The present case describes a 23-year-old woman with no pathological history of interest. The patient presented with 48-hour-standing supraumbilical abdominal pain in the absence of disturbed intestinal rhythm, nausea, sickness or dysthermic sensations. Her last menstruation had taken place 5 days prior to the onset of disease. The patient was alert and oriented during the course of the physical exploration. She had febricula (37.5 ºC) and tenderness in the supraumbilical region, with signs of peritoneal irritation at the same level. Murphy and Rovsing signs were negative. A laboratory workup revealed a leukocyte count of 12,200 with 80.5% neutrophils. C-reactive protein was 21.80 (0-1). All the remaining laboratory parameters were within normal limits. No alterations were seen on abdominal X-ray films. On suspecting a strangulated epigastric hernia, an abdominal ultrasonography was performed (Fig. 1), following which a hyperechogenic lesion, delimited by a hyperechogenic ring surrounded by a small amount of fluid, was seen in the painful region. An abdominal CT was performed (Fig. 2) focused on the pathological zone using no intravenous or oral contrast material, during which the presence of a rounded mass with a density slightly higher than that of the adjacent fat tissue, and with a hyperdense central area was confirmed. Considering the severity of pain and the presence of signs indicating local peritoneal irritation, the patient was operated upon, and a torsion of the epiploic appendix was seen and solved by a partial resection of the greater omentum. The patient evolved favourably, and her abdominal manifestations remitted. The omentum is a free fold of peritoneum formed by the latter's union with the anterior and posterior lining of the stomach. Epiploic appendices are small peritoneal prolongations, under 5 cm in size, which contain several vessels and fat, located on the serosal surface of the colon from the cecum to the rectal-sigmoid junction. Both structures may occasionally develop an infarction as a result of torsion or spontaneous venous thrombosis, which is usually designated as omental torsion or epiploic appendicitis, depending on whether the omenta or epiploic appendices have been involved (1). The incidence of this complaint is 3-7% in patients with suspected acute diverticulitis, and 1% in patients with pain in the right fossa iliac (2).
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