Kataoka Jun, Nitta Toshikatsu, Ota Masato, Takashima Yuko, Yokota Yuta, Fujii Kensuke, Higashino Takeshi, Ishibashi Takashi
Department of Surgery, Gastroenterological Center, Shunjukai Shiroyama Hospital, 2-8-1 Habikino Habikino-city, Osaka, 583-0872, Japan.
Department of Internal Medicine, Gastroenterological Center, Shunjukai Shiroyama Hospital, Osaka, Japan.
Surg Case Rep. 2019 May 9;5(1):76. doi: 10.1186/s40792-019-0618-5.
Torsion of the greater omentum is a rare cause of acute abdominal pain in adults and children. It is very difficult to make a correct diagnosis of torsion clinically because it mimics other acute pathologies; however, the preoperative diagnosis can be easily confirmed with the use of computed tomography (CT). Herein, we report a case of laparoscopic omentectomy for primary torsion of the omentum, which was not improved by conservative treatment.
A 50-year-old Japanese man presented to our hospital with acute right lower quadrant abdominal pain of a few hours' duration. Routine blood tests showed a white blood cell count of 8900/mm, and the C-reactive protein (CRP) level was 8.13 mg/dl. Contrast-enhanced CT scan of the abdomen revealed twisting of the omentum with a local mass of fat density and fluid distributed in a whirling oval-shaped mass pattern at the right flank and iliac fossa. Therefore, the patient was admitted to our hospital based on a diagnosis of omental torsion. The patient was treated with conservative treatment with analgesics, anti-inflammatories, and antibiotics. Although his symptoms were ameliorated, his laboratory and radiological findings worsened. We performed laparoscopic omentectomy 6 days after admission. The resected omentum was 24 cm × 22 cm in size and was twisted and dark red in color, suggesting infarction. Histological analysis revealed that the specimen was ischemic and hemorrhagic omentum, accompanied by inflammatory infiltration. The patient's postoperative course was uneventful, and he was discharged 9 days later.
This is a rare case of primary torsion of the greater omentum that was treated successfully with laparoscopic omentectomy. Considering the increase in surgical difficulty due to inflammation from prolonged torsion and the limited efficacy of conservative treatment, we conclude that surgical intervention is warranted as early as possible when torsion of the greater omentum is suspected.
大网膜扭转是成人和儿童急性腹痛的罕见原因。临床上很难对扭转做出正确诊断，因为它与其他急性病症相似；然而，使用计算机断层扫描（CT）可轻松确诊术前诊断。在此，我们报告一例因大网膜原发性扭转行腹腔镜网膜切除术的病例，该病例经保守治疗未改善。
一名50岁日本男性因持续数小时的急性右下腹疼痛前来我院就诊。常规血液检查显示白细胞计数为8900/mm，C反应蛋白（CRP）水平为8.13mg/dl。腹部增强CT扫描显示大网膜扭转，局部有脂肪密度肿块，液体呈漩涡状椭圆形肿块分布于右侧腹和髂窝。因此，患者因大网膜扭转诊断入院。患者接受了镇痛药、抗炎药和抗生素的保守治疗。尽管他的症状有所改善，但实验室和影像学检查结果却恶化了。入院6天后我们进行了腹腔镜网膜切除术。切除的大网膜大小为24cm×22cm，呈扭曲状且颜色暗红，提示梗死。组织学分析显示标本为缺血性和出血性大网膜，伴有炎症浸润。患者术后恢复顺利，9天后出院。
这是一例罕见的大网膜原发性扭转病例，通过腹腔镜网膜切除术成功治疗。考虑到长时间扭转引起的炎症会增加手术难度以及保守治疗效果有限，我们得出结论，当怀疑大网膜扭转时应尽早进行手术干预。
