Primary omental torsion (POT): a review of literature and case report

Omental torsion - A mimicker of the acute appendicitis - A case report

INTRODUCTION

Omental torsion is due to the twisting of the omentum along its axis and is observed in young male patients. The first description of omental torsion was first made by Eitel in 1899.

CASE PRESENTATION

A 35-year-old male presented with right iliac fossa pain, nausea, occasional vomiting and loss of appetite for four days. His clinical and radiological findings were suggestive of acute appendicitis. However, he was diagnosed with greater omental torsion intraoperatively and successfully managed with laparoscopic omentectomy.

DISCUSSION

Omental torsion is a rare condition with a low incidence. Preoperative diagnosis of omental torsion continues to be a challenge as the symptoms reported in the literature are usually confused with other abdominal pathologies such as appendicitis or cholecystitis etc. Preoperative US or CT scans are mandatory, and these procedures can accurately accomplish the pre-operative diagnosis. In search for the treatment of choice, laparoscopy proved its effectiveness as a diagnostic tool since it allows for confirming the diagnosis, evaluating the severity of the ischemia, and ruling out other surgical pathologies and therapeutic tools. At the same time, the open surgery approach can be described in many cases as being too invasive.

CONCLUSION

Greater omental torsion should be considered a differential diagnosis in all patients with acute abdominal emergencies.

Omental torsion: diagnostic challenge in patients with sclerosing cholangitis and inflammatory bowel disease - case report

Introduction and importance

The omentum appears as an apron-like extension of the peritoneum.

Case presentation

A 30-year-old male patient, presented to the emergency department with the chief complaints of acute nonradiating pain localized in the right-side abdomen for the past 3 days. The patient had a past medical history of sclerosing cholangitis (SC) with inflammatory bowel disease (IBD). The patient reported the pain as persistent, pressure-like, and moderate. The patient also had a low-grade fever and nausea at the time of admission. On examination, the vital signs were found as normal. The patient reported that the abdominal pain gets exacerbated after the meals, and increase in physical activity and movement. Due to the patient's complaints and history of SC and IBD, these were considered as the possible diagnosis. After the diagnostic procedures, the patient was finally diagnosed with OT.

Clinical discussion

This report presents a case of a patient suffering from omental torsion having history of SC and IBD. During the laparoscopic procedure, the diagnosis of omental torsion was confirmed. To our knowledge, no case report of omental torsion with IBD and SC is published in the literature.

Conclusion

This seems to be a major diagnostic challenge as patients with IBD almost resembles the same clinical signs and symptoms as in the omental torsion. The possibility of misdiagnosis and delayed diagnosis could result in the unfavorable outcome. Therefore, the healthcare fraternities are advised to include the rare diseases such as OT as the differential diagnosis.

Acute abdomen caused by torsion of the omentum: A pediatric case report

RATIONALE

Torsion of the omentum and infarction are rare and unusual disorders that often present as acute abdominal pain in the population. The diagnosis of omental torsion is based on clinical and imaging examinations.

PATIENT CONCERNS

A 7-year-old girl presented with acute right lower quadrant abdominal pain, with symptoms resembling acute appendicitis.

DIAGNOSIS

The patient was diagnosed with omental torsion based on imaging and laparoscopy.

INTERVENTIONS

Laparoscopic exploration was performed.

OUTCOMES

The patient was discharged seven days after satisfactory postoperative recovery.

LESSONS

Omental torsion should be included in the differential diagnosis of acute abdominal pain, particularly in patients with free hemorrhagic fluid in the abdominal cavity and pelvis.

Omental Fat Torsion: A Rare Mimicker of a Common Condition

Acute abdomen is a common emergency condition affecting young adults, and the first consideration is usually aimed to rule out acute appendicitis in this age group. Omental fat torsion has emerged as one of the rare etiologies of acute abdomen in the younger population. It warrants serious consideration as it closely mimics acute appendicitis in its clinical presentation. Herein we report a case of omental fat torsion in a 22-year-old male patient who presented with an acute right-sided lower abdominal pain which was highly suggestive of acute appendicitis. However, the diagnostic laparoscopy revealed a normally looking appendix and terminal ileum with an infarcted omental segment on the right side of the greater omentum. A laparoscopic omentectomy and an appendectomy were performed with an uneventful postoperative recovery. The pathology report confirmed omental fat infarction and a normal appendix. This case highlights omental fat infarction as a rare etiology of acute abdomen in a young male patient.

