A CASE OF PRIMARY TORSION OF THE GREATER OMENTUM

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Primary torsion of the greater omentum in a rare entity as reported in 43 cases in Japan so far. This paper deals with such a case of primary torsion of the greater omentum. A 78-year-old man complaining of upper abdominal pain occurred during playing gate ball was admitted to another hospital with a diagnosis of intestinal obstruction. The patient was referred to the hospital because of persisting right lower quadrant pain and abdominal distension. ON admission an abdominal ultrasonography revealed biliary stone, dilatation of the common bile duct, and a 6×2.5cm oval tumor with a low echoic center. With a diagnosis of acute appendicitis and localized peritonitis, an emergency operation was performed. Upon laparotomy, the appendix lacked in inflammatory findings and a moderate volume of slightly bloody ascites was noted. So an exploration of the abdominal cavity was made after an appendectomy, when a tumor of the greater omentum dark red in color was found to adhere to the peritoneum above the navel. And a torsion twisted clockwise by 2.5 turns was seen in the neck of the omental tumor. The greater omentum below the torsion was resected including normal portion. Histopathologically acute circulatory disturbance in the entire fatty tissues was demonstrated. Forty-four cases including this one which have been reported in the Japanese literature are also reviewed.