eMedicine Specialties > General Surgery > Abdomen

Omental Torsion: Treatment

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

Treatment

Surgical Therapy

Torsion of the omentum is usually discovered during laparotomy or laparoscopy for an acute abdomen.

Consider omental torsion if preoperatively diagnosed acute appendicitis is not found and if the gallbladder and ovaries reveal no disease. In addition, the presence of serosanguineous fluid in the peritoneal cavity mandates inspection of the omentum to exclude torsion.

Treatment consists of resection of the affected portion of the omentum. Correct any disease process associated with secondary torsion.

Preoperative Details

Preoperative differential diagnosis includes acute appendicitis, acute cholecystitis, and twisted ovarian cysts.

Intraoperative Details

An incision centered over the site of maximal tenderness facilitates the operative diagnosis and eases resection of the infarcted omentum. When a healthy appendix is found, search for the cause of the abdominal pain.

  1. Inspect the cecum for a perforated diverticulum.
  2. The terminal ileum is then examined for Meckel diverticulum and regional enteritis.
  3. The pelvic organs are inspected and palpated for disease.
  4. Visualize the gallbladder and duodenum.
  5. Evaluate the mesentery for mesenteric lymphadenitis.
  6. Continue to explore the abdomen until the cause of acute abdominal symptoms has been identified. This may require extension of the original incision or creation of a new incision.

More on Omental Torsion

Overview: Omental Torsion
Workup: Omental Torsion
Treatment: Omental Torsion
Follow-up: Omental Torsion
Multimedia: Omental Torsion
References
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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.

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Further Reading

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Keywords

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

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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

 
 
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