Primary Omental Torsion Research Articles

Primary Omental Torsion in Children in the Laparoscopy Era: What Have we Learned so far?

Primary omental torsion is uncommon, mimicking appendicitis and other acute abdominal pathologies. It often escapes diagnosis on imaging investigation or conventional open laparotomy. This study aimed to evaluate the effect of laparoscopy on the various parameters of this entity, including incidence, diagnosis, and treatment. A systematic review was performed, including PubMed and Scopus databases, without a time limit, following the PRISMA principles. A total of 16 articles from January 2000 to December 2023, corresponding to 56 children with primary omental torsion, complied with the research criteria. Primary omental torsion was associated with obesity. Symptoms were right abdomen oriented, often compared to those of acute appendicitis. Preoperative ultrasound displayed low diagnostic accuracy, whereas computerized tomography diagnosed only two thirds of cases. In all patients, the vermiform appendix was normal. Laparoscopy affected both diagnosis and treatment of primary omental torsion in children. Easy peritoneal cavity access rendered possible the diagnosis of cases previously discharged as abdominal pain of unknown etiology. Combined with the increased pediatric obesity, it also affected primary omental torsion incidence. The recent pathogenetic theories may be better supported today, as laparoscopy provides a detailed view in situ, and facilitates harvesting of fat tissue from the omentum for molecular investigation. The diagnostic efficiency of laparoscopy is superior to ultrasonography and computerized tomography. Finally, the removal of the ischemic omentum is technically easier compared to the open laparotomy alternative with all the technical difficulties of traction of a vulnerable hemorrhagic tissue through a small incision.

Primary omental torsion in children: single-center experience of 17 cases.

Primary omental torsion (POT) is a rare condition in children often misdiagnosed because of a lack of clinical manifestations. Here we present insights gained from the treatment of pediatric POT cases at a single center over 8 years and summarize some influencing factors found in diagnosis and treatment, in order to reduce the misdiagnosis of POT in children in the future. Demographic and clinical data of 17 children with POT treated in Shanghai Children's Hospital, Shanghai Jiaotong University from June 2012 to December 2020 were reviewed. The mean age of the 17 pediatric patients was 7.65 ± 2.12years (range: 4-12years), sixteen were male. The average time from the pain onset to operation was 73.82 ± 47.21h (range: 21-144h). In 5 cases, the ultrasound scan revealed a low-intensity inflammatory mass in the abdominal cavity. Only 1 of the 17 patients had normal body mass index, while others were overweight or obese. The mean computed tomography (CT) value of the mass in the lower right abdomen was - 58.74 ± 10.32 HU (range: - 70 to - 46 HU), which is close to that of its own abdominal wall fat [- 46.29 ± 9.45 HU (range: - 62 to - 32 HU)]. The location of the mass was located in front of the right colon in ten cases, except for two cases near the ligamentum teres. Five patients had whirl sign on CT images and 8 patients had pelvic fluid. Five cases were diagnosed as acute appendicitis and 12 were diagnosed as POT, the preoperative diagnosis was correct in 70.59% of cases. All 17 patients were treated with laparoscopic omentectomy. The average duration of hospitalization was 5.53 ± 1.12days (range: 4-8days). All cases were followed up. 1 case relapsed 8months post operation, while the remaining cases had no complications. POT is rare in children with acute abdominal pain, which is more common in obese boys. The fatty mass in front of colon and between rectus abdominis sheath in CT image is specific, which is helpful for diagnosis of POT. Laparoscopy is an effective method for the treatment of POT in children.

Omental torsion as a possible cause of acute abdomen.

Primary torsion of large omentum is a rare cause of abdominal pain. The knowledge of this disease is essential for surgeons. It plays an important role in differential diagnosis of acute abdomen. The authors present two cases of primary omental torsion. They describe the diagnostic and therapeutic process. Diagnosis of omental torsion is difficult. Frequently, it presents with abdominal pain and imitates other acute abdominal diseases such as acute appendicitis in most cases. It is difficult to diagnose before surgical revision is approached. Laboratory and paraclinical examinations may not provide any clear findings. Laparoscopic revision is the method of choice, with confirmation of the diagnosis and laparoscopic resection of the ischemic part of omentum.

Primary omental torsion in a pediatric patient.

Omental infarction although infrequent should be considered as a possible cause of acute abdomen precisely in those with negative appendectomy.

Laparoscopic Treatment of A Rare Causes of Acute Abdomen; Primary Omental Torsion

Laparoscopic Treatment of A Rare Causes of Acute Abdomen; Primary Omental Torsion

Omental torsion, an overlooked differential diagnosis of acute abdomen in children. A case series

Acute surgical abdomen is still forming a diagnostic dilemma in children. Omental torsion was an overlooked differential diagnosis in the era of open appendectomy, but nowadays with the propagation of laparoscopic surgery in pediatric age group there are more reports published describing the omental torsion. Clinical picture of Primary omental torsion is mimicking the diagnosis of acute appendicitis and for most of the cases the diagnosis will be only discovered intraoperatively. Primary omental torsion is more common on the right side of the greater omentum. Free peritoneal serosanguinous fluid is a common intraoperative finding. Due to increasing number of reported cases, omental torsion should always be ruled out in cases of negative laparoscopic exploration for acute abdomen in children. Here we are reporting three cases of omental torsion presented with right lower abdominal pain and primary omental torsion was found during laparoscopic exploration. Laparoscopic excision of the infarcted omentum was done. The clinical course, findings and treatment are highlighted. .

