Torsion of the greater omentum: two case reports

Abstract

IntroductionTorsion of the omentum is a benign self-limiting disorder, which is difficult to diagnose because the main symptoms are similar to those of other abdominal diseases. Most of the published cases had been diagnosed during operation via direct eye view. According to several studies, it is important that the correct preoperative diagnosis is made as omental torsion can be treated conservatively in most cases without any complications avoiding surgical intervention. However, patients should be under clinical and laboratory observation in order to detect symptoms that would lead to surgical intervention in which case a laparoscopy is the appropriate surgical treatment.Case presentationTorsion of the great omentum is a rare cause of acute abdominal pain which is usually misdiagnosed. In this study we report two cases, a 52-year-old Greek woman and a 68-year-old Greek man, who presented at our emergency room with symptoms such as right lower quadrant pain and tenderness similar to acute appendicitis. In both cases a surgical exploratory laparotomy of the abdomen revealed a twisted heavily congested segment of the right part of the greater omentum accompanied by intra-abdominal serosanguinous fluid.ConclusionsGreater omental torsion is difficult to diagnose preoperatively. It presents as acute abdominal pain located more often in the right iliac fossa. It is very important to make a correct preoperative diagnosis because omental torsion is a benign self-limiting disorder that can be treated conservatively, avoiding laparotomy. When a patient’s clinical, laboratory and radiological findings worsen or diagnosis is doubtful then laparoscopy is the appropriate method for diagnosis and treatment.

Omental torsion, a rare cause of acute abdomen

“…The literature regarding methodology remains conflicting. Laparoscopy is considered by some to be the most appropriate technique for both diagnosis and treatment in cases where the diagnosis is doubtful 7. However, it has also been argued that although exploratory laparoscopy may aid diagnosis, laparotomy should be the definitive method for omental excision 8.…”

Incarcerated recurrent inguinal hernia as a cause of secondary torsion of the greater omentum: a rare case report and literature review

“…7 Such causes include ingestion of a large amount of food, strenuous exercise, sneezing, coughing, abdominal surgery or trauma, sudden change of body position, intestinal peristalsis caused by oversaturation, and pregnancy. 8…”

Primary greater omental torsion as a cause of acute abdomen—a rare case report

“…The condition was first described by deMarcetti in 1858, while the first report of primary omental torsion came from Eitel in 1899 [ 5 ]. The condition mainly occurs in middle-aged adults, and is twice as common in men [ 2 ].…”

“…In both primary and secondary, all causes of increased abdominal pressure could serve as precipitating factors. Those could be heavy meals, physical activity, sneezing, coughing, recent abdominal surgery or trauma, sudden changes in body position, increased peristalsis and even pregnancy [ 2 ]. Manual hernia reduction could also be considered as a factor in some cases [ 7 ].…”

“…Torsion of the greater omentum is a rare, benign cause of acute abdominal pain, caused by twisting of the omentum around a pivotal point, usually in a clockwise direction [ 1 ]. Twisting causes compromised venous return, which leads to peritonitis and serosanguineous fluid accumulation in the peritoneal cavity, as well as arterial compromise, which induces ischemia and necrosis of the involved part [ 2 ]. Omental torsion can be primary or secondary [ 3 ], according to its correlation to pre-existing abdominal pathologies such as cysts, tumors, hernias or inflammation.…”