Omental torsion, a rare cause of acute abdomen

Abstract

Omental torsion is a rare cause of acute abdominal pain. We report a case of omental torsion in a 7-year-old girl, who presented with right iliac fossa pain. The patient underwent an open appendicectomy, during which a normal appendix was identified and a diagnosis of omental torsion was made. The affected segment of omentum was resected along with the appendix. The patient made an uncomplicated recovery and was discharged on day 1 postoperatively. A normal appendix in the presence of omental torsion is found in 0.1% of all appendicectomies in children. We suggest routine visualisation of the omentum in the presence of a normal appendix during appendicectomy.

Secondary Omental Torsion with Acute Appendicitis

“…However, omental torsion is less associated with nausea, vomiting or anorexia as in our patient and the blood parameters are usually normal [4]. In late presentation, patients can have peritonitis and raised septic parameters due to omental gangrene [2,4,5]. That is why it is often found incidentally during surgery for acute abdomen.…”

“…The main symptom is sudden, localized right abdominal pain which intensify gradually [4]. Therefore, it is often misdiagnosed as appendicitis, cholecystitis, Meckel's diverticulitis, salphingitis or torsion ovarion cyst [1,2,4,5]. However, omental torsion is less associated with nausea, vomiting or anorexia as in our patient and the blood parameters are usually normal [4].…”

“…The causes of secondary omental torsion are cysts, tumours, hernias, adhesions or intra-abdominal inflammations as in this case [2][3][4]. Omental torsions usually involved the distal right epiploic artery because the right side of the omentum is longer and thus more mobile and susceptible to torsion [5]. Clinical presentation of omental torsion is non-specific and depends on the causes and severity.…”

“…Ultrasonography may show a combination of hyperechoic, non-compressible mass with hypoechoic rim or a complex mass and intraperitoneal free fluid [2,4,5]. Computed Tomography (CT) scan will be more specific.…”

“…Computed Tomography (CT) scan will be more specific. Findings include a well circumscribed or oval fatty mass with heterogeneous attenuation, containing strands of twisted blood vessels whirling around a central rod, the "whirl sign" [2,[4][5][6].…”