Omental Torsion Treatment & Management

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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Treatment

Surgical Therapy

Preoperative differential diagnosis includes acute appendicitis, acute cholecystitis, and twisted ovarian cysts. Torsion of the omentum is usually discovered during laparotomy or laparoscopy for an acute abdomen. [11]  With the advent of diagnostic laparoscopy and the increased demand for laparoscopic appendectomy, omental torsion may become a more frequently recognized clinical entity.

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. [15]

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.

First, inspect the cecum for a perforated diverticulum. The terminal ileum is then examined for Meckel diverticulum and regional enteritis, and the pelvic organs are inspected and palpated for disease.

Visualize the gallbladder and duodenum, and evaluate the mesentery for mesenteric lymphadenitis. 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.

Postoperative recovery is usually rapid, and morbidity is minimal. If left untreated, the natural process of omental torsion is necrosis and fibrosis.