Strangulated inguinal indirect hernia as a cause of secondary torsion of the greater omentum: A rare case report and literature review

Abstract

Rationale: Omental torsion is a rare surgical acute abdomen. Due to the lack of specific clinical manifestations and atypical symptoms, preoperative diagnosis is very difficult, and it is often confused with acute abdomen caused by other reasons. Secondary omental torsion caused by the incarcerated hernia is extremely rare.

Patient concerns: A 40-year-old male patient was admitted to the hospital on January 1, 2020, due to "nonrecoverable mass in the right inguinal region for 6 hours." The patient had a history of right inguinal hernia for 5 years and denied a history of abdominal trauma or surgery. Physical examination: normal vital signs, slightly distension in the abdomen, light tenderness in the whole abdomen, obvious in the right lower abdomen, accompanied by light rebound tenderness, weak bowel sounds. A mass of about 5 cm × 5 cm × 6 cm can be touched in the right inguinal region, with medium texture and obvious tenderness.

Diagnoses: Secondary omental torsion caused by an incarcerated inguinal hernia on the right side.

Interventions: Laparoscopic exploration.

Outcomes: The patient recovered well and was discharged on the 8th day after surgery.

Lessons: Omentum torsion is a rare disease that is difficult to diagnose preoperatively, and surgeons should raise awareness of it. Detailed medical history consultation, careful physical examination, combined with auxiliary examination, can help to reduce misdiagnosis.

Keywords: acute abdomen; diagnosis; incarcerated hernia; omental torsion; treatment.

Figure 1.

Omentum incarcerated in the right inguinal canal (A). The omentum was rotated 720° clockwise from the root with ischemic necrosis (B). The picture was taken during the emergency surgery.