Omental infarction oi is a rare cause of acute abdomen in children. Clinically, primary and secondary omental torsions are similar. Acute presentations are usually due to complication in cyst. Oct 31, 2019 omental torsion should be considered if preoperatively diagnosed acute appendicitis is not found and if the gallbladder and ovaries reveal no disease. The first case of omental torsion was reported in 1899 by eitel. The pdf file portable document format of a torsional spring design which lists the torsion springs parameters that were calculated using torsional spring design formulas based on theory. With the advent of diagnostic laparoscopy and the increased demand for laparoscopic appendectomy, omental torsion may become a more frequently recognized clinical entity. Omental cysts are rare abdominal lesions and are difficult to diagnose. Omental torsion is usually diagnosed intraoperatively and resected. Torsion of the greater omentum can be a cause of acute abdomen and could be.
Omental torsion is an infrequent cause of acute abdomen and its symptoms are nonspecific, often presenting with pain at the right iliac fossa as the only symptom. Torsion of the omentum due to omental hydatid has also been reported. Torsion of the omentum is a rare cause of abdominal pain. Abdominal computed tomography showed a whirling pattern of fatty streaks and vessels within the greater omentum, and surgery confirmed infarction of the omentum secondary to torsion. It is easy to understand how a twist in the omentum may be produced by forcible taxis of. It is clinically similar to common causes of acute surgical abdomen and is often diagnosed during surgery. Nm, lbft in this chapter, we will develop formulas. Omental torsion is defined as a twist of the omentum along its long axis with consequent impeding of its vascularity that may mimic acute abdomen 1. The syndrome is clinically indistinguishable from acute appendicitis when the infarcted segment lies in the right lower abdominal quadrant. Omental infarction, or omental torsion, is an acute vascular disorder which compromises tissue of the greater omentum the largest peritoneal fold in the abdomen. Describe the typical clinical feature of omental torsion and the specific ct findings that may help with preoperative and differential diagnosis.
Mostly they are detected incidentally during imaging studies performed for unrelated reasons. The cause of torsion was forcible attempts at reduction of a hernia in four instances, severe coughing in one, and unknown in four. Preoperative diagnosis is a challenge and mistaken with appendicitis, cholecystitis, diverticulitis, pancreatitis, epiploic appendagitis, incarcerated hernia, duodenal ulcer, ovarian torsion and ectopic pregnancy. We encountered a case of giant lymphatic cyst presenting. Recently, we encountered a case of omental torsion diagnosed as omental infarction preoperatively. Although omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon because it mimics the common causes of acute surgical abdomen. Its aetiology remains unknown, but different risk factors have been associated with the disease, including obesity, congenital malformations, and tumours. During surgery, omental torsion was diagnosed and the involved omentum was resected. The widespread and increasing use of computer tomography ct in differential diagnosis of acute abdomen can be useful. Laparoscopic excision of an omental leiomyoma with a giant. Omentum anatomy, pathological conditions and surgical.
It more frequently occurs in the right side because. A 65yearold man presented to the emergency department complaining of right lower abdominal pain. We know very well what causes climate change, and in general terms, what the dangers are. An 18yearold male presented to our emergency room with a chief complaint of lower abdominal pain since previous 2 days. Intraoperative diagnosis and treatment by resection are the current management of choice, however with increasing use of preoperative imaging this may need to be reconsidered. We encountered a case of giant lymphatic cyst presenting with. Torsion of greater omentum is one of the rare causes of acute abdominal pain. The first published report of torsion of the greater omentum is generally ascribed to eitel in 1899, 5, 6 who described what he found after surgical exploration for a palpable omental tumor although some credit demarchetti with. 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. Because of his history of down syndrome, an abdominal examination was very difficult. Omental whirl associated with bilateral inguinal hernia. Laparoscopic resection for torsion of an omental lipoma. Patients commonly present with right iliac fossa pain resembling appendicitis, but they lack the associated gastrointestinal symptoms of nausea, vomiting, or anorexia. Primary torsion of the greater omentum in childhood.
Omental infarction in children misdiagnosed as acute. Torsion of the greater omentum secondary to omental. Omental cysts are the least common variety of intraabdominal cystic lesions encountered in children. Acute appendicitis is a frequent differential diagnosis that should be taken into account. Omental infarction can occur with torsion, as it did in our patient as viewed in fig. The most frequent complaint is pain in the right iliac. Omental torsion ot is a condition in which a pedicle of the omental apron twists on its longer axis to such an extent that its vascularity is compromised.
