Primary torsion of the greater omentum: An overlooked cause of acute abdomen

Abstract

Background/purpose Primary torsion of the greater omentum is an uncommon cause of acute abdomen in children. It was estimated to be found in 0.1% of cases operated for acute appendicitis and is almost impossible to be diagnosed preoperatively. Surgical excision of the infarcted omentum is the treatment of choice. In this study, we aimed to highlight the importance of suspecting primary omental torsion when operating upon a child presenting with a picture of acute appendicitis with normal appearing appendix intraoperatively.
Patients and methods Through the period from June 2009 to May 2016, medical records of patients who had definite diagnosis of primary omental torsion were retrospectively reviewed. Clinical presentations, laboratory findings, imaging studies results, intraoperative findings, and histopathological findings were reviewed.
Results During the specified time period, out of 1344 patients operated upon for acute appendicitis in our department, only four patients proved to have primary torsion of the greater omentum. All the patients were obese with clinical picture mimicking acute appendicitis. The postoperative histopathological examination showed normal appendix and ischemic necrosis of the resected omental segment.
Conclusion Inspection of the greater omentum is essential when finding a normal appearing appendix in any case operated for suspicion of acute appendicitis. 

Keywords: acute abdomen, appendix, greater omentum, omental torsion