Secondary Torsion of the Greater Omentum Caused by Right Inguinal Hernia

Hiroki Nakamura¹⁾, Shoji Kubo²⁾, Kunihiro Katsuragi²⁾, Hiroaki Kinoshita²⁾, Takashi Ikebe³⁾

Department of Surgery, Nakamoto Hospital¹⁾, Second Department of Surgery²⁾ and Second Department of Pathology³⁾, Osaka City University Medical School

We report the case of 62-year-old man with secondary torsion of the greater omentum caused by a right inguinal hernia. His chief complaints were lower abdominal pain and vomiting. On admission, his pulse was 114 beats/min, and his temperature was 37.1°C. He had tenderness and peritoneal rebound pain in the right lower abdomen, and bulging in the right groin region. On blood analysis, the white blood cell count was elevated to 16,300/µl, and C-reactive protein was 38.5 mg/dl. The abdominal X-ray film revealed absence of intestinal gas in the right lower quadrant. Computed tomography of the lower abdomen demonstrated concentric folds or an arrow pattern. Ultrasonography of right groin region revealed a hyperechoic structure in the bulging region. Emergency surgery was performed under the diagnosis of intussusception of the small intestine; however, the definitive diagnosis was made intraoperatively as a secondary torsion of the greater omentum caused by a right inguinal hernia. Torsion of the greater omentum is a rare acute abdominal disease and generally is difficult to diagnose preoperatively. In our case, if we had had knowledge and experience of this rare disease, preoperative diagnosis by computed tomography and ultrasonography would have been possible. The combination of computed tomography and ultrasonography seems important for differential diagnosis of acute abdominal diseases.

Key words
torsion of the greater omentum, preoperative ultrasonography of omental torsion, preoperative computed tomography of omental torsion

Reprint requests
Hiroki Nakamura Second Department of Surgery, Osaka City University Medical School
1-5-7 Asahi-machi, Abeno-ku, Osaka, 545 JAPAN

Accepted
February 12, 1997

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