Omental torsion diagnosed by abdominal contrast-enhanced computed tomography: A case report

Omental torsion (OT) is a rare cause of acute abdomen, it can be difficult to diagnose preoperatively and is frequently misdiagnosed. Computed tomography (CT) is the primary imaging modality for OT. It typically shows the swirl sign. contrast-enhanced CT can better visualize the central vascular structure of the mass, thus improving the diagnostic accuracy for OT. Surgical resection is the mainstay of treatment for OT. Laparoscopy allows direct visualization of the primary torsion site and comprehensive abdominal exploration, thereby decreasing misdiagnoses. It is a safe and reliable approach for OT treatment, which offers the advantages of minimal trauma, mild postoperative pain, and rapid recovery for stylistic precision.

A 48-year-old man was admitted to our hospital due to lower right abdominal pain for the preceding 70 hours. Physical examination revealed lower right abdominal muscle strain, tenderness, and rebound pain, but no mass was palpable. Contrast-enhanced CT revealed a thickened, blurred omentum with swirling changes in the right abdomen. Laparoscopic exploration and omentectomy were performed in the emergency setting. The procedure revealed 50 mL of dark-red bloody ascites in the pelvis and twisting of the right omentum along its longitudinal axis, with a 10 cm × 8 cm purple-black necrosis at the distal end. Post-surgical pathology revealed omental hemorrhage, degeneration, and necrosis. The patient had an uneventful recovery and was discharged on the fourth postoperative day. During the subsequent nine-month follow-up, he remained asymptomatic.

OT is a rare disease that lacks specific clinical manifestations. Abdominal contrast-enhanced CT plays a crucial role in diagnosing OT, and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.