Abstract
A 45-year-old man was admitted to our hospital with high fever and abdominal pain of 5 days' duration. There was a wide distribution of lower abdominal tenderness, but no peritoneal signs were observed. The right inguinal region had a chicken egg-sized mass, and repositioning was impossible. Laboratory testing revealed an elevated white blood cell count of 12,800/μL and a C-reactive protein of 36.31mg/dL. On abdominal CT scan, the greater omentum showed a layered structure consisting of a high density area, that was continuous with the right inguinal canal. Based on a diagnosis of omental torsion caused by a right inguinal hernia, the patient underwent surgery on the day after admission. The operation was performed through a lower abdominal midline incision. A part of the greater omentum had twisted and entered into the right inguinal hernia sac. Resection of the necrotic omentum and contract sewing of the internal inguinal ring were performed. In addition, the mesh plug method was performed on the inguinal hernia on day 19 after surgery. Omental torsion should be considered in patients with an inguinal hernia and abdominal pain, and a CT examination can facilitate the diagnosis.
