Torsion of the Greater Omentum Secondary to Inguinal Hernia: A Case Report and Review of the Literature.

Abstract

Torsion of the greater omentum is a rare cause of acute abdominal pain and is often challenging to diagnose preoperatively. Secondary torsion due to a right inguinal hernia is the most commonly described form. While laparoscopic surgery is the preferred treatment, some authors have reported success with non-operative management. We present a 36 years old patient with omental torsion treated operatively following an unsuccessful attempt at conservative management. Through laparoscopic route, an extensive necrosis of the greater omentum was observed, with associated sero-hematic peritoneal effusion, bowel adhesions, and localized inflammatory response. the omentum-trapped within the right inguinal hernia-was carefully mobilized and found to be completely ischemic with necrotic patches. A complete omentectomy was performed at the level of the transverse colon. The specimen was extracted through an extended 3 cm subumbilical incision. The deep inguinal ring was closed with a continuous suture. The postoperative course was uneventful apart from transient bowel dysfunction, which resolved spontaneously. Hernia repair was delayed for six weeks.