A CASE OF PRIMARY TORSION OF THE GREATER OMENTUM

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  • 特発性大網捻転症の1例

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Abstract

Primary torsion of the greater omentum which presents with acute abdomen is a relatively rare entity. There have been only 47 cases in the domestic literature so far. In this paper case of the disease is reported with some bibliographical comments.<br> A 69-year-old man was referred to the hospital with a suspicion of acute appendicitis for right lower abdominal pain. On admission, the body temperature was 37.6°C. There were tenderness, muscular defense, and Blumberg's sign in the right lower abdomen. On a blood analysis, the white blood cell count and CRP increased to 12, 000/μl and 13.6mg/dl, respectively.<br> Abdominal ultrasonography (US) visualize no mass, but ascites in the right ileocecal region. CT Scan showed the mass with mixture of the high and low-density areas. Emergency laparotomy was performed under a diagnosis of perforative appendicitis. At laparotomy, a fistic size of dark red, edematous omental mass was found associated with moderate bloody ascites. It was a part of the greater omentum, which twisted conuter-clockwise by two turns. Excision of the omentum at the second postoperative day, but improved on the next day. He was discharged from the hospital on the 9th postoperative day.<br> It may be a rare disease, but we have to entertain the existence of the disease as a probable diagnosis for patients with acute abdomen. US or CT would be useful when we have difficulty in differentiation from appendicitis. Forty-eight cases including our case in the Japanese literature are reviewed.

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