Torsion of abdominal appendages presenting with acute abdominal pain

Diseases of the abdominal appendages are rare causes of abdominal pain in all age groups.

Nine patients with torsion and infarction of abdominal appendages were retrospectively reviewed.

Four patients had torsion and infarction of the appendices epiploicae, four patients had torsion and infarction of part of the greater omentum, and one patient had torsion and infarction of the falciform ligament. The patient with the falciform ligament disease represents the first reported case of primary torsion and infarction of the falciform ligament, and the patient with the transverse colon epiploica represents the first reported case of vibration-induced appendix epiploica torsion and infarction. The patient with the falciform ligament disease presented with a tender upper abdominal mass, and the remaining patients were operated upon with the preoperative diagnosis of acute appendicitis.

The presence of normal appendix with free serosanguinous fluid in the peritoneal cavity should raise the possibility of a disease, and calls for further evaluation of the intra-abdominal organs. If the diagnosis is suspected preoperatively, CT scan and ultrasound may lead to a correct diagnosis and possibly conservative management. Laparoscopy is playing an increasing diagnostic and therapeutic role in such situations.