Modern management of omental torsion and omental infarction: a surgeon's perspective

Abstract

Omental infarction is a rare cause of acute abdomen that until recently was diagnosed only on exploratory surgery for presumed acute appendicitis or similar abdominal emergency. The increasing use of high-quality imaging, especially computerized tomography, in the diagnosis of appendicitis and the acute abdomen, has allowed preoperative diagnosis to be made much more often. Coupled with the increasing popularity of laparoscopic appendectomy, this finding has led to a spate of recent reports of omental infarction and omental torsion. It has also sparked a debate as to the best management of omental infarction, with strong support for both nonoperative management and definitive laparoscopic surgery. We present a case of omental torsion diagnosed preoperatively by the characteristic whirl sign and ultimately treated by laparoscopic surgery together with a brief review of the condition and our own recommendations.