The syndrome is clinically indistinguishable from acute appendicitis when the infarcted segment lies in the right lower abdominal quadrant. Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. Torsion of the omentum is a rare cause of abdominal pain. Pdf omental torsion is an infrequent cause of acute abdomen and its symptoms are nonspecific, often presenting with pain at the right iliac fossa as. It affects predominantly young and middle aged women. Omental torsion is an infrequent cause of acute abdomen and its symptoms are nonspecific, often presenting with pain at the right iliac fossa as the only symptom. Torsion of greater omentum is one of the rare causes of acute abdominal pain. This suggests that spontaneous derotation of an omental torsion may occur, and may be an unusual cause of recurrent abdominal pain. Nov 18, 2009 a case report of omental torsion, which is a rare differential diagnosis of the acute abdomen. But there is an even smaller group of omental infarction which. Torsion of the greater omentum secondary to omental. They may also be generated using a torsion spring design program which. Laparoscopic resection for torsion of an omental lipoma.
Omental torsion is usually diagnosed intraoperatively and resected. The treatment for omental torsion is the resection of necrotised tissue by a laparoscopic approach. We know very well what causes climate change, and in general terms, what the dangers are. Full text is available as a scanned copy of the original print version. Because of his history of down syndrome, an abdominal examination was very difficult.
Links to pubmed are also available for selected references. Pdf torsion of the greater omentum is one of the rare causes of acute abdomen. Preoperative diagnosis is a challenge and mistaken with appendicitis, cholecystitis, diverticulitis, pancreatitis, epiploic appendagitis, incarcerated hernia, duodenal ulcer, ovarian torsion and ectopic pregnancy. Recent literature supports conservative management after diagnosis of omental torsion using radiological imaging.
Manual hernia reduction could also be considered as a factor in some cases 7. In conclusion, omental cysts are considered to be a rare entity that needs to be taken into consideration. Omental cysts are the least common variety of intraabdominal cystic lesions encountered in children. Omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon as it mimics common acute surgical abdomen. Torsion of the greater omentum can be a cause of acute abdomen and could be.
The most frequent complaint is pain in the right iliac. Primary omental torsion is an entity that mimics many acute abdominal pathologies and hence should be included in the differential diagnosis. Idiopathic omental torsion simulating appendicitis jama. Background torsion of the greater omentum is a rare cause of acute abdomen that affects mainly young and middleage women 1. Abdominal computed tomography showed a whirling pattern of fatty streaks and vessels within the greater omentum, and surgery confirmed infarction of the omentum secondary to torsion. Mostly they are detected incidentally during imaging studies performed for unrelated reasons. In our series, we found a twofold higher incidence of omental torsion, compared with previously reported incidence data.
Imaging is helpful in excluding other causes of lump abdomen. A distinction between torsion of omentum and infarction has been made in the past. Omental torsion is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Primary omental torsion is less common than secondary torsion 11. An 18yearold male presented to our emergency room with a chief complaint of lower abdominal pain since previous 2 days. Omental infarction oi is a rare cause of acute abdomen in children. Primary greater omental torsion as a cause of acute abdomena. The majority of omental cysts are discovered incidentally. Omental torsion must be considered as a differential consideration of an acute abdominal emergency especially in a patient with an inguinal hernia.
The pdf file portable document format of a torsional spring design which lists the torsion springs parameters that were calculated using torsional spring design formulas based on theory. Secondary omental torsion is always associated with abdominal pathology including tumors and cysts, postsurgical scarring, and hernia sacs. Primary torsion of the greater omentum in childhood. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. Acute appendicitis is a frequent differential diagnosis that should be taken into account. Omental infarction in children misdiagnosed as acute. In contrast to secondary torsion of the greater omentum, which occur with intraabdominal pathology like adhesions or tumors, primary omental torsion pot results from twisting of the greater omentum along its long axis causing vascular compromise, without any intraabdominal pathology it was first described by eitel in 1899, and since then only few case reports were. Full text get a printable copy pdf file of the complete article 3k, or click on a page image below to browse page by page. A 40yearold caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal. Laparoscopic resection for torsion of an omental lipoma presenting as an acute abdomen in a 5yearold girl yousuke kinjo 2 yasushi adachi 1 kunihiko seki 0 michihiko tsubono 2 0 department of pathology, jr tokyo general hospital, tokyo, japan 1 division of surgical pathology, toyooka hospital, toyooka, japan 2 department of surgery, toyooka. Torsion of the omentum due to omental hydatid has also been reported. The widespread and increasing use of computer tomography ct in differential diagnosis of acute abdomen can be. Abdominal computed tomography showed a whirling pattern of fatty streaks and vessels in the greater omentum. Describe the typical clinical feature of omental torsion and the specific ct findings that may help with preoperative and differential diagnosis.