English

English

Primary torsion of epliplon major as a cause of acute abdomen

It presents the clinical case of a pediatric patient of 9 years old male, of urban origin who underwent surgery for acute abdomen box with preoperative diagnosis of complicated appendicitis, finding the findings transquirúrgicos a primary omental torsion greater, performed a case report and a review of existing literature.

A RARE CAUSE OF ACUTE ABDOMINAL PAIN: THE OMENTAL TORSION

lntroduction: Omental torsion represents the rotation of the omentum on its long axis. it is a rare cause of acute abdominal pain and can mimic clinically many diseases. in this case report, a boy with omental torsion which was detected during laparotomy. Case report: We report a case of primary torsion in a nine-year-old boy who presented with abdominal pain on the right lower abdom inal area. The abdomina l pain was initially localized to right lower quadrant. Physical exam ination which revealed tenderness in the right lower quadrant. The patient did not have rebound tenderness. Ultrasonographyfindings were normal except minimal free fluid in abdomen. The patient had undergone laparotomy. Rotation of greater omentum was seen during operation. Appendec tomy and partial omentectomy was performed . Conclusion: Typical symptom of acute appendicitis begin as periumbilical or epigastric pain migrating to the right lower quadrant of the abdomen. This pain migration is the most discriminating feature ofthe patient's history. Primaryomental torsion should be kept in mind as anunusual cause of acute abdominal pain. Especially, ifthepatient 's abdominal pain initial location right lowerquadrant.

Cause of rare acute abdomen: Primary omental torsion

Omental infarction is a rare pathology which develops as a result of impairment of perfusion of the omentum magus, which can imitate almost all acute abdomen symptoms with its clinical findings. The patient who applied to our emergency department with the complaint of abdominal pain that has started three days ago was taken under operation with the prediagnosis of omental infarction as a result of the analyses conducted. In laparotomy, omentum torsioned along normal appendix and long axis and undergone necrosis was observed. Torsioned necrotic omentum tissue has been excised. Our conclusion from the case and literature is that omental torsion and idiopathic omental necrosis should be also considered in patients with abdominal pain complaint.

Primary torsion of the greater omentum

Background/purpose Primary torsion of the greater omentum is an uncommon cause of acute abdomen in children. It was estimated to be found in 0.1% of cases operated for acute appendicitis and is almost impossible to be diagnosed preoperatively. Surgical excision of the infarcted omentum is the treatment of choice. In this study, we aimed to highlight the importance of suspecting primary omental torsion when operating upon a child presenting with a picture of acute appendicitis with normal appearing appendix intraoperatively. Patients and methods Through the period from June 2009 to May 2016, medical records of patients who had definite diagnosis of primary omental torsion were retrospectively reviewed. Clinical presentations, laboratory findings, imaging studies results, intraoperative findings, and histopathological findings were reviewed. Results During the specified time period, out of 1344 patients operated upon for acute appendicitis in our department, only four patients proved to have primary torsion of the greater omentum. All the patients were obese with clinical picture mimicking acute appendicitis. The postoperative histopathological examination showed normal appendix and ischemic necrosis of the resected omental segment. Conclusion Inspection of the greater omentum is essential when finding a normal appearing appendix in any case operated for suspicion of acute appendicitis. Keywords : acute abdomen, appendix, greater omentum, omental torsion

Primary Omental Torsion Mimicking Acute Appendicitis: An Unusual Cause of Acute Abdominal Pain in a Young Male

Primary Omental Torsion Mimicking Acute Appendicitis: An Unusual Cause of Acute Abdominal Pain in a Young Male

