Secondary omental torsion in children: report of two cases and review of the literature

Diagnostic Value of CT Window Technique for Primary Omentum Infarction

Objective

The diagnostic value of CT window width technique in primary omentum infarction was evaluated by this study.

Methods

The abdominal CT data of 32 patients with clinically diagnosed abdominal omentum infarction were retrospectively selected and analyzed. The fixed window position was 50 HU, and the window width was 135 HU, 250 HU (abdomen), 350 HU (mediastinum), and 500 HU, respectively. The detection rate of lesions was analyzed and compared.

Results

Window widths of 135 HU, 250 HU (abdomen), 350 HU (mediastinum), and 500 HU have a detection rate of 12.5% (4 cases), 62.5% (20 cases), 100% (32 cases), 100% (32 cases) for abdominal omental lesions, respectively. However, 500 HU showed worse abdominal bowel and parenchymal organs than 350 HU.

Conclusion

According to the comprehensive image quality, the ideal window width for diagnosis of primary omentum infarction is 350HU (mediastinal) window width.

Incarcerated recurrent inguinal hernia as a cause of secondary torsion of the greater omentum: a rare case report and literature review

Torsion of the greater omentum is a rare condition with a low incidence. However, secondary torsion of the greater omentum caused by an incarcerated recurrent inguinal hernia is extremely rare. Such torsion is fairly difficult to diagnose preoperatively because the symptoms are not typical and can mimic those of other causes of acute abdominal disease. If only the incarcerated inguinal hernia is treated, associated torsion of the greater omentum may be missed. We herein report a case of secondary torsion of the greater omentum caused by an incarcerated recurrent inguinal hernia. Exploratory laparotomy was performed because the preoperative computed tomography findings suggested torsion of the greater omentum. The diagnosis of torsion of the greater omentum was confirmed intraoperatively. The patient developed no recurrence throughout the 5-year follow-up.

Omental torsion in a captive polar bear (Ursus maritimus)

This is the first case report of an omental torsion in a polar bear (Ursus maritimus). A captive, 23-yr-old, 250-kg, intact female polar bear presented to the University of Minnesota Veterinary Medical Center with a 2-day history of lethargy, depression, and vomiting. Abdominal ultrasound identified large amounts of hyperechoic free peritoneal fluid. Ultrasound-guided abdominocentesis was performed and yielded thick serosanguinous fluid compatible with a hemoabdomen. An exploratory laparotomy revealed a large amount of malodorous, serosanguineous fluid and multiple necrotic blood clots associated with a torsion of the greater omentum and rupture of a branch of the omental artery. A partial omentectomy was performed to remove the necrotic tissue and the abdomen was copiously lavaged. The polar bear recovered successfully and is reported to be clinically well 6 mo later. This condition should be considered as a differential in bears with clinical signs of intestinal obstruction and hemoabdomen.

Omental torsion after repeated abdominal blunt trauma

Omental torsion is caused by the rotation of the greater omentum on its axis which may lead to tissue infarction and necrosis. It is a rare cause of acute abdomen. Signs, symptoms and paraclinical data are not specific. The patients usually undergo laparotomy for acute abdomen of poorly defined origin. High index of suspicious is required for the diagnosis of this entity. The diagnosis is usually confirmed after an explorative laparotomy. We present clinical characteristics and imaging findings of omental torsion in a young man following repeated blunt abdominal trauma.

Secondary omental torsion

A middle-aged-woman presented with symptoms and signs of acute abdomen. Clinically a suspicion of acute appendicitis was raised, although the abdominal x-ray and ultrasound were normal. She was managed conservatively, which she failed to respond. In the view of persisting pain, a contrast enhanced CT (CECT) was done. CECT showed a whirling mass of fatty and fibrous tissue adherent to the anterior abdominal wall suggestive of omental torsion and the diagnosis was confirmed on laparotomy and she underwent excision of the ischaemic omentum. Omental torsion though rare, should be included in the differential diagnosis of acute abdomen. High index of suspicion is required to diagnose this entity. CECT abdomen shows the classical finding of fatty mass with whirling pattern. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during the surgical procedure.

Laparoscopic diagnosis and treatment of torsion of the omentum: a report of 4 cases

AIM: To evaluate the value of laparoscopy in the diagnosis and therapy of torsion of the omentum.

METHODS: The clinical data of 4 patients with torsion of the omentum treated by laparoscopy were retrospectively analyzed.

RESULTS: Laparoscopic exploration proved that all four patients had torsion of the omentum. Laparoscopic resection of necrotic omentum was then performed. All patients were discharged from hospital 3 to 5 d postoperatively. A follow-up examination one month later showed that clinical symptoms disappeared.

CONCLUSION: Laparoscopic surgery has the advantages of clear visualization and minimal trauma and can achieve accurate diagnosis of torsion of the omentum.

A rare cause of right iliac fossa pain

A child with torsion of appendix epiploicae presenting as acute right iliac fossa pain in abdomen is reported.

Segmental omental infarction in childhood: an unusual case of left-sided location with extension into the pelvis

Segmental omental infarction (OI) is a rare cause of abdominal pain in children. It generally occurs in the right lower and upper quadrants of the abdomen and only a few cases of other locations have been described in adults. We report a unique paediatric case of OI with an unusual left-sided location extending into the pelvis in a 6-year-old non-obese girl. The diagnosis was suspected on US and CT based on imaging patterns previously described in adults and children. Laparoscopic resection should be balanced with nonsurgical management.

Omental infarction in children: color Doppler sonography correlated with surgery and pathology findings

OBJECTIVE

The objective of our report is to describe color Doppler sonography findings of omental infarction and correlate them with surgical and pathology findings. Ten children underwent preoperative gray-scale and color Doppler sonographic examinations; omental infarction was confirmed at surgery.

CONCLUSION

Color Doppler sonography findings were reviewed and correlated with surgical and pathology findings. Color Doppler sonography features of idiopathic omental infarction differ from those of infarction secondary to omental torsion.