Secondary Omental Torsion with Acute Appendicitis

Special Article – Surgery Case Reports

Austin J Surg. 2017; 4(4): 1113.

Secondary Omental Torsion with Acute Appendicitis

Pui WC*

Department of Surgery, Kapit Hospital, Malaysia

*Corresponding author: Pui WC, Department of Surgery, Kapit Hospital, Jalan Mamora, 96800, Kapit, Sarawak, Malaysia

Received: November 24, 2017; Accepted: December 14, 2017; Published: December 20, 2017


Omental torsion is a rare cause of acute abdomen with non-specific presentations mimicking other common pathologies. It is commonly found incidentally during surgery. This case presented as acute appendicitis and noted to have secondary omental torsion with simultaneous acute appendicitis intraoperatively. Open appendicectomy and partial omentectomy were performed. Ultrasonography and Computed Tomography can detect omental torsion preoperatively and is beneficial especially when patients have vague presentations. Hence, imaging can assist in planning of surgical treatment options.

Keywords: Omental torsion; Acute appendicitis; Acute abdomen; Appendicectomy


Omental torsion was first described by Eitel in 1899 [1]. It is a rare cause of acute abdomen which mimics other commoner diagnoses and is commonly found intraoperatively. Omental torsion can be divided into primary, without any intra-abdominal pathology, or secondary torsion which happens alongside with other pre-existing conditions [2].

Case Report

This is a case of secondary omental torsion due to underlying acute appendicitis. A forty nine years old gentleman with no underlying illness presented with 3 days of right iliac fossa pain. He did not have anorexia, nausea or vomiting and was a febrile. Physical examination revealed tenderness over right iliac fossa at Mc Burney’s point with rebound tenderness. His white blood cell was 12.4 x109/L, urinalysis was normal and KUB radiograph did not show any stones. Alvarado score was 6/103. A diagnosis of acute appendicitis was made planned for open appendicectomy via Lanz’s incision. Intra-operative finding was torsion of the right omentum (1080 degree) which was gangrenous. The distal omentum was adhered to the appendix which was inflamed. Patient underwent appendicectomy and partial omentectomy. He recovered well post-operatively and was discharged the next day. Histopathology examination confirmed the diagnosis of acute appendicitis (Figure 1).

Citation: Pui WC. Secondary Omental Torsion with Acute Appendicitis. Austin J Surg. 2017; 4(5): 1113. ISSN:2381-9030