Abstract
Introduction: Primary omental torsion represents one of
the rare causes of acute abdomen. Its preoperative diagnosis is
challenging owing to its unspecific symptoms and signs. There is no
definite consensus for its best management approach. We present a case
of primary omental torsion that was successfully managed
non-operatively.
Case Presentation: A young male patient presented with
recurrent attacks of abdominal pain in the right lower quadrant
associated with nausea, and vomiting. He had rebound tenderness at the
right iliac fossa and leukocytosis with elevated inflammatory markers.
Computed tomography of the abdomen revealed a right-sided
intraperitoneal mass of fat density suggestive of omental torsion. He
was kept on conservative management and his abdominal pain gradually
subsided. He was discharged home after seven days.
Conclusion: Primary omental torsion is a rare cause of
acute abdomen especially in obese patients with inconsistent history,
examination, and laboratory findings. Despite the controversy, the
conservative approach, which depends on accurate radiological diagnosis,
analgesia, prophylactic antibiotics and close follow up, should be
attempted as a first line of management. Laparoscopic resection should
be only considered after failure of conservative management.
Keywords: Omental torsion, acute abdomen, conservative
management