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

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.

Torsion of the omentum: A rare cause of acute abdomen.

“…It was first described by Eitel in 1899, followed with almost three hundred cases so far with only a few have been diagnosed pre operatively. [4][5][6] The most of cases were identified as an incidental per operative finding. This condition can mimic other surgical conditions like acute appendicitis therefore accurate preoperative diagnosis was reported only in 0.6-4.8% patients.…”

“…This condition can mimic other surgical conditions like acute appendicitis therefore accurate preoperative diagnosis was reported only in 0.6-4.8% patients. 6 Omental torsion consists of 1.1% of all cases of abdominal pain and its incidence ranges between 0.0016% and 0.37%, which is a ratio of less than 4 cases per 1000 cases of acute appendicitis. [6][7][8] Omental torsion can present in two ways; primary and secondary.…”

“…6 Omental torsion consists of 1.1% of all cases of abdominal pain and its incidence ranges between 0.0016% and 0.37%, which is a ratio of less than 4 cases per 1000 cases of acute appendicitis. [6][7][8] Omental torsion can present in two ways; primary and secondary. In primary torsion, which constitutes almost one third of the cases 4 spontaneous torsion and is idiopathic.…”

“…Secondary torsion is more common and is associated with pre-existeing abdominal pathologies like inguinal hernias with omentocele (most common), omental cyst, tumor or adhesion with the dependent omentum becoming fixed in the position and unable to untwist. [6][7][8] Diagnosing a case of omental torsion could be very difficult as the primary symptom associated with omental torsion is un remitting abdominal pain of acute onset localized in the right iliac fossa similar to acute appendicitis. 9,10 Pain is usually sudden in onset which does not radiate but is associated with nausea, vomiting and low-grade fever; the bowel moments are usually normal.…”

Torsion of the greater omentum in a child: review of literature and own a case reports

“…До факторів, які сприяють виникненню перекрута чепця, належать посилена перистальтика, порушення кровообігу застійного характеру, різке переміщення тіла, швидке напруження м'язів при підйомі важких предметів, раптове підвищення внутрішньочеревного тиску (часто після рясного прийому їжі), надмірна маса тіла, злуковий процес у черевній порожнині, грижі передньої черевної стінки, хронічні та гострі процеси органів черевної порожнини [19,28].…”