Laparoscopic primary right omental torsion: a challenging diagnosis in acute abdomen: a case report

Abstract

Omental torsion is rarely diagnosed preoperatively and often misdiagnosed with other pathologies as acute abdomen, the most common of them being acute appendicitis. The current choice for the management of omental torsion is laparoscopic surgery. We present a case of a 35-year-old male with 48 h of acute abdominal pain mainly located in the epigastrium but then progressively migrated to the right iliac fossa. Abdominal CT showed mild thickening of the appendix. It also shows that the greater omentum locally hyperdense fat. The patient was brought to the operating room for diagnostic laparoscopy, revealing a primary right omental torsion. The patient was discharged 48 h later with no complications.

Keywords: acute abdomen; diagnosis laparoscopy; omental torsion.

Figure 1

(a) A simple coronal and (b) axial CT showing the density of intra-abdominal fat on the right side was markedly increased, indicating inflammation of the greater omentum.

Figure 2

(a, b) Twisted segments of the greater omentum with necrotic-looking patches of blood clots covered with an ischemic portion of omental fat on exploring the omentum on the right side of the transverse colon. (c, d) Necrotic twisted omentum resected.