28 year old male who underwent right inguinal hernia repair one month back, now complains of pus discharge from the operative site since 15 days
- Twisting of greater omentum along its long axis
- Fat stranding, free fluid, free air foci within
- A pseudo capsule around the twisted omentum measuring
- Ascending colon compressed and displaced posteriorly and superiorly.
- No bowel obstruction and no communication with bowel
- Hyperdense tract extending upto the skin surface at operative site could be site of discharge
- Torsion of greater omentum with infarction, necrosis infection.
- Secondary infection with track extending into the operated scar of the right inguinal hernia
- Greater omental torsion is defined as twist of omentum along its long axis with consequent impeding of its vascularity that may mimic acute abdomen.
- Clinical presentation –right lower quadrant /paraumbilical pain
Types of Omental hernia1
- Primary torsion maybe due to omental anatomic variations such as bifid omentum, bulky omentum, accessory omentum etc.
- Secondary torsion – secondary to hernial sacs, surgical scars, tumours and cysts.
- Inguinal hernias are the most common cause of secondary omental torsion.2
- Complications of torsion are -omental infarction, peritonitis, adhesive bowel obstruction, sepsis/abscess formation
- Therefore, although omental torsion is a rare cause of acute abdominal pain, it should be taken into consideration in the differential diagnoses of acute abdomen especially in patients with untreated inguinal hernia.1
- Differentials include – acute appendicitis, cholecystitis, ovarian torsion, epiploic appendagitis, mesenteric panniculitis, omental infarction
- Liming Deng, Guozuo Xiong, Right sided omental torsion with inguinal hernia :report of case ,International Surgery Journal,2017,No.1,Vol4
- Ebouda,F,Neto,A.Omental torsion.Radiopaedia.org
- Ankit Anil Tandon, Kian Soon Lim, Torsion of greater omentum :A rare preoperative diagnoses, Indian J Radiol Imaging.2010 Nov;20 (4):294296
- Silva,E.,Carvalho,A.F.,Rocha, D. et.al. Omental whirl associated with bilateral inguinal hernia:a case report. J Med Case Reports 8,239(2014)
Case contributed by:
Senior Consultant Radiologist
Columbia Asia Radiology Group
Cross sectional fellow