Omental Torsion Treatment & Management

Updated: Aug 19, 2021
  • Author: Alan A Saber, MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Treatment

Approach Considerations

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. [13]  With the advent of diagnostic laparoscopy and the increased demand for laparoscopic appendectomy, omental torsion may become a more frequently recognized clinical entity.

Omental torsion should be considered 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 generally consists of resection of the affected portion of the omentum. Any disease process associated with secondary torsion should be corrected. [17]  However, some have argued in favor of a conservative nonoperative approach when the diagnosis of omental torsion is well established, with surgical therapy reserved for failure of nonoperative treatment. [18]

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Surgical Therapy

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, the cause of the abdominal pain should be sought.

First, the cecum should be inspected 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.

The gallbladder and duodenum should be visualized, and the mesentery should be evaluated for mesenteric lymphadenitis. Exploration of the abdomen should continue until the cause of acute abdominal symptoms has been identified. This may require extension of the original incision or creation of a new incision.

Successful treatment via a laparoscopic approach has been reported. [19, 20, 21, 22]

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

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