pain. Epidemiology omental torsion is a rare cause of acute abdominal pain that occurs in the third. The central portion of the omentum torses between the two fixed points.
Torsion of greater omentum is a quite uncommon cause of acute abdomen. Omental torsion usually occurs in adults of either sex. Patients commonly present with right iliac fossa pain resembling appendicitis, but they lack the associated gastrointestinal symptoms of nausea, vomiting, or anorexia. According to several studies, it is important that the correct preoperative diagnosis is made as omental torsion can be treated. Primary or idiopathic segmental infarction of the greater omentum is a rare surgical condition. Torsion of greater omentum is a rare cause of acute abdominal pain. Primary omental torsion is unipolar where the proximal omentum is fixed and the other parts remain free 2. It was first documented by eitel in 1899 as an independent entity, hence called primary omental torsion. Secondary omental torsions are associated with a number of preexisting conditions like inguinal hernia most common, tumours, cysts, internal or external herniation, foci of intraabdominal inflammation and postsurgical wound or scarring.