Omental torsion at the time of COVID-19 in Northern Italy: a case report of conservative management with a review of the pertinent literature
Keywords:
Omental Torsion, COVID-19, Conservative management, Pandemic outbreakAbstract
Background and aim: In middle-aged men, omental torsion (OT) can be a cause of acute abdomen.The right side of the omentum is longer, heavier and more mobile than the left one and, as a consequence, it can twist more easily on its vascular axis. Consequently, OT localization in the lower right quadrant is more frequent, and therefore it can mimic acute appendicitis clinical onset.In most cases, OT is defined as “primary” in the absence of any other underlying pathologies, or, rarely, “secondary”, when caused by other intra-abdominal diseases such as inguinal hernia, tumors, cysts or post-surgical scarring. To date, clinical diagnosis of OT still remains a challenging one in a preoperative setting and most cases are diagnosed intraoperatively. If diagnosis is correctly achieved preoperatively by adequate imaging examinations, most patients presenting with OT do not undergo surgery anymore. Such considerations gain importance at the time of COVID 19 pandemic, where a conservative management and an early discharge may be preferred owing to in-hospital morbidity after abdominal surgery whenever surgery may be avoided.
Methods and Results : We present a case of an OT successfully treated in a non-operative manner during COVID-19 outbreak in Norhern Italy and offer a review of the literature that supports such a clinical attitude.
Conclusions: OT preoperative diagnosis is challenging and is usually achieved by abdominal CT-scan. The suggested OT initial management is conservative, leaving a surgical approach, preferably by laparoscopy, for the 15% of cases not improving with a non-surgical approach.
References
Eitel G.G. Rare omental torsion. NY Med Rec. 1899;55:715–716.
Charieg A., Ben Ahmed Y., Nouira F. A diagnosis to keep in mind: primary omental torsion in children. EC Paediatrics. 2016;2:245–249.
López-Rubio M.A., Martínez-Ruiz Y. Una causa infrecuente de dolor abdominal: el infarto de omento. Rev Clin Med Fam. 2011;4:254–255
Vagholkar K., Chougle Q., Agrawal P. Omental torsion: a rare cause of acute abdomen. Int. Surg. J. 2016;3:1711–1713
Ceresoli M, Coccolini F and the Appendicitis-COVID study group The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic
Eur J Trauma Emerg Surg 2021 Apr 12;1-7. Online ahead of print.
Miguel Perelló J., Aguayo Albasini J.L., Soria Aledo V. Torsión de epiplón: las técnicas de imagen pueden evitar intervenciones innecesarias. Gastroenterol. Hepatol. 2002;25(8):493–496.
N.A. Medina-Gallardo N.A., Y. Curbelo-Peña, T. Stickar, et al. Omental infarction: surcical or conservative treatment? A case reports and case series systematic review Ann Med Surg (Lond) 2020 Jun 27;56:186-193.
Soobrah R., Badran M., Smith S.G. Conservative management of segmental infarction of the greater omentum : a case report and review of literature. Case Rep Med. 2010;2010:1–4.
Kerr S.F., Hyland R., Rowbotham E. Postoperative omental infarction following colonic resection. Clin. Radiol. 2012;67:134–13911.
Bachar G.N., Shafir G., Postnikov V. Sonographic diagnosis of right segmental omental infarction. J. Clin. Ultrasound. 2005;33(2):76–79
. Agarwal S., Shaikh A., Navare M.S. Primary omental infarction presenting as a parietal wall swelling: a rare case report. J Med Sci Clin Res. 2015:7267–7270. 03(08)
Chauhan V., Stephenson J.A., Shah V. Intra-abdominal focal fat infarction of the omentum: diagnosis and percutaneous management. Br J Radiol Case Reports. 2015
Costi R, Cecchini S, Randone B et al. Laparoscopic diagnosis and treatment of primary torsion of the greater omentum. L.Surg Laparosc Endosc Percutan Tech. 2008 Feb;18(1):102-5. doi: 10.1097/SLE.0b013e3181576902. PMID: 18287998
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Filippo Montali, Renato Costi, Edoardo Virgilio, Cristina Presicci, Carlotta Sartorio, Massimo Pedrazzini
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
