PICTURES IN DIGESTIVE PATHOLOGY

 

Omental torsion: an infrequent cause of abdominal pain

Torsión omental: una causa infrecuente de abdomen agudo

 

 

José Ramón Torres-Alfonso, Delia Cortés-Guiral, Javier Jesús Barambio-Buendía and Damián García-Olmo

Department of General Surgery and Digestive Diseases. Hospital Universitario Fundación Jiménez Díaz. Madrid, Spain

 

 

Case report

We present the case of a 65-year-old male, who presented at the Emergency Department due to an increasing abdominal pain with a three-day history. Physical examination revealed a painful mass in the right iliac fossa and was clearly palpable. The patient also presented sinus tachycardia of 115 bpm. The blood test only revealed a C-reactive protein level of 5.6 mg/dl. A computed tomography (CT) scan showed rotation and thickening of mesenteric vessels, mesocolic fat edema and retrograde dilatation of the small bowel. These findings suggested colon volvulus as a first diagnostic possibility, and this is shown in figure 1.

 

 

Urgent exploratory laparotomy was performed, finding torsion, venous congestion and ischaemia of the greater omentum. No signs of intestinal ischaemia were found.

The pathology report described blood extravasation and fat necrosis with no evidence of malignancy. These findings suggest greater omentum torsion as first diagnostic possibility.

The postoperative period was favorable and the patient progressively recovered oral tolerance and bowel transit.

 

Discussion

Omental torsion of the greater omentum is an uncommon cause of abdominal pain. It was first described by Eitel in 1899 (1). It is an unknown-cause disease difficult to diagnose (2), and is related to obesity, surgery, abdominal trauma and chronic cough. It can cause both aseptic and infectious peritonitis. Urgent exploratory laparotomy allows diagnosis (3), while urgent resection prevents serious complications such as hemoperitoneum, infectious peritonitis and intraabdominal abscess.

 

References

1. Alexiou K, Ioannidis A, Drikos I, et al. Torsion of the greater omentum: Two case reports. J Med Case Rep 2015;9:160. DOI: 10.1186/s13256-015-0641-5.         [ Links ]

2. Gosh Y, Arora R. Omental torsion. J Clin Diagn Res 2014;8(6):NE01-2.         [ Links ]

3. Mendoza-Moreno F, Díez-Gago M, Córdova-García D, et al. Primary omental torsion as presentation of acute abdomen. Case report. Rev Esp Enf Dig 2016;108(2):105-6.         [ Links ]