Torsion of Abdominal Appendages Presenting with Acute Abdominal Pain

Abstract

Background: Diseases of the abdominal appendages are rare causes of abdominal pain in all age groups. Patients and Methods: Nine patients with torsion and infarction of abdominal appendages were retrospectively reviewed. Results: Four patients had torsion and infarction of the appendices epiploicae, four patients had torsion and infarction of part of the greater omentum, and one patient had torsion and infarction of the falciform ligament. The patient with the falciform ligament disease represents the first reported case of primary torsion and infarction of the falciform ligament, and the patient with the transverse colon epiploica represents the first reported case of vibrationinduced appendix epiploica torsion and infarction. The patient with the falciform ligament disease presented with a tender upper abdominal mass, and the remaining patients were operated upon with the preoperative diagnosis of acute appendicitis. Conclusion:The presence of normal appendix with free serosanguinous fluid in the peritoneal cavity should raise the possibility of a disease, and calls for further evaluation of the intra-abdominal organs. If the diagnosis is suspected preoperatively, CT scan and ultrasound may lead to a correct diagnosis and possibly conservative management: Laparoscopy is playing an increasing diagnostic and therapeutic role in such situations.

Omental Torsion After Repeated Abdominal Blunt Trauma

“…If a large segment of the omentum is involved, a mass may be felt (17). In general, patients with omental torsion compared to patients with acute appendicitis are less unwell, and the duration of the disease extends over a longer period of time (18). Compared to appendicitis, torsion has an incidence of 0.0016 – 0.37%, which is a ratio of less than 4 cases per 1 000 cases of appendicitis (19).…”

A diagnostic challenge: primary omental torsion and literature review - a case report

“…Omental torsion is a rare cause of abdominal pain presenting mainly in the 3 rd to 5 th decade of life with a slight male predominance (3:2) [5,6]. The omentum twists around its long axis, clockwise at a pivotal point.…”

“…cysts, adhesions, hernial sacs) resulting in a distal fixation point (bipolar torsion) [2,7]. In some cases the omentum may infarct without torsion, which is known as primary idiopathic segmental infarction [6]. …”

“…Common differential diagnosis include appendicitis, cholecystitis or twisted ovarian cyst [2]. In general patients with omental torsion are less systemically unwell compared to acute appendicitis and the disease process extends over a longer period of time [6]. …”

Primary epiploic appendagitis: from A to Z

“…Presentation usually involves abrupt onset of focal abdominal pain mostly in the lower quadrants, which worsens with cough or stretching of the abdominal wall muscles 10,11. Associated symptoms are rare, bowel function and appetite are usually unchanged, and nausea and vomiting are rare 4,12. The patient usually does not appear to be very ill and the white blood cell count is either normal or mildly elevated 13.…”