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Maqbool N, Shafiq K, Ali SA, Saeed N. Diagnostic challenge: Secondary omental torsion misdiagnosed as acute appendicitis-A case report. SAGE Open Med Case Rep 2024; 12:2050313X241252352. [PMID: 38778908 PMCID: PMC11110511 DOI: 10.1177/2050313x241252352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
This case presents a diagnostic challenge in a 28-year-old male initially evaluated for severe abdominal pain, vomiting, and constipation, leading to the presumption of post-appendectomy complications. Clinical examination revealed abdominal distension, tenderness, and signs of peritonism, along with a reducible inguinal hernia. On subsequent CT scan, a large, inflamed area of omentum localized to the right abdomen extending up to the defect in the inguinal region with mild ascites was revealed. Upon exploration, it was discovered that the patient's initial surgery had focused solely on an appendix deemed mildly inflamed by the operating surgeon, while a concurrent diagnosis of secondary omental torsion was missed. This oversight underscores the challenges in diagnosing abdominal pathologies, with the initial misdiagnosis leading to ongoing patient distress. Meticulous adhesiolysis and omentectomy were performed, resulting in the resolution of the patient's symptoms.
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Affiliation(s)
- Nargis Maqbool
- Department of Surgery, Murshid Hospital and Health Care Centre, Karachi, Pakistan
- Department of Surgery, Fatima Jinnah Dental College, Karachi, SD, Pakistan
| | - Khalid Shafiq
- Department of Surgery, Murshid Hospital and Health Care Centre, Karachi, Pakistan
| | - Syed. Abid Ali
- Department of Surgery, Fatima Jinnah Dental College, Karachi, SD, Pakistan
| | - Nida Saeed
- Department of Surgery, Murshid Hospital and Health Care Centre, Karachi, Pakistan
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Komatsu K, Nozawa H, Sonoda H, Abe S, Emoto S, Murono K, Sasaki K, Ishihara S. Colectomy, especially right hemicolectomy, is a possible predisposing factor of omental torsion. ANZ J Surg 2023; 93:3006-3007. [PMID: 37641485 DOI: 10.1111/ans.18674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Koichi Komatsu
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinya Abe
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
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Mansoor A, Shaukat R. Inguinal hernia leading to omental torsion: Role of CT in differentiating from other clinical mimics - a case report and literature review. J Radiol Case Rep 2023; 17:8-17. [PMID: 38638552 PMCID: PMC11022751 DOI: 10.3941/jrcr.v17i11.4722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Omental torsion is a very rare cause of acute abdomen. Clinically, it mimics other common pathologies such as acute appendicitis, acute diverticulitis and acute cholecystitis. It is therefore no surprise, that it was rarely diagnosed pre operatively before the advent and easy availability of modern imaging techniques. CT scan, in particular, can diagnose omental torsion with confidence pre operatively. This can make conservative treatment possible in cases of primary omental torsion and guide regarding the appropriate treatment in cases of secondary torsion. We present a case of a young male patient who presented to Emergency department with symptoms of acute abdomen. Clinical and laboratory findings were non-specific for any specific cause of acute abdomen. CT scan, however, showed omental fat stranding with whirlpool sign representing omental torsion which was seen to be secondary to left inguinal hernia. Patient was operated in emergency and necrotic omentum was resected and hernia repaired. Post-operative recovery was uneventful.
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Affiliation(s)
- Ali Mansoor
- Department of Radiology, Post Graduate Medical Institute, Ameer-Ud-Din Medical College, Lahore General Hospital, Pakistan
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Malik N, Chorosho SH, Kumari P, Kaur R, Singh R, Chopra H, Bin Emran T. Omental torsion: diagnostic challenge in patients with sclerosing cholangitis and inflammatory bowel disease - case report. Ann Med Surg (Lond) 2023; 85:4543-4546. [PMID: 37663741 PMCID: PMC10473358 DOI: 10.1097/ms9.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/01/2023] [Indexed: 09/05/2023] Open
Abstract
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.
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Affiliation(s)
- Neha Malik
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | | | - Pratima Kumari
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Rupinder Kaur
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Ravinder Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
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A comprehensive radiologic review of abdominal and pelvic torsions. Abdom Radiol (NY) 2021; 46:2942-2960. [PMID: 33388807 DOI: 10.1007/s00261-020-02868-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.
