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

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

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
  • The hyperdense tract extending up to the skin surface at the operative site could be the site of discharge

 

DIAGNOSIS:

  • Torsion of greater omentum with infarction, necrosis infection.
  • Secondary infection with track extending into the operated scar of the right inguinal hernia

Discussion:

  • 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

REFERENCES/FURTHER READING

  1. Liming Deng, Guozuo Xiong, Right sided omental torsion with inguinal hernia :report of case ,International Surgery Journal,2017,No.1,Vol4
  2. Ebouda,F,Neto,A.Omental torsion.Radiopaedia.org
  3. Ankit Anil Tandon, Kian Soon Lim, Torsion of greater omentum :A rare preoperative diagnoses, Indian J Radiol Imaging.2010 Nov;20 (4):294296
  4. 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)

Dr Sunita Gopalan
DMRD, FRCR
Senior Consultant Radiologist
Columbia Asia Radiology Group

Dr Shashwat Priyadarshi,
MBBS DNB

Cross-sectional fellow