Primary omental torsion diagnosed and treated laparoscopically: a case report

Omental torsion, a rare cause of acute abdomen in children and adults, is difficult to correctly diagnose before surgery because it mimics the common causes of acute surgical abdomen. We present a case of greater omental torsion that was diagnosed by laparoscopy. A 37-year-old man presented with right lower abdominal pain and was suspected to have appendicitis. Blood tests revealed elevated C-reactive protein and white blood cell count, whereas computed tomography revealed a nodular mass and high-density lesions in the fat tissue. As the patient's abdominal symptoms were severe and a clear diagnosis could not be made, we performed exploratory laparoscopy. Laparoscopy revealed omental torsion, and an omentectomy was performed. The patient's pain had significantly reduced post-surgery, and post-operative recovery was uneventful. Thus, laparoscopic examination is useful for accurately diagnosing omental torsion and is less invasive than surgery.

Laparoscopic Management of Primary Omental Torsion

Primary omental torsion is an unusual condition, known for its rarity and for the particularity of being intraoperatively diagnosed, in nearly all cases. At the clinical evaluation, this pathology commonly mimics other etiologies of acute abdomen. Hemoperitoneum and necrosis of the omentum are rarely associated with the omental torsion, but when the association is found, then it means that the vascular injuries are irreversible and the required surgical procedure may be far more complex than simple devolvulus. In search of the treatment of choice, laparoscopy proved its effectiveness as a diagnostic and therapeutic tool, while the open surgery approach can be described in many cases as being too invasive. A 37-year-old female patient presented with the generic symptoms of acute appendicitis. Surgical treatment was initiated. During laparoscopy, the abdomen was attentively explored, highlighting the presence of a twisted omentum with hemoperitoneum and necrosis. Omental excision and peritoneal drainage were performed. The evolution was favorable. Another check-up was done at 6 months postoperatively, displaying no signs or symptoms of relapse.

OMENTAL INFARCTION: SURGICAL or CONSERVATIVE TREATMENT? A CASE REPORTS and CASE SERIES SYSTEMATIC REVIEW

BACKGROUND

Omental infarction (OI) is an infrequent cause of acute abdominal pain and there is no consensus on whether conservative or surgical treatment is the best strategy when performing positive CT diagnosis.

OBJECTIVES

To assess which of the two treatments is the most commonly adopted and compare outcomes in terms of success rate in resolution of symptoms and hospital length of stay.

ELIGIBILITY CRITERIA

Case report and case series of patients with abdominal pain and positive diagnosis by CT of omental infarction.

DATA SOURCES

PubMed, Science Direct and Google Scholar in combination with cross-referencing searches and manual searches of eligible articles from January 2000 to June 2018.

PARTICIPANTS

Patients older than 18 years of age.

METHODS

Patient characteristics and results were summarized descriptively. Categorical variables were assessed by chisquare test or Fischer's exact test, and continuous variables by the Wilcoxon-Mann-Whitney or Kruskal-Wallis test. Risk factors for failure of the conservative management were identified using multivariate logistic regression.

RESULTS

90 articles were included in the final analysis (146 patients). 107 patients (73.3%) received conservative treatment with a failure rate of 15.9% (patients needing surgery) and 39 patients (26.7%) received surgery as first treatment. The mean hospital length of stay was 5.1 days for the conservative treatment group and 2.5 days for the surgery group with statistically significant differences (p = 0.00). Younger age and white blood cells count ≥12000/μl were predictive factors of conservative treatment failure.

CONCLUSIONS

Although conservative treatment is effective in most patients, surgery has advantages in terms of hospital length of stay.

Laparoscopic omentectomy in primary torsion of the greater omentum: report of a case

Background

Torsion of the greater omentum is a rare cause of acute abdominal pain in adults and children. It is very difficult to make a correct diagnosis of torsion clinically because it mimics other acute pathologies; however, the preoperative diagnosis can be easily confirmed with the use of computed tomography (CT). Herein, we report a case of laparoscopic omentectomy for primary torsion of the omentum, which was not improved by conservative treatment.