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Yang Q, Gao Y. Incarcerated recurrent inguinal hernia as a cause of secondary torsion of the greater omentum: a rare case report and literature review. J Int Med Res 2019; 47:5867-5872. [PMID: 31578894 PMCID: PMC6862910 DOI: 10.1177/0300060519878372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Qian Yang
- Department of General Surgery, Chongqing Emergency Medical Center (Central Hospital of Chongqing University), Chongqing, China
| | - Yunhan Gao
- Department of General Surgery, Chongqing Emergency Medical Center (Central Hospital of Chongqing University), Chongqing, China
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Karanikas M, Kofina K, Boz Ali F, Vamvakerou V, Effraemidou E, Lyratzopoulos N, Polychronidis A. Primary greater omental torsion as a cause of acute abdomen-a rare case report. J Surg Case Rep 2018; 2018:rjy207. [PMID: 30094002 PMCID: PMC6080049 DOI: 10.1093/jscr/rjy207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/14/2018] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Michael Karanikas
- Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Konstantinia Kofina
- Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Ferdi Boz Ali
- Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Vasileia Vamvakerou
- Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Eleni Effraemidou
- Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Nikolaos Lyratzopoulos
- Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Alexandros Polychronidis
- Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
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Okamoto K, Okada Y, Ohno K, Yagi T, Tsukamoto M, Akahane T, Shimada R, Hayama T, Tsuchiya T, Nozawa K, Matsuda K, Ishida T, Kondo F, Hashiguchi Y. A rare case of perivascular epithelioid cell tumor (PEComa) of the greater omentum. World J Surg Oncol 2018; 16:113. [PMID: 29921303 PMCID: PMC6008935 DOI: 10.1186/s12957-018-1407-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/06/2018] [Indexed: 12/28/2022] Open
Abstract
Background A tumor composed exclusively or predominantly of human melanin black 45 (HMB45)-positive epithelioid cells is called a perivascular epithelioid cell tumor (PEComa). We report a very rare case of a PEComa of the greater omentum. Case presentation MRI conducted to examine the orthopedic disease of the patients, a 49-year-old Japanese woman, also identified a tumor in her pelvis. A CT scan revealed a tumor mass on the right side of the pelvic floor and clear nutrient vessels originating from the splenic and celiac arteries. An omental primary tumor or accessory spleen was thus suspected, and tumor resection was performed. The tumor was a light brown solid tumor with a smooth margin, measuring 5.2 × 3.8 × 3.5 cm. Histopathologically, the tumor was composed mainly of spindle and epithelioid cells, and large and small blood vessel formation was observed. In the immunohistochemical staining, tumor cells were positive for human melanin black 45 (HMB-45) and Melan-A and partially positive for alpha-smooth muscle actin. The final diagnosis was PEComa of the greater omentum. Conclusions Although omental PEComa is very rare, it should be considered as a differential disease of an omental primary tumor.
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Affiliation(s)
- Koichi Okamoto
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Yuka Okada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Kohei Ohno
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Takahiro Yagi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Mitsuo Tsukamoto
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Takuya Akahane
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Ryu Shimada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Tamuro Hayama
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Takeshi Tsuchiya
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Keijiro Nozawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Tsuyoshi Ishida
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Fukuo Kondo
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
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Torsion of the Omentum: A Rare Cause of Acute Abdomen in a 14-Year-Old Boy. Case Rep Surg 2018; 2018:7257460. [PMID: 29666745 PMCID: PMC5831312 DOI: 10.1155/2018/7257460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
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.
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Dhooghe V, Reynders D, Cools P. Torsion of a bifid omentum as a rare cause of acute abdomen: a case report. J Med Case Rep 2016; 10:289. [PMID: 27756378 PMCID: PMC5070124 DOI: 10.1186/s13256-016-1070-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/16/2016] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Vicky Dhooghe
- Department of Abdominal Surgery, GZA Hospitals, Campus Sint Vincentius, Sint Vincentiusstraat 20, 2018, Antwerp, Belgium
| | - David Reynders
- Department of Abdominal Surgery, GZA Hospitals, Campus Sint Vincentius, Sint Vincentiusstraat 20, 2018, Antwerp, Belgium
| | - Peter Cools
- Department of Abdominal Surgery, GZA Hospitals, Campus Sint Vincentius, Sint Vincentiusstraat 20, 2018, Antwerp, Belgium.
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