A CASE OF PRIMARY TORSION OF THE GREATER OMENTUM DIAGNOSED PREOPERATIVELY

Abstract

Primary torsion of the greater omentum is a relatively rare entity disease, and we have great difficulty in diagnosis this disease preoperatively. This paper presents a case of the disease diagnosed preoperatively. A 28-year-old man was admitted to the hospital with a 5-day history of progressive pain in the right lateral abdomen. While he was observed with conservative treatment, abdominal pain and laboratory data were aggravated. Abdominal helical CT scan on the 4th hospital day disclosed characteristic whirled sign by the animated imaging. Emergency operation was performed under a diagnosis of torsion of the greater omentum. On laparotomy, the necrotic omental mass twisted counter-clockwise by single turn and bloody ascites were observed. We resected the necrotic part of the omentum. The patient's postoperative course was uneventful. Of reviewed 87 cases in the Japanese literature including our case, most of the patients were operated on with the diagnosis of appendicitis. Only five patients were correctly diagnosed preoperatively on CT scan of the abdomen. Torsion of the omentum should be considered and meticulous observation of CT scan is needed in a patient with suspected appendicitis.