Omental Torsion and Infarction Secondary to Omental Hernia in the Right Inguinal Canal

Abstract

Omental torsion secondary to inguinal hernia has rarely been reported as a cause of acute abdominal pain. However, in our case, omental infarction due to prolonged inguinal hernia-associated omental torsion led to the formation of a large omental mass with marginal fibrosis, and the patient presented with chronic abdominal pain. A 74-year-old man presented with complaints of lower abdominal pain for 1 month; subsequently, bilateral inguinal hernias were identified through inguinal ultrasonography. CT scans revealed that the greater omentum was trapped within the right inguinal canal, leading to omental torsion. The greater omentum, distal to the pedicle, appeared as a 30 cm-sized oblong fibrofatty mass in the right lower abdomen and pelvic cavity. Laparoscopic omentectomy with hernia repair was successfully performed.

Keywords: Hernia, Inguinal; Omentum; Peritoneal Diseases.

Fig. 1. Omental tortion and infacrtion secondary to omental hernia in the right inquinal canal.

A. Inguinal ultrasonography reveals inguinal hernia containing hyperechoic fat (asterisk) with ascites. B. A coronal reconstructed CT image shows the greater omentum trapped within the right inguinal canal, suggesting the presence of incarcerated omental hernia (dashed arrow). A whirling fibrofatty mass (asterisk) is suspended by a torsion pedicle (arrow) at the medial side of the ascending colon. Additionally, the mesenteric fat is partially herniated through the left inguinal canal (arrowhead). C. The omentum appears as a twisted, oval-shaped, fibrofatty mass with vascular whirling (arrow). D. The extended greater omentum adheres to the right lateral pelvic wall and rectovesical space (arrow). E. Resected gross specimen shows hardened omentum with hemorrhagic and necrotic appearance, measuring 25.3 × 7 × 3.9 cm.