Omental Torsion

Omental Torsion

Hattori Taro Kanzaki, MD

Table of Contents

Background
Presentation and Diagnosis
Treatment

Background

Definition: The Omentum Twists Upon its Long Axis/Vascular Pedicle

Torsion Can Compromise the Blood Supply of the Associated Omentum and Cause Omental Infarction/Necrosis, Infection, and Sepsis

Classification

  • Primary Omental Torsion – No Underlying Pathology
    • Very Rare
    • Torsion is Unipolar (The End Opposite the Vascular Pedicle is Free)
    • Most Common on the Right and is Often Confused with Appendicitis
  • Secondary Omental Torsion – Associated with Another Pathology
    • Most Common
    • Torsion is Bipolar (The End Opposite the Vascular Pedicle is Fixed as Well)

Anatomical Risk Factors

  • Bifid Omentum
  • Accessory Omentum
  • Obese with a Fatty/Bulky Omentum
  • Redundant Omentum
  • Narrowed Omental Pedicle

Secondary Causes

  • Inguinal Hernia – The Most Common Cause
  • Ventral Hernia
  • Internal Hernia
  • Adhesions/Scarring
  • Trauma/Wounds
  • Cysts
  • Malignancy

Most Common in Middle-Aged Males

Can Be Incited by Strenuous Activity, Sudden Change in Position, or Cough

Omental Torsion at Laparoscopy 1

Presentation and Diagnosis

Symptoms

  • Sudden Onset Severe Abdominal Pain
  • Nausea and Vomiting
  • Fever
  • Palpable Abdominal Mass

The Presentation is Nonspecific and Mimics Other Causes of Abdominal Pain (Appendicitis, Perforation, etc.)

CT Scan is the Primary Preoperative Diagnostic Tool and May Note Swirling of the Mesentery

Rarely Diagnosed Preoperatively and is Most Often Identified at Surgery

Treatment

The Primary Treatment is Surgical Omentectomy (Resection of Diseased Omentum)

Minimally Invasive Surgery/Laparoscopy is Generally Preferred Over Laparotomy if Able

May Consider an Initial Trial of Nonoperative Observation if Diagnosed Preoperatively and Stable without Peritonitis – Controversial with Increased Risk of Adhesions, Bowel Obstruction, and Abscess Formation without Resection

References

  1. Dhooghe V, Reynders D, Cools P. Torsion of a bifid omentum as a rare cause of acute abdomen: a case report. J Med Case Rep. 2016 Oct 19;10(1):289. (License: CC BY-4.0)