A rare cause of acute abdomen in children: Primary omental torsion

A rare cause of acute abdomen in children: Primary omental torsion

Diagnosis and treatment of primary omental torsion: an analysis of 12 cases

Objective To analyze the clinical features, diagnosis and treatment of the primary omental torsion (POT). Method The clinical data of 12 patients with POT admitted to our hospital from May 2010 to May 2015 were retrospectively reviewed. The clinical manifestations, laboratory investigation, medical image, treatment and outcomes of patients were analyzed. Results Twelve cases were all males with median age of 50. The POT was diagnosed during surgical exploration and confirmed pathologically after operation. Right abdominal pain was the main complaint in 11 cases, and pain migration to right lower quadrant in 1 case. In physical examination, the local peritonitis signs were elicited, including right quadrant tenderness and rebound tenderness at same location. All cases had normal temperature except one presenting low fever of 37.5 ℃. White blood cell counts was 12×109/L in one case, and( 4-10)×109/L in other 11 cases. Abdominal solid mass was found in one case by ultrasonic scan, measured 7 cm×5 cm with unclear surrounding boundary. Mesenteric fat opacity and dropsy were shown in 10 cases on CT plain scan, while thickness and effusion of hepatic flexure of colon was found in one case; however, none of them were suggested as POT by these two image study before operation. All patients were diagnosed as localized peritonitis or appendicitis clinically before emergent surgical exploration. The necrotic omentum was resected and all patients recovered smoothly. There were no complications in all cases during one-year follow-up. The CT images were reviewed after operation, which indicated that the mesentery of dropsy and the thickened hepatic flexure of colon should be the imaging signs of omental torsion; and also 9 of 12 cases had whirlpools sign. Conclusion The preoperative diagnosis of POT is difficulty, the typical whirlpools sign of abdominal mass on CT imaging is of highly value in diagnosis. The surgical removal of omental infarction is effective and the prognosis is good. Key words: Torsion, omentum; Fat necrosis; Diagnosis; Therapy

A rare cause of acute abdomen due to primary omental torsion: Value of laparoscopy in diagnosis and treatment

Background Primary omental torsion is a rare cause of acute abdomen and is almost never diagnosed clinically. Laparoscopic management of this condition has been infrequently reported in the literature. Herein, we present a series of patients with omental torsion that presented as acute abdomen treated laparoscopically.

Primer Omental Torsiyon

Omentum torsiyonu akut karın ağrısının nadir bir nedenidir. Bu olgulara bilgisayarlı tomografinin daha sık kullanılmasıyla birlikte preoperatif olarak tanı konulabilmektedir. Bu çalışmada, karın ağrısı şikâyeti ile başvuran 21 yaşındaki erkek olguda primer omentum torsiyonu incelenmiştir. Olgunun fizik muayenesinde batın sağ alt kadranda rebound pozitifliği saptandı. Lökositin 8.600/mm3, diğer biyokimyasal parametrelerin ise normal olduğu görüldü. Olgunun ultrasonografisinde patolojik bulgu saptanmadı. Bilgisayarlı tomografide omental torsiyon tanısı konuldu. Ameliyat sırasında omentumun torsiyone olduğu görüldü. Olguya apendektomi ve parsiyel omentektomi yapıldı. Bu hastalarda ultrasonografi bulguları genellikle normaldir ve bilgisayarlı tomografi tanıda tercih edilen yöntemdir. Primer omental torsiyon akut abdomenin nadir bir nedeni olarak akılda tutulmalıdır.

Adolesan Yaşta Primer Omentum Torsiyonu

Adolesan Yaşta Primer Omentum Torsiyonu

Torsion omentum mimicking appendicitis: A rare cause of pain abdomen

Omental torsion is a rare cause of acute abdomen. It usually presents with acute onset right-sided abdominal pain. The most common risk factors are adult male between 40 and 50 years of age and obesity. Clinical diagnosis is challenging and difficult to differentiate from more common clinical pathologies such as acute appendicitis and acute cholecystitis. Transabdominal imaging such as ultrasonography and computed tomography are useful showing typical whirl pattern. Advocated management is surgical excision of torted omentum. Herein, we report a case of primary omental torsion in an adult and a review of current literature. The diagnosis was incidental when patient was undertaken for laparoscopic appendectomy. This case not only highlights the importance of considering omental torsion in the differential diagnosis of right-sided acute abdominal pain but also endorses the changing practice to the laparoscopic approach for management of right-sided abdominal pain.

Case report of primary omental torsion

Omental torsion is an uncommon diagnosis for an acute abdomen. We present a case of a 45-year-old obese male who presented with acute pain on the right side of the abdomen for 2 days. Ultrasonography and computed tomography abdomen suggested an omental torsion, which was confirmed on laparoscopy. The omental infarct was resected, and the patient is asymptomatic for the past 15 months.

Acute Abdomen due to Primary Omental Torsion and Infarction.

Background. Torsion of greater omentum is a quite uncommon cause of acute abdomen. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. Symptoms are unspecific and preoperative diagnosis is difficult. The widespread and increasing use of computer tomography (CT) in differential diagnosis of acute abdomen can be useful for making a specific diagnosis. Objectives. This work aims to describe primary omental torsion in order to help avoid misdiagnosis, especially with acute appendicitis, which is eventually based solely on a physical examination. Case Report. We present a case of primary omental torsion in a young man and discuss contemporary methods in diagnosis and management of the condition. Conclusions. When a right diagnosis has been posed, possible treatments for omental torsion and necrosis are two: conservative or surgical. Conservative treatment had been rarely carried out because of frequent and important sequelae just like abdominal abscesses. Nowadays, surgical treatment, laparoscopic or laparotomic, is preferred because it is a safe method in diagnosis and management of this condition.