But there is an even smaller group of omental infarction which. Torsion of the omentum is usually discovered during laparotomy or laparoscopy for an acute abdomen. Idiopathic omental torsion simulating appendicitis jama. Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. Wed like to understand how you use our websites in order to improve them. Imaging is helpful in excluding other causes of lump abdomen. In our series, we found a twofold higher incidence of omental torsion, compared with previously reported incidence data. This suggests that spontaneous derotation of an omental torsion may occur, and may be an unusual cause of recurrent abdominal pain. Radiologic and clinical features of omental torsion.
Omental torsion and infraction due to axial twisting along its long axis if twist is thight enough or venous obstruction is of sufficient duration arterial in flow is compromised leadind to infraction and necrosis two type 1primary no cause usually on right side 2secondary associated with other conditions like hernia. A case report of omental torsion, which is a rare differential diagnosis of the acute abdomen. We also found a difference in age and sex distribution among. Institute omental infarction is a rare cause of acute omental infarction manual guide pdf read online now omental infarction manual guide ebook pdf at our library get omental infarction manual guide pdf file for free from our online library pdf file. Omental torsion is a rare cause of acute abdomen which is frequently diagnosed intraoperatively. Manual hernia reduction could also be considered as a factor in some cases 7. In cases, where, imaging may not help, laparoscopy can be used as a diagnostic and therapeutic tool. A 33yearold male presented to the emergency department complaining of right upper quadrant pain and was initially diagnosed with acute cholecystitis. Idiopathic torsion of the omentum consists of an omental twist in the absence of any recognizable etiologic factor such as a hernia, inflammatory process, or adhesions. It affects predominantly young and middle aged women.
They may also be generated using a torsion spring design program which automatically calculates these formulas. Get a printable copy pdf file of the complete article 240k, or click on a page image below to browse page by page. We describe here two girls with omental cysts with very unusual clinical presentations. Omental torsion is a rare cause of acute abdomen and sometimes requires surgery. Primary omental infarction as cause of nonsurgical acute abdomen. A computed tomography of abdomen revealed findings suggestive of omental torsion. Modern management of omental torsion and omental infarction. Inguinal hernia is a common condition but not frequently related with torsion of the omentum. Laparoscopic resection of an omental cyst with pedicle torsion. May 12, 2004 abdominal computed tomography showed a whirling pattern of fatty streaks and vessels within the greater omentum, and surgery confirmed infarction of the omentum secondary to torsion. The widespread and increasing use of computer tomography ct in differential diagnosis of acute abdomen can be.
Torsion of greater omentum is a quite uncommon cause of acute abdomen. From this typical finding, a diagnosis of omental torsion was made immediately, which was confirmed by subsequent surgery. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. Omental torsion is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. The more common secondary torsion is associated with adhesion of the free end of the greater omentum to a cyst, tumor, surgical scar, sac of a hernia or an inflammatory focus 12. Primary omental torsion occurs when the mobile thickened segment of the omentum rotates around a proximal fixed point in the absence of any. We report a case of 23yearold pregnant woman who presented to our hospital with right lower. However with an increase in the incidence of obesity in. 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. A member subjected to torsional moments would twist about a longitudinal axis through the shear centre of the cross section. Acute abdomen because of omental torsion is a rare entity. Links to pubmed are also available for selected references. The majority of omental cysts are discovered incidentally. Although it is rarely diagnosed preoperatively, knowledge of this entity is important to the surgeon because it mimics the common causes of acute surgical abdomen.
Primary omental torsion is an entity that mimics many acute abdominal pathologies and hence should be included in the differential diagnosis. Omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon as it mimics common acute surgical abdomen. Eitel 2 first reported a case of omental torsion unassociated with a hernia. Laparoscopic resection for torsion of an omental lipoma presenting as an acute abdomen in a 5yearold girl yousuke kinjo 2 yasushi adachi 1 kunihiko seki 0 michihiko tsubono 2 0 department of pathology, jr tokyo general hospital, tokyo, japan 1 division of surgical pathology, toyooka hospital, toyooka, japan 2 department of surgery, toyooka. Pdf eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. Recent literature supports conservative management after diagnosis of omental torsion using radiological imaging. The diagnostic and therapeutic role of laparoscopy.
