eMedicine Specialties > General Surgery > Abdomen

Omental Torsion: Workup

Author: Alan A Saber, MD, MS, FACS, Chief, Minimally Invasive Surgery and Bariatric Surgery, Associate Professor, Department of Surgery, Michigan State University
Coauthor(s): Raymond D LaRaja, MD, Chairman, Program Director, Clinical Professor, Department of Surgery, Cabrini Medical Center, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Oct 23, 2009

Workup

Laboratory Studies

  • CBC counts may reveal moderate leukocytosis, which occurs in two thirds of cases.

Imaging Studies

  • Reports suggest that ultrasonography and computed tomography (CT) scanning may show a characteristic appearance of twisted omentum; however, because the disease may mimic other surgical emergencies, extensive radiologic studies are usually not indicated.
    • CT scanning may show a concentric distribution of fibrous and fatty folds converging radially toward the torsion.2
    • Ultrasonography, on the other hand, may show a complex mass and mixture of solid material and hypoechoic zones.

Diagnostic Procedures

  • Laparoscopy is a safe diagnostic and therapeutic modality. In a report from Italy, for example, ultrasonographic and radiologic findings in 3 patients who presented with acute abdominal symptoms were unclear, prompting the use of diagnostic laparoscopy.3 Because laparoscopic examination allowed exploration of the entire peritoneal cavity, an accurate diagnosis of omental torsion, and laparoscopic resection of necrotic omentum, was achieved in each patient, according to the report.

Histologic Findings

Acute hemorrhagic infarct and fat necrosis

More on Omental Torsion

Overview: Omental Torsion
Workup: Omental Torsion
Treatment: Omental Torsion
Follow-up: Omental Torsion
Multimedia: Omental Torsion
References
[ CLOSE WINDOW ]

References

  1. Efthimiou M, Kouritas VK, Fafoulakis F, et al. Primary omental torsion: report of two cases. Surg Today. 2009;39(1):64-7. [Medline].

  2. Jeon YS, Lee JW, Cho SG. Is it from the mesentery or the omentum? MDCT features of various pathologic conditions in intraperitoneal fat planes. Surg Radiol Anat. Jan 2009;31(1):3-11. [Medline].

  3. Costi R, Cecchini S, Randone B, et al. Laparoscopic diagnosis and treatment of primary torsion of the greater omentum. Surg Laparosc Endosc Percutan Tech. Feb 2008;18(1):102-5. [Medline].

  4. Adams JT. Primary torsion of the omentum. Am J Surg. Jul 1973;126(1):102-5. [Medline].

  5. Basson SE, Jones PA. Primary torsion of the omentum. Ann R Coll Surg Engl. Mar 1981;63(2):132-4. [Medline].

  6. Beattie GC, Irwin ST. Torsion of an omental lipoma presenting as an emergency. Int J Clin Pract Suppl. Apr 2005;130-1. [Medline].

  7. Lipsett PJ. Torsion of the greater omentum: report of 2 cases. Ann Surg. 1941;114:1026-34.

  8. Mainzer RA, Simoes A. Primary idiopathic torsion of the omentum. Arch Surg. 1964;88:974-81.

  9. Tompkins RK, Sparks FC. Primary torsion of the omentum: mimic of appendicitis. Am Surg. 1966;32:399-402.

  10. Young TH, Lee HS, Tang HS. Primary torsion of the greater omentum. Int Surg. Apr-Jun 2004;89(2):72-5. [Medline].

  11. Zager JS, Gadaleta D, De Noto G. Primary omental torsion in adults: a small series of cases. Contemp Surg. 1999;55(5):261-63.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

omental torsion, omentum, omental, omental infarction, volvulus of the omentum, twisted omentum, acute abdomen, accessory omentum, bifid omentum, omental fat, omentum pedicle

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Alan A Saber, MD, MS, FACS, Chief, Minimally Invasive Surgery and Bariatric Surgery, Associate Professor, Department of Surgery, Michigan State University
Alan A Saber, MD, MS, FACS is a member of the following medical societies: American College of Surgeons, American Society for Gastrointestinal Endoscopy, and American Society for Metabolic and Bariatric Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Raymond D LaRaja, MD, Chairman, Program Director, Clinical Professor, Department of Surgery, Cabrini Medical Center, Mount Sinai School of Medicine
Raymond D LaRaja, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, New York Academy of Medicine, and New York County Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Amy L Friedman, MD, Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse
Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.