Omental Torsion Clinical Presentation

Updated: Oct 19, 2015
  • Author: Alan A Saber, MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History and Physical Examination

Torsion of the omentum is difficult to diagnose clinically in the preoperative setting. Accurate preoperative diagnosis was reported in the range of 0.6-4.8%. In a report from Greece, for example, a 14-year-old boy who was admitted to the hospital for acute appendicitis was found during surgery to be suffering from omental torsion on the long axis. [8]

Omental torsion usually occurs in adults (of either sex). The twisted portion of the omentum tends to be localized to a right-side segment, thereby giving rise to the sudden onset of pain and signs of peritoneal irritation on the right side of the abdomen. The condition may be associated with nausea, vomiting, or low-grade fever. An abdominal mass may be palpable in half of the patients.

This right-side acute pain with rebound tenderness is often mistaken for acute appendicitis, acute cholecystitis, or twisted ovarian cysts. At laparotomy, the finding of free serosanguineous fluid in association with a normal appendix, gallbladder, or pelvic organs should alert the surgeon to the possibility of omental torsion.