In our case, omental torsion is located on the left side. Case reporta 25yearold male presented with a 3day history of right sided abdominal. Omental torsion is a rare and very unusual cause of acute abdominal pain. The preoperative diagnosis was accurately accomplished using computerized tomography ct. Idiopathic segmental infarction of the omentuma rare. Because of his history of down syndrome, an abdominal examination was very difficult. No identifiable cause but may be related to local omental anatomical variations that allow a movable segment of omentum to twist around the proximal. Chronic abdominal pain is a common complaint following rouxeny gastric bypass rygb and has a wide array of presentations and causes. 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. Pdf eitel first described omental torsion in 1899, since then, fewer than 250 cases. Segmental omental infarction soi is a rare cause of acute abdominal pain. 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.
Here we present 2 cases admitted through emergency with the pain in right iliac fossa with this unusual diagnosis. Omental infarction oi is a rare cause of acute abdomen. Omental torsion is a kind of volvulus that occurs due to a twist in the omentum along its long axis and may result in ischemia and necrosis, and it is a rarely seen in the acute condition. Omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon as it mimics common acute surgical abdomen.
Conservative management of segmental infarction of the. Preoperative differential diagnosis includes acute appendicitis, acute cholecystitis, and twisted ovarian cysts. Primary omental torsion without any underlying cause was first reported by eitel in 1899. With the advent of diagnostic laparoscopy and the increased demand for laparoscopic appendectomy, omental torsion may become a more frequently recognized clinical entity. 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. Idiopathic segmental infarction of the omentum is a rare cause of acute severe abdominal pain. Acute abdomen due to primary omental torsion and infarction. A concentric or spiral pattern of omental fat has been described as a computed tomography ct appearance of omental torsion. We report a case of omental torsion in a 7yearold girl, who presented with right iliac fossa pain.
Primary torsion of the greater omentum is an uncommon cause of acute abdominal pain that. Omental torsion develops with a set of turns around its own axis that compress the distal right epiploic artery. It was therefore decided to perform a partial laparoscopic omentectomy and incidental appendectomy figure 1, figure 2, figure 3. Torsion of greater omentum is a quite uncommon cause of acute abdomen. Primary greater omental torsion as a cause of acute abdomena.
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. 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 widespread and increasing use of computer tomography ct in differential diagnosis of acute abdomen can be useful. Omental torsion ot is a condition in which a pedicle of the omental apron twists on its longer axis to such an extent that its vascularity is compromised. Torsion of the greater omentum can be either primary or secondary. A case of omental torsion seen in a 16 year old male is reported herein. 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. Jul 11, 2015 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. Torsion of the greater omentum may be primary or secondary. Symptoms are unspecific and preoperative diagnosis is difficult. According to literature1 omental torsion can be primary or secondary, precise causes for primary torsion are not well recognised, several factors like anatomical variation, accessory omentum and venous malformations have been proposed1,2.
Pdf left sided omental torsion with inguinal hernia. Common presentation uncommon diagnosis primary omental. 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. Soi produces characteristic radiological appearances on ct scan. The widespread and increasing use of computer tomography ct in differential diagnosis of acute abdomen can be. 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 solves. Pdf a case report of omental torsion, which is a rare differential diagnosis of the acute abdomen. A middleagedwoman presented with symptoms and signs of acute abdomen.
Histological examination of the resected specimen showed hemorrhage without any venous. Patients commonly present with right iliac fossa pain resembling appendicitis, but they lack the associated gastrointestinal symptoms of nausea, vomiting, or anorexia. Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. Laparoscopic resection of this necrotic omentum was performed using an ultrasonic coagulation device harmonic, ethicon endosurgery, inc. The syndrome is clinically indistinguishable from acute appendicitis when the infarcted segment lies in the right lower abdominal quadrant. In the view of persisting pain, a contrast enhanced ct cect was done. Torsion of the greater omentum is a rare, benign cause of acute abdominal pain, caused by twisting of the omentum around a pivotal point, usually in a clockwise direction. We report a case of 23yearold pregnant woman who presented to our hospital with right lower. Omental torsion must be considered as a differential consideration of an acute abdominal emergency especially in a patient with an inguinal hernia. Depending on the site of infarction, it mimics conditions like appendicitis, cholecystitis, and diverticulitis. A case report of omental torsion, which is a rare differential diagnosis of the acute abdomen. We report a case of surgically and pathologically proven omental torsion that demonstrated the typical whirling appearance on computed tomography. Omental necrosis as a cause of chronic abdominal pain in. We present a case of a male patient with greater omental torsion mimicking the symptoms of acute appendicitis.
