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. Omental infarction in children misdiagnosed as acute. If often mimics other acute pathologies and it is very difficult to diagnose preoperatively, which can lead to deterioration of the patient. Open access case report a diagnosis to keep in mind. Omental torsion is classified as primary or secondary,3,4,6 the latter being more common. 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. Omental torsion is a rare and very unusual cause of acute abdominal pain. Primary omental torsion pot occurs because a mobile, thicken segment. Omental torsion, exploratory laparotomy, acute surgical abdomen. Histological examination of the resected specimen showed hemorrhage without any venous.
Omental torsion is an infrequent cause of acute abdomen and its symptoms are. Torsion of a bifid omentum as a rare cause of acute. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. Idiopathic omental torsion simulating appendicitis jama. The affected segment of omentum was resected along with the appendix. 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, which can present in two ways. We describe a case of omental torsion in an adult patient who was diagnosed preoperatively by contrastenhanced computed tomography and managed by laparoscopy.
A computed tomography of abdomen revealed findings suggestive of omental torsion. In most cases, other differentials are considered before omental torsion. The patient underwent an open appendicectomy, during which a normal appendix was identified and a diagnosis of omental torsion was made. It is a mimicker of acute cholecystitis and other causes of acute abdomen. Pdf eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported.
In contrast, secondary omental torsion has both fixed proximal and. 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. 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. The caecum and ascending colon were entirely normal fig. Incidences of omental gangrene presenting as acute cholecystitis and acute appendicitis were 0. Omental definition of omental by medical dictionary.
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. Of them, 2 patients were intraoperatively diagnosed to have omental torsion and 7 patients had segmental omental infarction. This causes right abdominal pain in up to 90% of cases. Herein, we report a case of laparoscopic omentectomy for primary torsion of the.
A captive, 23yrold, 250kg, intact female polar bear presented to the university of minnesota veterinary medical center with a 2day history of lethargy, depression, and vomiting. Omental bleeding with spontaneously derotated torsion. The white arrow shows the free torsion after entering the omental bursa and resecting the adhesion between the transverse colon and omentum ab. Torsion of the omentum due to omental hydatid has also been reported. The syndrome is clinically indistinguishable from acute appendicitis when the infarcted segment lies in the right lower abdominal quadrant. 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. On ct scan a mass of fat density may be present showing whirling pattern of concentric streaks. Primary omental torsion is unipolar where the proximal omentum is fixed and the other parts remain free 2. Radiologic and clinical features of omental torsion.
Omental torsion is a rare cause of acute abdominal pain. Torsion of the greater omentum is a rare cause of acute abdominal pain in adults and children. We report a case of 23yearold pregnant woman who presented to our hospital with right lower. 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 central portion of the omentum torses between the two fixed points. Torsion of a bifid omentum as a rare cause of acute abdomen. It usually occurs between the third to fifth decade and more commonly affects male compared to female with ratio of 2. Case report of primary omental torsion shinde j, pandit s. Omental torsion develops with a set of turns around its own axis that compress the distal right epiploic artery. Omental torsion usually occurs in adults of either sex. It predominates in the latter because it is longer, so that it is more likely to turn towards. Omental torsion is a rare cause of acute abdominal pain that occurs in the third to fifth decade of life with slight male predominance. It was first documented by eitel in 1899 as an independent entity, hence called primary omental torsion.
Most of the published cases had been diagnosed during operation via direct eye view. 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. A 11yearold boy presented with symptoms and signs suggestive of appendicitis. Omental torsion is a rare cause of acute abdomen which is frequently diagnosed intraoperatively. Omental infarction oi is a rare cause of acute abdomen in children.
It is very difficult to make a correct diagnosis of torsion clinically because it mimics other acute pathologies. Symptoms are unspecific and preoperative diagnosis is difficult. Ct features, abdominal radiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Eitel first described primary omental torsion in 1899. No identifiable cause but may be related to local omental anatomical variations that allow a movable segment of omentum to twist around the proximal. 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. Primary omental torsion is less common than secondary torsion 11. On laparoscopy, a 710 cm rightsided segment of greater omentum was inflamed and necrotic, without adjacent mischief or signs of omental torsion fig. A case of omental torsion seen in a 16 year old male is reported herein. The presence of free serosanguineous fluid within the peritoneum cavity with normal appendix should raise the possibility of primary omental torsion.
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. Primary torsion is unipolar with one end of the omentum free and it is generally associated with. Omental infarction may be primary or may occur after surgery secondary omental. Greater omental torsion secondary to a right inguinal hernia. Torsion of greater omentum is a rare cause of acute abdominal pain. Omental torsion is a rare cause of acute abdomen which is difficult to diagnose. It is more common in males than females and usually occurs in the 4th and 5. Omental torsion means a partial or total rotation of the omentum around its main axis. Acute abdominal pain is a common surgical presentation, and most often, the first line of consideration is to rule out acute appendicitis. Torsion of greater omentum is a quite uncommon cause of acute abdomen. Torsion of omentum is a rare acute condition in which the organ twists around its long axis. 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.
He reported mild nausea, but no fever, chills, or changes in bowel habits. Omental torsion is a rare entity occurring in 4 cases of all cases of acute abdominal pain abdomen. 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. A 33yearold male presented to the emergency department complaining of right upper quadrant pain and was initially diagnosed with acute cholecystitis. 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. According to several studies, it is important that the correct preoperative diagnosis is made as omental torsion can be treated.
Pdf omental torsion is a rare cause of acute abdomen. Torsion of the greater omentum can be either primary or secondary. Differential onsiderations for omental fat infiltration. A case report of omental torsion, which is a rare differential diagnosis of the acute abdomen. Abstract vascular disturbances of the omentum, described variously as acute epiploitis, primary omental torsion, idiopathic segmental infarction, etc. Omental infarction can be classified into two categories. Ct findings of primary torsion of the greater omentum with. This is the first case report of an omental torsion in a polar bear ursus maritimus. 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. 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.
We report a case of omental torsion in a 7yearold girl, who presented with right iliac fossa pain. Omental torsion is a cause of acute abdominal pain and sometimes mimics acute appendicitis in its. Epidemiology omental torsion is a rare cause of acute abdominal pain that occurs in the third. 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. Laparoscopic omentectomy in primary torsion of the greater.
Primary or idiopathic segmental infarction of the greater omentum is a rare surgical condition. Abdominal ultrasound identified large amounts of hyperechoic free peritoneal fluid. At laparoscopy, free hemorrhagic fluid was seen and further exploration showed torsion of the right part of her omentum. Omental torsion can be classified as primary or secondary. Acute abdomen due to primary omental torsion and infarction. Omental torsion is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. The omentum is a double fold of peritoneum joining the stomach to the posterior abdominal wall, anterior to the transverse colon. Primary omental torsion is a diagnostic challenge in acute. Initial treatment included analgesia with intravenous fluids, nasogastric tube on free drainage and intravenous antibiotics. The most common preoperative diagnosis is acute appendicitis and the proper preoperative diagnosis is important for the appropriate treatment option. Pdf a case report of omental torsion, which is a rare differential diagnosis of. 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. 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. 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.
1424 1370 998 660 1475 1486 1583 533 505 1133 491 668 1100 1187 243 540 1527 11 255 1627 108 1482 580 514 660 1427 1386 629 382 700