We report a case of surgically and pathologically proven omental. Full text is available as a scanned copy of the original print version. Background torsion of the greater omentum is a rare cause of acute abdomen that affects mainly young and middleage women 1. Oct 31, 2019 omental torsion is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Mar 27, 2014 omental torsion and infraction due to axial twisting along its long axis if twist is thight enough or venous obstruction is of sufficient duration arterial in flow is compromised leadind to infraction and necrosis two type 1primary no cause usually on right side 2secondary associated with other conditions like hernia. Resultsmdct findings of all cases with omental torsion, cystic lymphangioma, and loculated fluid in the greater omentum correlated with the surgical and histopathological findings with 100% diagnostic accuracy. Omental torsion must be considered as a differential consideration of an acute abdominal emergency especially in a patient with an inguinal hernia. For this reason, in the absence of diagnosed preexisting abdominal pathology, including cysts, tumors, foci of. A 11yearold boy presented with symptoms and signs suggestive of appendicitis. We report a case of surgically and pathologically proven omental torsion that demonstrated the typical whirling appearance on computed tomography. They may also be generated using a torsion spring design program which.
Pdf torsion of the greater omentum is one of the rare causes of acute abdomen. In contrast to secondary torsion of the greater omentum, which occur with intraabdominal pathology like adhesions or tumors, primary omental torsion pot results from twisting of the greater omentum along its long axis causing vascular compromise, without any intraabdominal pathology it was first described by eitel in 1899, and since then only few case reports were. Pdf omental torsion is an infrequent cause of acute abdomen and its symptoms are nonspecific, often presenting with pain at the right iliac fossa as. Laparoscopic resection of this necrotic omentum was performed using an ultrasonic coagulation device harmonic, ethicon endosurgery, inc.
In conclusion, omental cysts are considered to be a rare entity that needs to be taken into consideration. Primary greater omental torsion as a cause of acute abdomena. Primary omental torsion is less common than secondary torsion 11. Epidemiology omental torsion is a rare cause of acute abdominal pain that occurs in the third. This condition could be produced by omental torsion which is due to adhesion of previous surgery and is called bipolar or secondary, and it could be produced by torsion without an understand able cause and is called primay or unipolar 2,4. They are often identified incidentally, although they may also cause acute abdominal pain. For this reason, in the absence of diagnosed preexisting abdominal pathology, including cysts, tumors, foci of intra. Diagnostic laparoscopy confirmed the diagnosis of torsion of a segment of the greater omentum. Torsion spring design pdf quality spring, affordable prices. However, they have anticipatable course and favorable outcomes if. Omental torsion is a rare cause of acute abdomen in children and adults who may present with various signs and symptoms. Ct features, abdominal radiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips.
The treatment for omental torsion is the resection of necrotised tissue by a laparoscopic approach. Primary torsion of the greater omentum in childhood europe. In addition, the presence of serosanguineous fluid in the peritoneal cavity mandates inspection of the omentum to exclude torsion. Get a printable copy pdf file of the complete article 496k, or click on a page image below to browse page by page. Jan 26, 2011 eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. The twisted omental pedicle was seen just below the transverse colon, and the lower part of the omentum distal to the torsion point appeared necrotic fig. A 40yearold caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal. Secondary omental torsion is always associated with abdominal pathology including tumors and cysts, postsurgical scarring, and hernia sacs. Full text get a printable copy pdf file of the complete article 3k, or click on a page image below to browse page by page.
Omental infarction is a differential diagnosis in the postpartum acute abdomen. This is a new kind of environmental problem, and it is important to understand why responding to climate change is so challenging. Abdominal computed tomography showed a whirling pattern of fatty streaks and vessels in the greater omentum. Primary omental torsion international archives of integrated medicine. Preoperative differential diagnosis includes acute appendicitis, acute cholecystitis, and twisted ovarian cysts. Symptoms are unspecific and preoperative diagnosis is difficult. Acute abdomen due to primary omental torsion and infarction.
Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. A 40yearold caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal distension for 2 days. Nov 18, 2009 a case report of omental torsion, which is a rare differential diagnosis of the acute abdomen. This is a case report of a 26yearold caucasian woman with spontaneous omental infarction two weeks after normal vaginal delivery. Eitel first described omental torsion in 1899, since then, fewer than 250 cases have been reported. Full text full text is available as a scanned copy of the original print version. Gi tract pathology mcqs the most common cause of intestinal obstruction is.
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