2021 Volume 57 Issue 3 Pages 674-677
The patient was an 11-year-old girl. Although her mild abdominal pain was recognized one week before her first visit, it was only closely monitored and followed up. Since the abdominal pain became worse one day before her urgent hospital visit, she had a medical examination at our hospital. At the time of consultation, low-grade fever and marked tenderness from the right flank to the right upper quadrant were recognized, and peritoneal irritation was mild. Abdominal ultrasonography was performed with the suspicion of acute appendicitis and mesenteric lymphadenitis. Although the appendix and lymph nodes were not enlarged, a low-echoic mass with an unclear boundary was found in the right upper quadrant. Abdominal CT scan revealed a whirl sign in the omental fat tissue weaving, and it was diagnosed as greater omental torsion. The abdominal pain gradually worsened, and walking became difficult. Thus, single-incision laparoscopic surgery was carried out on the same day. The operative findings were torsion of the greater omentum in the right upper quadrant and necrosis of the twisted omentum. The necrotic omentum was extracted through the umbilicus and excised. The postoperative course was uneventful, and the patient was discharged on postoperative day 3. Preoperative diagnosis is possible for pediatric idiopathic omental torsion, and single-incision laparoscopic surgery is regarded as a less invasive and useful therapy.
