Omental torsion

Case contributed by Dr Arkadi Tadevosyan

Presentation

Patient with known history of an abdominal type of familial Mediterranean fever admitted to emergency department with pain and palpable mass at the umbilical region.

Patient Data

Age: 55
Gender: Female
CT
  • fat density lesion in the umbilical region with streaks of whirling and concentric pattern (whirl sign)
  • some compression of adjacent small bowel loops
  • a small amount of free fluid in the pelvis and near the lower pole of the liver
  • no signs of bowel obstruction

Finding are consistent with omental torsion, which was proved intraoperatively.

Photo

A lower midline laparotomy was performed. 

  • greater omentum was twisted five times in a counterclockwise direction
  • a twisted specimen of the omental torsion shown to be congested and hemorrhagic

Greater omentum was resected. The patient was in good condition and discharged on the 5th days in admission.

Case Discussion

The whirlpool sign, also known as the whirl sign, is seen in a number of settings when a structure twists upon its pedicle. It is most commonly described in the abdomen where bowel rotates around its mesentery, with mesenteric vessels creating the whirls. It can also be seen in omental and ovarian torsion.

Omental torsion is a rare cause of acute abdominal pain that occurs in the third to fifth decade of life with slight male predominance. It can be primary or secondary.

  • primary omental torsion: No identifiable cause but may be related to local omental anatomical variations that allow a movable segment of omentum to twist around the proximal fixed point.
  • secondary omental torsion: More frequent than primary omental torsion. It occurs secondary to hernial sacs, surgical scars or wounds, tumors, and cysts. Inguinal hernias are the most common cause of secondary omental torsion.

Special thanks to Dr. Naina Hakobyan, "AMC" Hospital, Armenia Department of Radiology, for contributing this case.

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Case information

rID: 61325
Published: 28th Jun 2018
Last edited: 29th Jun 2018
Inclusion in quiz mode: Included
Institution: "AMC" Yerevan

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