For this reason, in the absence of diagnosed preexisting abdominal pathology, including cysts, tumors, foci of intra. Omental cysts are rare abdominal lesions and are difficult to diagnose. The diagnostic and therapeutic role of laparoscopy. Omental torsion is a rare cause of acute abdomen and sometimes requires surgery. From this typical finding, a diagnosis of omental torsion was made immediately, which was confirmed by subsequent surgery. The cause of torsion was forcible attempts at reduction of a hernia in four instances, severe coughing in one, and unknown in four. Omental infarction can occur with torsion, as it did in our patient as viewed in fig. A 40yearold caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal distension for 2 days. A 11yearold boy presented with symptoms and signs suggestive of appendicitis.
We report a case of surgically and pathologically proven omental torsion that demonstrated the typical whirling appearance on computed tomography. Omental torsion is defined as a twist of the omentum along its long axis with consequent impeding of its vascularity that may mimic acute abdomen 1. We encountered a case of giant lymphatic cyst presenting with. Institute omental infarction is a rare cause of acute omental infarction manual guide pdf read online now omental infarction manual guide ebook pdf at our library get omental infarction manual guide pdf file for free from our online library pdf file. Resultsmdct findings of all cases with omental torsion, cystic lymphangioma, and loculated fluid in the greater omentum correlated with the surgical and histopathological findings with 100% diagnostic accuracy. Torsion of the omentum is usually discovered during laparotomy or laparoscopy for an acute abdomen. The first case of omental torsion was reported in 1899 by eitel. Greater omental torsion is a rare entity that can cause acute. 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.
Primary omental infarction as cause of nonsurgical acute abdomen. During surgery, omental torsion was diagnosed and the involved omentum was resected. Acute abdomen because of omental torsion is a rare entity. Oct 31, 2019 omental torsion should be considered if preoperatively diagnosed acute appendicitis is not found and if the gallbladder and ovaries reveal no disease. Omental torsion ot is a condition in which a pedicle of the omental apron twists on its longer axis to such an extent that its vascularity is compromised.
Wed like to understand how you use our websites in order to improve them. The first published report of torsion of the greater omentum is generally ascribed to eitel in 1899, 5, 6 who described what he found after surgical exploration for a palpable omental tumor although some credit demarchetti with. Omental torsion is a rare cause of acute abdomen in children and adults who may present with various signs and symptoms. Laparoscopic excision of an omental leiomyoma with a giant.
Intraoperative diagnosis and treatment by resection are the current management of choice, however with increasing use of preoperative imaging this may need to be reconsidered. A 33yearold male presented to the emergency department complaining of right upper quadrant pain and was initially diagnosed with acute cholecystitis. The widespread and increasing use of computer tomography ct in differential diagnosis of acute abdomen can be useful. May 12, 2004 abdominal computed tomography showed a whirling pattern of fatty streaks and vessels within the greater omentum, and surgery confirmed infarction of the omentum secondary to torsion. Nm, lbft in this chapter, we will develop formulas. Clinically, primary and secondary omental torsions are similar. A member subjected to torsional moments would twist about a longitudinal axis through the shear centre of the cross section. Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. However, they have anticipatable course and favorable outcomes if. Modern management of omental torsion and omental infarction. This condition could be produced by omental torsion which is due to adhesion of previous surgery and is called bipolar or secondary, and it could be produced by torsion without an understand able cause and is called primay or unipolar 2,4. Jan 26, 2011 eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported.
