Omental torsion; an unusual case of acute abdomen. Case report

Abstract

Introduction and importance: Omental torsion as a cause of acute abdominal pain is extremely rare and difficult to diagnose preoperatively given the non-specific clinical picture.

Presentation of case: We report the case of an adult male who went to the emergency room due to abdominal pain, presented clinical symptoms and laboratory findings consistent with acute appendicitis but was diagnosed intraoperatively with omental torsion and associated necrosis, which was successfully treated by laparoscopic omentectomy.

Discussion: It is a rare entity with a low incidence. The symptoms of the cases reported in the literature are usually confused with other abdominal pathologies such as appendicitis or cholecystitis, so preoperative diagnosis continues to be a challenge. The treatment of choice is the laparoscopic approach, since it allows confirming the diagnosis, evaluating the severity of the ischemia, and ruling out other surgical pathologies.

Conclusion: It is important to consider omental torsion as another differential diagnosis of acute abdomen, which can be satisfactorily resolved via laparoscopy, thus avoiding the development of complications associated with its natural evolution.

Keywords: Acute abdomen; Case report; Laparoscopic surgery; Omental torsion.

Fig. 1

Abdominal ultrasound. RLQ: right lower quadrant. A: appendix. D: 6 mm outer diameter appendix. FL: fluid collection.

Fig. 2

Diagnostic laparoscopy: torsion of the greater omentum in its axial plane with associated distal necrosis.