Omental torsion is a rare cause of acute abdomen which is frequently diagnosed intraoperatively. She was managed conservatively, which she failed to respond. Torsion of the greater omentum is a rare condition of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. Most of the published cases had been diagnosed during operation via direct eye view. Left sided omental torsion with inguinal hernia article pdf available in world journal of gastroenterology 124. Omental torsion is a rare cause of acute abdomen and sometimes requires surgery. Torsion of the greater omentum with infarction clinical radiology. Herein, we report a case of laparoscopic omentectomy for primary torsion of the. Torsion of the omental leaflets, created by cleavage of the greater omentum during the bypass procedure, has been previously described as a cause of acute abdominal pain. This causes right abdominal pain in up to 90% of cases. Torsion of a bifid omentum as a rare cause of acute abdomen. Eitel 2 first reported a case of omental torsion unassociated with a hernia.
A 11yearold boy presented with symptoms and signs suggestive of appendicitis. The treatment for omental torsion is the resection of necrotised tissue by a laparoscopic approach. Nov 18, 2009 a case report of omental torsion, which is a rare differential diagnosis of the acute abdomen. Omental bleeding with spontaneously derotated torsion. Omental torsion is a rare cause of acute abdominal pain that occurs in the third to fifth decade of life with slight male predominance. Laparoscopic omentectomy in primary torsion of the greater.
This report describes one case of a male adult who presented with acute abdomen and in whom omental torsion was the definitive surgical diagnosis. Of them, 2 patients were intraoperatively diagnosed to have omental torsion and 7 patients had segmental omental infarction. Greater omental torsion is difficult to diagnose preoperatively. According to several studies, it is important that the correct preoperative diagnosis is made as omental torsion can be treated conservatively in. The twisted omental pedicle was seen just below the transverse colon, and the lower part of the omentum distal to the torsion point appeared necrotic fig. Acute abdominal pain is a common surgical presentation, and most often, the first line of consideration is to rule out acute appendicitis. Miguel perell 00f3 j, aguayo albasini jl, soria aledo v, et al. Recently, we encountered a case of omental torsion diagnosed as omental infarction preoperatively. Acute torsion of the greater omentum can be primary or secondary. Torsion of a bifid omentum as a rare cause of acute abdomen core. Primary greater omental torsion as a cause of acute. 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. In most cases, other differentials are considered before omental torsion.
Omental torsion is an infrequent cause of acute abdomen and its symptoms are nonspecific, often. Omental infarction can be classified into two categories. Pdf omental torsion is a rare cause of acute abdomen. Omental torsion was detected during surgery, with signs of necrosis. Omental torsion, a rare cause of acute abdomen bmj case reports. Clinically a suspicion of acute appendicitis was raised, although the abdominal xray and ultrasound were normal. Omental torsion is a rare cause of acute abdominal pain. Idiopathic omental torsion simulating appendicitis jama. The affected segment of omentum was resected along with the appendix. The most common symptom is right lower abdominal pain. Twisting causes compromised venous return, which leads to peritonitis and serosanguineous fluid accumulation in the peritoneal cavity, as well as arterial compromise, which induces ischemia and. 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 2, 3. To determine the risk factors and clinical presentation of primary omental torsion pot in children. Laparoscopic management of acute torsion of the omentum.
