Publication:

Omental torsion: a diagnostic challenge

Torsion of the greater omentum is a rare acute abdominal condition that is seldom diagnosed preoperatively. We report a case of surgically proved right-sided torsion of the greater omentum that occurred secondary to recurrent inguinal hernia. A 39-year-old man presented to our hospital with abdominal pain.He had been diagnosed with right indirect inguinal hernia many years back for which herniorrhaphy was done. Contrast-enhanced Computed Tomography (CT) of the abdomen showed omental torsion with extension in the right inguinal hernia, mild ascites with subtle layering of blood. Exploratory laparotomy revealed torsion and gangrene of the greater omentum with small bloody ascites. An omentectomy was performed. Post-operative period was uneventful. Omental torsion is a rare cause of acute abdominal pain but should be included in the differential diagnosis of acute abdomen, especially in patients with untreated inguinal hernia. Knowledge of this pathology is important to the surgeon as it mimics common acute surgical abdomen. For this reason, in the absence of diagnosed preexisting abdominal pathology including cysts, tumors, foci of intra-abdominal inflammation, post-surgical wounds or scarring, omental torsion can present a surprise. Exploratory laparotomy represents the diagnostic and definitive therapeutic procedure.Presently laparoscopy is the first choice procedure. A rare and unique case of omental torsion with gangrene presenting with abdominal signs of peritonism without leucocytic reaction is being reported.