| disease | Omental Torsion |
| alias | Torsion of the Omentum |
Torsion of the Omentum is relatively rare, occurring more frequently in men than women, with an age range of 3 to 75 years and most commonly seen between 25 to 50 years old. It predominantly affects obese individuals. This condition can cause significant abdominal pain and gastrointestinal symptoms, making it difficult to differentiate from other acute abdominal conditions.
bubble_chart Pathological Changes
The torsion of the omentum can be divided into two types: one type is secondary, resulting from adhesions or hernias, and mostly occurs under the following circumstances:
1. Localized or band-like adhesions after abdominal inflammation or adhesions between the abdominal membrane under the surgical incision and the greater omentum.
2. When the hernia contents include the greater omentum, especially if it adheres to the hernia sac wall.
3. Cysts or tumors on the omentum are also prone to torsion. The other type is primary torsion, which can occur without any intra-abdominal disease, unrelated to adhesions or tumors, and has no clear cause. It may be due to malformations of the omentum, such as a free edge protruding in a swallowtail shape, variations in the amount or position of fat, excessive or contracted veins, increased motility, or the presence of nonspecific inflammatory lesions in the omentum, all of which may be predisposing factors for torsion. Additionally, sudden coughing, changes in body position, or lifting and moving heavy objects can also be triggering factors. Some scholars speculate that omental torsion is often reversible and can occur multiple times. After torsion occurs, congestion and even infarction may develop in the distal part of the torsion.
Torsion is usually simple and can be classified as complete or incomplete. Complete torsion can involve up to six full turns, and such omentum is often quite hypertrophic, with a long pedicle and a narrow attachment site.bubble_chart Clinical Manifestations
Abdominal pain is the main symptom of mesenteric torsion, mostly occurring in the lower right abdomen, presenting as dull pain or distending pain. Initially, it may be tolerable but gradually progresses to persistent pain with paroxysmal exacerbations. Statistics show that 80% of cases involve pain in the lower right abdomen, while 10% experience pain in the upper right abdomen. Approximately half of the patients are accompanied by nausea and vomiting. If infarction occurs, fever may also be present.
Abdominal examination may reveal a localized mass, tenderness, rebound tenderness, and localized peritoneal irritation signs.
Most patients experience extensive tenderness and grade I rebound tenderness, and sometimes a mass can be palpated. They are often misdiagnosed with appendicitis or cholecystitis before surgery. Mainzer et al. collected 165 cases, with only one correctly diagnosed preoperatively. About half of the patients show elevated peripheral white blood cell counts in auxiliary examinations.
bubble_chart Treatment Measures
Surgical resection can achieve satisfactory results. Since torsion often causes infarction of the omental vessels, the resection range should be larger, generally performed 2-3 cm above the site of torsion.
The prognosis is good.
Differentiate from acute appendicitis, cholecystitis, and other acute abdominal conditions.
