Presentation
A male presented to ER with acute lower abdominal pain.
Patient Data
Pre and post IV dual phase CT images were obtained. Oral contrast was also given.
The greater omentum appears hazy with concentric hyperdensity. 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 inguinoscrotal hernia contains hazy omental fat only.
Plain CT done post laparoscopic surgery for case proved to be omental torsion. Abdominopelvic pneumoperitoneum is seen. Small volume fluid seen in subhepatic and operative bed regions. Right inguinoscrotal hernia & bilateral scrotal pneumohydrocoele. Misty pelvic mesenteric fat with multiple surgical metallic clips are seen. Left upper & lower abdominal wall subcutaneous emphysema and contusions.
Case Discussion
Omental torsion must be considered as a differential consideration of an acute abdominal emergency especially in a patient with an inguinal hernia.
Omental infarcts: the omentum may infarct without any torsion and when this happens it is considered a primary idiopathic segmental infarct.
This case is courtesy of Dr. Sikander Ali, Radiology Consultant RCMC.