Omental torsion

Case contributed by Dr Fakhry Mahmoud Ebouda

Presentation

A male presented to ER with acute lower abdominal pain.

Patient Data

Age: 40 years.
Gender: Male
CT

Pre and post IV dual phase CT images were obtained.Oral contrast was also given.

The greater omentum appears hazy with concentric hyperdensity is seen. It shows streaks of whirling pattern (whirl sign). It is displacing bowel loops. The abdominal and pelvic fat appears streaky. The rectum and sigmoid colon appear collapsed. An associated right inguino-scrotal hernia containing Omental fat only. The hernial fat looks misty. 

CT

Plain CT done post laparoscopic surgery for case proved to be omental torsion. Pelvi-abdominal pneumoperitoneum is seen. Minimal fluid seen in sub hepatic & operative bed regions. Right inguino-scrotal hernia & bilateral scrotal pneumo-hydrocele. Misty pelvic mesentric fat with multiple surgical metalic clips are seen. Left upper & lower abdominal wall surgical emphysema & subcutaneous contusions.

Case Discussion

Omental torsion must be considered as a differential consideration of acute abdominal emergency specially in patient with inguinal hernia. Omental infarcts: the omentum may infarct without any torsion which is considered as primary idiopathic segmental infarct.

The case is courtesy of Dr. Sikander Ali, Radiology Consultant RCMC.

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Case information

rID: 39009
Case created: 15th Aug 2015
Last edited: 15th Oct 2015
Inclusion in quiz mode: Included

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