Diagnosis and treatment of primary omental torsion: an analysis of 12 cases / 中华全科医师杂志

ABSTRACT

Objective To analyze the clinical features, diagnosis and treatment of the primary omental torsion (POT).Method The clinical data of 12 patients with POT admitted to our hospital from May 2010 to May 2015 were retrospectively reviewed.The clinical manifestations, laboratory investigation, medical image, treatment and outcomes of patients were analyzed.Results Twelve cases were all males with median age of 50.The POT was diagnosed during surgical exploration and confirmed pathologically after operation.Right abdominal pain was the main complaint in 11 cases, and pain migration to right lower quadrant in 1 case.In physical examination, the local peritonitis signs were elicited, including right quadrant tenderness and rebound tenderness at same location.All cases had mal temperature except one presenting low fever of 37.5 ℃.White blood cell counts was 12×109/L in one case, and(4-10)109/L in other 11 cases.Abdominal solid mass was found in one case by ultrasonic scan, measured 7 cm×5 cm with unclear surrounding boundary.Mesenteric fat opacity and dropsy were shown in 10 cases on CT plain scan, while thickness and effusion of hepatic flexure of colon was found in one case;however, none of them were suggested as POT by these two image study before operation.All patients were gnosed as localized peritonitis or appendicitis clinically before emergent surgical exploration.The necrotic omentum was resected and all patients recovered smoothly.There were no complications in all cases during one-year follow-up.The CT images were reviewed after operation, which indicated that the mesentery of dropsy and the thickened hepatic flexure of colon should be the imaging signs of omental torsion;and also 9 of 12 cases had whirlpools sign.Conclusion The preoperative diagnosis of POT is difficulty, the typical whirlpools sign of abdominal mass on CT imaging is of highly value in diagnosis.The surgical removal of omental infarction is effective and the prognosis is good.