Obstet Gynecol Sci.  2014 Sep;57(5):415-418. 10.5468/ogs.2014.57.5.415.

Primary omental torsion diagnosed during hysterectomy

• Park CM
• Kim SY

• KMID: 2051727
• DOI: http://doi.org/10.5468/ogs.2014.57.5.415

Abstract

Omental torsion is a rare cause of acute abdominal pain. It presents with nonspecific symptoms and signs of an acute abdomen, making it difficult to diagnose preoperatively, because symptoms mimic those caused by other conditions such as appendicitis, cholecystitis, diverticulitis, and other gynecologic diseases. Computed tomography is an effective and useful method to diagnose and exclude other acute abdominal conditions. Our case presented with sudden right upper abdominal pain with tenderness, rebound tenderness, mild fever (37.2degrees C), increased erythrocyte sedimentation rate (37 mm/hr), increased high-sensitivity C-reactive protein level (5.97 mg/dL). Computed tomography showed a large, well-circumscribed heterogeneous fatty mass and a 7.3 cm subserosal myoma. We could not exclude the myoma as the cause of acute abdominal pain, so we performed an emergency operation with suspicion of omental torsion or necrotic degeneration of the myoma. During the operation, we diagnosed primary omental torsion with infarction and subserosal myoma without secondary degeneration.

Keyword

Computed tomography; Infarction; Omental torsion

MeSH Terms

Abdomen, Acute
Abdominal Pain
Appendicitis
Blood Sedimentation
C-Reactive Protein
Cholecystitis
Diverticulitis
Emergencies
Female
Fever
Genital Diseases, Female
Hysterectomy*
Infarction
Myoma
C-Reactive Protein

Figure

• 

  Fig. 1 Axial computerized tomography scan shows a fat pattern characteristic of omental torsion. The vascular pedicle extends caudally and enters a large well-circumscribed heterogeneous fatty mass in the right upper quadrant, and fat density is increased.

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  Fig. 2 During the operation, a 10.0×8.0-cm dark brown clockwise omental torsion was observed in the right side of the greater omentum.

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