A Case of Primary Torsion of the Greater Omentum

Role of Abdominal CT for Preoperative Diagnosis

Abstract

A 54-year-old man admitted for sudden severe left lower abdominal pain had a several-year history of gastric ulcer. We palpated a painful mass in the left lower quadrant of the abdomen. Abdominal ultrasonography (US) showed a low echogenic mass with high echogenic spots. Abdominal radiographic computed tomography (CT) showed a low fat density mass with concentric strands on the thickened anterior wall of the stomach angle. A small amount of ascites was also seen. We diagnosed the case as stomach ulcer perforation with abscess formation. At laparotomy, we found that the right free portion of the greater omentum was twisted and adheded to the stomach angle. We excised the necrotic omentum and the attached portion of the stomach. Pathology showed massive dilation of the vessels, hemorrhage, and infarction without thrombus. The postoperative course was uneventful. Primary torsion of the omentum is rare, but must be considered in differential diagnosis of acute abdomen. Abdominal radiographic CT is extremely useful in preoperative diagnosis.