A CASE OF OMENTAL TORSION COMBINED WITH INGUINAL HERNIA

Abstract

A rather rare case of omental torsion which was secondary to inguinal herniation of the omentum was reported. The patient, a 60-year-old male, was admitted to our hospital because of right lower abdominal pain. Laparotomy for the preoperative diagnosis of right inguinal hernia with incarceration disclosed that the greater omentum was fully rotated in a clockwise direction and moderate amount of bloody ascites in the peritoneal cavity was present. The rotated portion of the omentum was totally resected and histologically it was extensively necrotic with focal hemorrhage and inflammatory cell infiltration but free of any neoplastic change.
We reviewed 57 cases of omental torsion reported in Japan, of which 13 (23%) were of primary idiopathic type, 40 (70%) were secondary type and four were not specified. The preoperative diagnosis of omental torsion seems extremely difficult and none of the 57 cases was diagnosed correctly; the majority (74%) were diagnosed as acute appendicitis. It seems to be justifiable as the generally accepted treatment of this disease that invaded portions of the omentum should be resected completely regardless of the extent of the involved areas.