Omental torsion is a rare cause of acute abdomen which is frequently diagnosed intraoperatively. It is easy to understand how a twist in the omentum may be produced by forcible taxis of. Idiopathic torsion of the omentum consists of an omental twist in the absence of any recognizable etiologic factor such as a hernia, inflammatory process, or adhesions. Torsion of greater omentum is a quite uncommon cause of acute abdomen. In addition, the presence of serosanguineous fluid in the peritoneal cavity mandates inspection of the omentum to exclude torsion. A 65yearold man presented to the emergency department complaining of right lower abdominal pain. It is clinically similar to common causes of acute surgical abdomen and is often diagnosed during surgery. Although it is rarely diagnosed preoperatively, knowledge of this entity is important to the surgeon because it mimics the common causes of acute surgical abdomen.
Omentum anatomy, pathological conditions and surgical. Inguinal hernia is a common condition but not frequently related with torsion of the omentum. Primary omental torsion occurs when the mobile thickened segment of the omentum rotates around a proximal fixed point in the absence of any. Omental infarction is a differential diagnosis in the postpartum acute abdomen. The twisted omental pedicle was seen just below the transverse colon, and the lower part of the omentum distal to the torsion point appeared necrotic fig. A case report of omental torsion, which is a rare differential diagnosis of the acute abdomen. A computed tomography of abdomen revealed findings suggestive of omental torsion. Diagnostic laparoscopy confirmed the diagnosis of torsion of a segment of the greater omentum. Omental whirl associated with bilateral inguinal hernia. They are often identified incidentally, although they may also cause acute abdominal pain. Preoperative differential diagnosis includes acute appendicitis, acute cholecystitis, and twisted ovarian cysts.
We report a case of 23yearold pregnant woman who presented to our hospital with right lower. Recently, we encountered a case of omental torsion diagnosed as omental infarction preoperatively. With the advent of diagnostic laparoscopy and the increased demand for laparoscopic appendectomy, omental torsion may become a more frequently recognized clinical entity. Primary omental torsion international archives of integrated medicine. Full text full text is available as a scanned copy of the original print version. Get a printable copy pdf file of the complete article 240k, or click on a page image below to browse page by page. 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 will present with a sudden onset of crampsabdominal pain or a stitch. Although omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon because it mimics the common causes of acute surgical abdomen. Symptoms are unspecific and preoperative diagnosis is difficult.
Ct features, abdominal radiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Torsion spring design pdf quality spring, affordable prices. Primary torsion of the greater omentum in childhood europe. We also found a difference in age and sex distribution among. We encountered a case of giant lymphatic cyst presenting. Pdf eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. Laparoscopic resection of an omental cyst with pedicle torsion. We describe here two girls with omental cysts with very unusual clinical presentations.
Radiologic and clinical features of omental torsion. Acute abdomen due to primary omental torsion and infarction. This is a new kind of environmental problem, and it is important to understand why responding to climate change is so challenging. Omental torsion and infraction due to axial twisting along its long axis if twist is thight enough or venous obstruction is of sufficient duration arterial in flow is compromised leadind to infraction and necrosis two type 1primary no cause usually on right side 2secondary associated with other conditions like hernia. We report a case of surgically and pathologically proven omental. The more common secondary torsion is associated with adhesion of the free end of the greater omentum to a cyst, tumor, surgical scar, sac of a hernia or an inflammatory focus 12. In cases, where, imaging may not help, laparoscopy can be used as a diagnostic and therapeutic tool.
Eitel 2 first reported a case of omental torsion unassociated with a hernia. Gi tract pathology mcqs the most common cause of intestinal obstruction is. Omental infarction, or omental torsion, is an acute vascular disorder which compromises tissue of the greater omentum the largest peritoneal fold in the abdomen. They may also be generated using a torsion spring design program which automatically calculates these formulas. Laparoscopic resection of this necrotic omentum was performed using an ultrasonic coagulation device harmonic, ethicon endosurgery, inc. Mar 27, 2014 omental torsion and infraction due to axial twisting along its long axis if twist is thight enough or venous obstruction is of sufficient duration arterial in flow is compromised leadind to infraction and necrosis two type 1primary no cause usually on right side 2secondary associated with other conditions like hernia. However with an increase in the incidence of obesity in.
Its aetiology remains unknown, but different risk factors have been associated with the disease, including obesity, congenital malformations, and tumours. For this reason, in the absence of diagnosed preexisting abdominal pathology, including cysts, tumors, foci of. Acute presentations are usually due to complication in cyst. Epidemiology omental torsion is a rare cause of acute abdominal pain that occurs in the third. It more frequently occurs in the right side because.
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