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. 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. The first published report of torsion of the greater omentum is generally ascribed to eitel in 1899, 5, 6 who described what he found after surgical exploration for a palpable omental tumor although some credit demarchetti with. The caecum and ascending colon were entirely normal fig. Omental infarction in adults is a rarely occurring phenomenon, with leftsided omental infarction being even more seldom. We, herein, report a case of omentum torsion in a 31yearold man with occlusive syndrome and abdominal pain. Modern management of omental torsion and omental infarction. Omental infarction can occur with torsion, as it did in our patient as viewed in fig. The patient underwent an open appendicectomy, during which a normal appendix was identified and a diagnosis of omental torsion was made. As in the current case, the significantly observed characteristic whirl pattern may not always be marked and, in fact, the whirl sign is not marked particularly if the axis of rotation is.
Greater omental torsion is a rare entity that can cause acute abdominal pain, may mimick other abdominal pathologies, and is difficult to be diagnosed preoperatively. The central portion of the omentum torses between the two fixed points. Abstract vascular disturbances of the omentum, described variously as acute epiploitis, primary omental torsion, idiopathic segmental infarction, etc. Eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. Torsion of the greater omentum is a rare cause of acute abdominal pain in adults and children.
A computed tomography of abdomen revealed findings suggestive of omental torsion. First reported in 1899 by eitel, omental torsion has consistently been confused preoperatively with acute appendicitis. Laparoscopic management of acute torsion of the omentum in adults. 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. If often mimics other acute pathologies and it is very difficult to diagnose.
On laparoscopy, a 710 cm rightsided segment of greater omentum was inflamed and necrotic, without adjacent mischief or signs of omental torsion fig. 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. The cause of primary omental torsion remains unknown but several predisposing factors have been described for example, anatomical. Torsion of the greater omentum is a relatively rare clinical event, the cause of which remains elusive. Torsion of the omentum is a rare cause of acute abdominal pain in humans and animals. Abdominal computed tomography showed a whirling pattern of fatty streaks and vessels within the greater omentum, and surgery confirmed infarction of the omentum secondary to torsion. Jan 31, 2018 acute abdominal pain is a common surgical presentation, and most often, the first line of consideration is to rule out acute appendicitis.
Operative management was adopted with rapid and uneventful recovery. Manual hernia reduction could also be considered as a factor in some cases 7. Primary omental torsion is a rare cause of acute abdomen and mimics common acute abdominal condition like appendicitis. Omental torsion is a rare cause of acute abdominal pain, which can present in two ways. The correct etiology is not clear in idiopathic omental torsion. It is very difficult to make a correct diagnosis of torsion clinically because it mimics other acute pathologies. Omental torsion is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. It predominates in the latter because it is longer, so that it is more likely to turn towards. Torsion of a bifid omentum as a rare cause of acute. Omental torsion may be located on either side of the abdomen, but rightsided conditions are more prevalent than leftsided ones. Some reports have suggested that abdominal computed tomography ct can be used to diagnose omental torsion. Eitel first described primary omental torsion in 1899.
Oct 19, 2016 omental torsion is a rare cause of acute abdominal pain, which can present in two ways. Greater omental torsion is a rare entity that can cause acute abdominal pain, may mimick other abdominal. Cect showed a whirling mass of fatty and fibrous tissue adherent to the. Before the widespread use of computed tomography ct, the diagnosis was usually made intraoperatively. Oct 31, 2019 omental torsion is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Pdf acute abdomen due to primary omental torsion and. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. An 18yearold male presented to our emergency room with a chief complaint of lower abdominal pain since previous 2 days. Epidemiology omental torsion is a rare cause of acute abdominal pain that occurs in the third.
Incidences of omental gangrene presenting as acute cholecystitis and acute appendicitis were 0. Torsion of the omentum is usually discovered during laparotomy or laparoscopy for an acute abdomen. Diagnostic laparoscopy confirmed the diagnosis of torsion of a segment of the greater. Omental torsion is a cause of acute abdominal pain and sometimes mimics acute appendicitis in its. However, pathology of the omental leaflets has not been shown to cause. May 12, 2004 abdominal computed tomography showed a whirling pattern of fatty streaks and vessels within the greater omentum, and surgery confirmed infarction of the omentum secondary to torsion.