Acute abdomen for omental volvulus

Abstract

d l P p s c t P 38-year-old man was admitted to our unit with right nferior quadrant pain, nausea, vomiting, diarrhea and fever temperature 38.5°C). His clinical history was positive for edically treated gastritis. No previous surgical operations ere referred. The physical examination was remarkable for iffuse tenderness and small right reducible inguinal hernia. he white blood cell count was 15.1 10 L, hemoglobin as 14.4 g/dL. The biochemical tests were within the noral limits, in particular lactate dyhydrogenase was 351 I/L and creatinine kinase was 106 UI/L. Abdominal plain -ray films revealed no abnormalities. The ultrasonography as negative for free fluid, mass, and signs of cholecistitis. he patient was observed for 12 hours with no improvement nd, for persisting pain and increasing white blood cell ount (up to 20.8 10 L), he underwent surgical operation. nder general anesthesia and complete myorelaxation, a ight inferior abdominal mass was noted, and the surgeon ecided for a median laparotomy. Signs and symptoms uggested an intrabdominal localized abscess for acute apendicitis. A partial laparotomy was performed, and immeiately a moderate amount of intraperitoneal serohemoragic fluid was evident. At the intraperitoneal exploration a emorragic mass (Fig. 1) with apparent omental adhesion as found in the lower right quadrant. When the incision as extended and an omental volvulus was documented, the omplete omental resection was performed. The macrocopic examination showed an omental twist with eight omplete clockwise rounds (Fig. 2). The histologic workup eported aspects of infarction and chronic inflammation. he recovery was uneventful, and the patient was disharged on the fifth postoperative day. Omental torsion is an uncommon cause of acute abdoen, usually mimicking acute appendicitis, rarely perfoated duodenal ulcer [1,2]. About 150 cases have been