Primary Torsion of the Greater Omentum: Case Report—Review of Literature

Abstract

The torsion of greater omentum is a rare cause of acute abdominal pain. After relating a case of torsion of the great omentum we review the literature. Its etiology is uncertain, although several factors have been underlined. The symptoms mimic surgical illness acute appendicitis, cholecystis, or diverticulitis. Sometimes ultrasonography and computed tomography can establish the diagnosis safely and allow conservative management. In the other ways, laparoscopy is a great help for the diagnosis and the treatment.

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

“…Thus, laparoscopy is the first choice procedure for diagnosis and treatment of acute omental torsion [23]. This procedure permits definitive diagnosis, when US and imaging (CT and MRI) findings are unclear [24]. In all cases laparoscopy permits a correct diagnosis of omental infarction and surgical excision [25].…”

Primary omental torsion: Report of two cases

“…11 Clinical presentations are diverse, including mainly a sudden increase of pain on the right side, enhanced with abdominal movements, associated with signs of peritoneal irritation or rebound tenderness in the right upper quadrant. When a large part of the omentum is involved, a mass might be palpable.…”

“…15 Computed tomography is of paramount importance in the diagnosis of torsion of the greater omentum. 11,16 Omental torsion can be easily differentiated from acute cholecystitis and appendicitis on CT by confi rming a normal, noninfl amed gallbladder and appendix, respectively. The presence of bowel wall thickening and paracolic abscess are a few of the fi ndings on CT that suggest diverticulitis.…”

“…10 Precipitating factors leading to an increased risk for omental torsion include trauma, coughing, a sudden change of body position, hyperperistalsis after a copious meal, or compression between the liver and the abdominal wall. 1,11 In secondary omental torsion, which is more common, some kind of abdominal pathology usually coexists, such as cysts, tumors, infl ammation, prior surgery or hernias, increased abdominal pressure as in the case of heavy exercise, sneezing or coughing, and the occupational use of vibrating tools. Obesity is again an important predisposing factor and explains the greater incidence of primary omental torsion in adults.…”

Acute abdomen caused by greater omentum torsion: a case report and review of the literature

“…[6] Omental torsion is difficult to diagnose preoperatively, and accurate preoperative diagnosis is reported in only 0.6-4.8% of cases. [7] When compared with appendicitis, this pathology has an incidence of 0.0016-0.37%, a ratio of less than 4 cases per 1000 cases of acute appendicitis. [8] Omental torsion is primarily seen in the 30-50-year age group, with male predominance.…”