Case presentation

A 50-year-old Japanese man presented to our hospital with acute right lower quadrant abdominal pain of a few hours’ duration. Routine blood tests showed a white blood cell count of 8900/mm³, and the C-reactive protein (CRP) level was 8.13 mg/dl. Contrast-enhanced CT scan of the abdomen revealed twisting of the omentum with a local mass of fat density and fluid distributed in a whirling oval-shaped mass pattern at the right flank and iliac fossa. Therefore, the patient was admitted to our hospital based on a diagnosis of omental torsion.

The patient was treated with conservative treatment with analgesics, anti-inflammatories, and antibiotics. Although his symptoms were ameliorated, his laboratory and radiological findings worsened. We performed laparoscopic omentectomy 6 days after admission.

The resected omentum was 24 cm × 22 cm in size and was twisted and dark red in color, suggesting infarction. Histological analysis revealed that the specimen was ischemic and hemorrhagic omentum, accompanied by inflammatory infiltration.

The patient’s postoperative course was uneventful, and he was discharged 9 days later.

Conclusion

This is a rare case of primary torsion of the greater omentum that was treated successfully with laparoscopic omentectomy. Considering the increase in surgical difficulty due to inflammation from prolonged torsion and the limited efficacy of conservative treatment, we conclude that surgical intervention is warranted as early as possible when torsion of the greater omentum is suspected.

Primary greater omental torsion as a cause of acute abdomen-a rare case report

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. We present a case of a male patient with greater omental torsion mimicking the symptoms of acute appendicitis. A 31-year-old male patient presented with right scrotal pain, initially treated by the urologists, however, 24 h later, he presented right lower quadrant pain, with characteristics of acute appendicitis. After finding in ischemic inflammatory mass on McBurney incision, an exploratory laparotomy was performed, revealing torsion of the greater omentum. Torsion of the greater omentum can be a cause of acute abdomen and could be misdiagnosed with acute appendicitis. Preoperative diagnosis is not easy and resection of the affected tissue is the preferred treatment of choice.

Torsion of the Omentum: A Rare Cause of Acute Abdomen in a 14-Year-Old Boy

Acute abdominal pain is a common surgical presentation, and most often, the first line of consideration is to rule out acute appendicitis; this is more so when the patient is an adolescent or within younger age group. In most cases, other differentials are considered before omental torsion. Omental torsion is a cause of acute abdominal pain and sometimes mimics acute appendicitis in its presentation. We present a case of a 14-yr-old boy who presented with acute abdomen with symptoms mimicking acute appendicitis. Laparoscopy revealed torsion of the omentum. Omentectomy and appendicectomy were done, and the child discharged four days after following a remarkable recovery.

Torsion of a bifid omentum as a rare cause of acute abdomen: a case report

Background

Omental torsion is a rare and very unusual cause of acute abdominal pain. If often mimics other acute pathologies and it is very difficult to diagnose preoperatively, which can lead to deterioration of the patient. It is seldom reported in the literature.

Case presentation

We report a well-documented case of a 67-year-old white woman who complained about abdominal pain, which was slowly increasing in severity. She had no previous abdominal interventions. An abdominal ultrasound showed multiple gallstones. At laparoscopy, free hemorrhagic fluid was seen and further exploration showed torsion of the right part of her omentum. A partial omentectomy was performed. Her postoperative course was uneventful.

Conclusions

Omental torsion is a rare cause of abdominal pain. Primary omental torsion is seldom reported in the literature. Blood examinations are frequently normal. Abdominal ultrasound and computed tomography can exclude other pathologies. Exploration remains the preferred diagnostic and therapeutic modality. Surgeons should include the diagnosis of omental torsion in their differential diagnosis of acute abdominal pain.

[Omental torsion. Case Report]

BACKGROUND

Omental torsion is an infrequent cause of acute abdomen and its symptoms are non-specific, often presenting with pain at the right iliac fossa as the only symptom. Its aetiology remains unknown, but different risk factors have been associated with the disease, including obesity, congenital malformations, and tumours. These risk factors have been classified as predisposing or triggering, primary or secondary, and external or internal.

CLINICAL CASE

The is a case of a 24-year-old male who complained about pain in the right iliac fossa without any other symptoms. The diagnosis was acute appendicitis, but during the laparoscopic approach, omental torsion was found.

CONCLUSION

The diagnosis of omental torsion is is complex. However, computed tomography and ultrasound have been used successfully. The treatment for omental torsion is the resection of necrotised tissue by a laparoscopic approach.

