A Case of Idiopathic Omental Torsion with Trans-Epiploic Hernia

Abstract

Idiopathic torsion of the omentum is relatively rare, with only 59cases reported in the Japanese literature. We treated a very rare idiopatic torsion of the omentum with transepiploic hernia in a 27-year-old man who was seen for lower abdominal pain. He had tenderness with Blumberg sign in the left lower abdomen. Computed tomography (CT) showed a large fat density mass with concentric linear strands in the right lower abdomen. Laparotomy under a diagnosis of omental tumor, revealed a dark-red omental mass with triple clockwise torsion and bloody ascites. The omentum contained many interstices and circulatory disturbance of the intestine was observed due to omental torsion. The necrotic omentum, including interstices, was resected. Although preoperative diagnosis of this disease is usually difficult, comfirmative diagnosis is possible when CT shows concentric linear strands.