Volume 183 - Issue 4
Acute abdomen due to omental torsion
Authors: Wen-Chan Yeow, Mohan V Jayasundera, Graham Hool and Rajalingam Sinniah
Med J Aust 2005; 183 (4): 212. || doi: 10.5694/j.1326-5377.2005.tb07000.x
Published online: 15 August 2005
Published online: 15 August 2005
A 44-year-old woman presented with a 3-day history of worsening right upper quadrant pain associated with nausea, anorexia and fever. She had localised tenderness and guarding in the epigastrium. Initial ultrasound imaging showed a distended gallbladder containing calculi, without wall thickening. A computed tomography scan (performed because of increasing pain) showed a whorled structure in the anterior abdomen (Box 1). At laparotomy this was seen to be torsion of a segment of the greater omentum. Histology of the resected specimen showed congestion of the vessels, haemorrhagic infarction and focal fat necrosis (Box 2). She made an uncomplicated and rapid recovery.
Primary omental torsion is a rare cause of acute abdomen. It may affect children and adults, and is commonly misdiagnosed preoperatively as appendicitis. Some cases have presented as acute cholecystitis.1,2 Kimber et al identified 13 cases of omental torsion or infarction in about 8000 cases of suspected appendicitis over a 20-year period.3
Large meals, sudden postural change, and abdominal trauma may be precipitating factors in primary torsion,4 while adhesions, hernia, tumour or focus of inflammation3 occur with secondary torsion. Resection is the preferred treatment,3,4 although some clinicians suggest conservative management2 when the diagnosis is apparent on computed tomography. Laparoscopic resection has also been advocated.5
References
- Saborido BP, Romero CJ, Medina EM, et al. Idiopathic segmental infarction of the greater omentum as a cause of acute abdomen: report of two cases and review of the literature. Hepatogastroenterology 2001; 48: 737-740.
- Abadir JS, Cohen AJ, Wilson SE. Accurate diagnosis of infarction of omentum and appendices epiploicae by computed tomography. Am Surg 2004; 70: 854-857. 0_i1091563
- Kimber CP, Westmore P, Hutson JM, et al. Primary omental torsion in children. J Paediatr Child Health 1996; 32: 22-24. 0_i1091565
- Itinteang T, van Gelderen WF, Irwin RJ. Omental whirl: torsion of the greater omentum. ANZ J Surg 2004; 74: 702-703. 0_i1091567
- Sanchez J, Rosado R, Ramirez D, et al. Torsion of the greater omentum: treatment by laparoscopy. Surg Laparosc Endosc Percutan Tech 2002; 12: 443-445. 0_i1091569
Early-Onset Colorectal Cancer With Liver-Only Metastases: A Retrospective Cohort Study Integrating Prospectively Collected Real-World Clinical and Molecular Data From an Australian National Database (2009–2024) to Guide Treatment Planning
Savio G. Barreto, Christos S. Karapetis, Shahid Ullah, Matthew Burge, Susan Caird, Angus Campbell, Azim Jalali, Ross Jennens, Muhammad A. Khattak, Belinda Lee, Stephanie H. Lim, Shehara Mendis, Louise Nott, Timothy J. Price, Jeremy D. Shapiro, Jeanne Tie, Javier Torres, Colin Williams, Rachel Wong, Vanessa Wong, Peter Gibbs
Australian Pathways for Specialist Pain Management and Early Palliative Care for People With Pancreatic Cancer: Developed Using a Community Consensus Approach
Jennifer Philip, Melanie R. Lovell, Kylee Bellingham, Gail Garvey, Gregory B. Crawford, Nicole M. Rankin, Kara Burns, Isabel Young, Vivienne Milch, Dorothy Keefe, Katrina Anderson, James Lawson, Meinir Krishnasamy
Cause‐specific mortality among Queensland people with cirrhosis, by cirrhosis aetiology and decompensation status, 2007–22: a retrospective cohort study
Vikas Bhasker, Jessica R Fong, Paul J Clark, Gunter F Hartel, Richard Skoien, James O’Beirne, Elizabeth E Powell, Patricia C Valery
Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations
Jacob George, Nicole L Allard, Stuart K Roberts, Leon A Adams, Jane Davies, Behzad Hajarizadeh, Jennifer H MacLachlan, Suzanne E Mahady, Rosalie Altus, Catherine Brown, David C Fry, Belinda Greenwood‐Smith, Natali Smud, Patricia C Valery, Nafisa Yussf, Kate Broun, Denise Campbell, Karen Canfell, Chelsea Carle Harrison, Victoria Freeman, Paul Grogan, Catherine Holliday, Suzanne Hughes, Anna Kelly, Cathelijne Kemenade, Claire Latumahina, Amanda McAtamney, Megan Varlow, Joachim Worthington, Susan Yuill, Eleonora Feletto
Assessment of metabolic dysfunction‐associated fatty liver disease in primary care: a consensus statement summary
Leon A Adams, William W Kemp, Kate R Muller, Elizabeth E Powell, Stuart K Roberts, Luis Calzadilla Bertot, Stephanie Best, Gary Deed, Jon D Emery, Samantha L Hocking, Graham R Jones, John S Lubel, Sinead Sheils, Stephen M Twigg, Gerald F Watts, Jacob George
Treatment outcomes for people with hepatitis C referred to tertiary care in Victoria, 2021–22: a retrospective observational study
Elly Layton, Nicole Matthews, Brendan Quinn, Nasra Higgins, Gabrielle Lindeman, Mielle Abbott, Jennifer MacLachlan, Elizabeth Birbilis, Margaret E Hellard, Joseph Doyle, Benjamin C Cowie, Mark Stoové