Primary omental torsion diagnosed during hysterectomy

Omental torsion is a rare cause of acute abdominal pain. It presents with nonspecific symptoms and signs of an acute abdomen, making it difficult to diagnose preoperatively, because symptoms mimic those caused by other conditions such as appendicitis, cholecystitis, diverticulitis, and other gynecologic diseases. Computed tomography is an effective and useful method to diagnose and exclude other acute abdominal conditions. Our case presented with sudden right upper abdominal pain with tenderness, rebound tenderness, mild fever (37.2℃), increased erythrocyte sedimentation rate (37 mm/hr), increased high-sensitivity C-reactive protein level (5.97 mg/dL). Computed tomography showed a large, well-circumscribed heterogeneous fatty mass and a 7.3 cm subserosal myoma. We could not exclude the myoma as the cause of acute abdominal pain, so we performed an emergency operation with suspicion of omental torsion or necrotic degeneration of the myoma. During the operation, we diagnosed primary omental torsion with infarction and subserosal myoma without secondary degeneration.

Omental torsion

Torsion of greater omentum is one of the rare causes of acute abdominal pain. It can be primary or secondary. Primary Omental Torsion (POT) occurs because a mobile, thicken segment of omentum rotates around a proximal fixed point in the absence of any associated or secondary intra-abdominal pathology. Secondary omental torsion is associated with a number of pre-existing conditions most common among them is inguinal hernia, other causes include tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting of omentum along its long axis resulting in impaired blood supply. This rare condition is more predominant in middle-aged males. It clinically mimics acute appendicitis. It should be kept in mind as a differential diagnosis for acute abdomen. Laparoscopy can aid in diagnosis and management but explorative laparotomy is the definitive and therapeutic procedure of choice. However the condition is not life threatening as omentectomy reduces the inflammation and focus of adhesions within the abdomen.

Primary omental torsion in a 9 year old girl: a case report

Primary torsion of the omentus is an extremely unusual cause of acute abdomen in the pediatric population. This condition occurs from twist of the pedicle of the omental apron around its longer axis, leading to edema, ischaemia and necrosis. Here we present a rare case of a 9 year old girl referred by her general practitioner due to severe right lower quadrant abdominal pain with a presumed diagnosis of acute appendiceal inflammation. Surgical operation disclosed primary omental torsion. The infarcted segment was resected and the girl's clinical recovery was uneventful without any complication. The condition may mimic a variety of other causes of acute abdominal symptoms. In this case report, a presumed diagnosis of acute appendicitis urgently induced the decision of a surgical approach. Physicians involved in the acute pediatric care have to include this rare condition in the differential diagnosis of acute onset right-sided abdominal pain.

Two cases of omental torsion mimicking acute appendicitis

Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel's diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion.

Primary Omental Torsion Is a Diagnostic Challenge in Acute Abdomen-a Case Report and Literature Review

Torsion of greater omentum is a rare cause of acute abdominal pain. It can be primary or secondary. Secondary omental torsions are associated with a number of preexisting conditions like inguinal hernia (most common), tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting along its long axis resulting in impaired blood supply. This condition is rare and predominant in males. Most patients are middle-aged adults. It clinically mimics acute appendicitis. If evaluated properly and diagnosed in time, good results can be achieved. We are presenting herewith a case of primary greater omental torsion and review of available literature.

Omental Infarction due to Omental Torsion

Omental torsion is a rare cause of acute abdomen and sometimes requires surgery. Recently, we encountered a case of omental torsion diagnosed as omental infarction preoperatively. An 18-year-old male presented to our emergency room with a chief complaint of lower abdominal pain since previous 2 days. Because of his history of Down syndrome, an abdominal examination was very difficult. Plain abdominal computed tomography (CT) suggested omental hernia adhering to the right paracolic gutters. Two days after hospital admission, symptoms did not improve, and contrast-enhanced abdominal CT suggested omental infarction. We performed an emergency surgery. Upon exploration of the abdominal cavity, the greater omentum was found to be twisted four times and adhered to the right paracolic gutters. We performed a partial omentectomy. He was discharged 9 days after the surgery. There was no cause of omental torsion in the abdominal cavity, and he was diagnosed as having idiopathic omental torsion. In cases wherein the cause of acute abdomen cannot be detected, omental torsion should be considered, and abdominal CT could be helpful for the diagnosis.