Omental torsion diagnosed by abdominal contrast-enhanced computed tomography: A case report

Table 1 Differential diagnosis of omental torsion

Characteristic	Symptoms	Physical examination	Auxiliary examination
Acute appendicitis	Migratory right lower quadrant pain, fever, nausea, vomiting	Tenderness and rebound pain in the right lower quadrant	Elevated white blood cell count; enlarged appendix on ultrasound and CT
Acute cholecystitis	Right upper quadrant pain radiating to the right shoulder, scapula, or back; nausea, vomiting	Right upper quadrant tenderness; positive Murphy’s sign	Leukocytosis; gallbladder enlargement and wall thickening on ultrasound
Acute pancreatitis	Epigastric pain, abdominal distension, nausea, vomiting	Epigastric tenderness; decreased or absent bowel sounds	Elevated serum amylase; pancreatic enlargement on ultrasound and CT
Perforated gastroduodenal ulcer	History of peptic ulcer disease; sudden severe abdominal pain, nausea, vomiting	Abdominal rigidity, generalized tenderness, rebound tenderness, decreased bowel sounds	Leukocytosis; subdiaphragmatic free air on upright abdominal X-ray
Incarcerated hernia	Sudden-onset pain with a tender mass	Irreducible abdominal mass	Ultrasound or CT shows protruding abdominal contents that cannot be reduced
Volvulus	Often occurs after exertion; sudden, severe abdominal pain, nausea, vomiting	Asymmetrically distended intestinal loops	Abdominal X-ray or CT demonstrates twisted bowel segments
Meckel’s diverticulum	Recurrent lower gastrointestinal bleeding, sometimes accompanied by abdominal pain	Often unremarkable	Contrast-enhanced abdominal CT may reveal the morphology and location of the diverticulum
Ectopic pregnancy	History of amenorrhea and/or irregular vaginal bleeding; sudden lower abdominal pain	Cervical motion tenderness; adnexal mass; non-clotting blood on culdocentesis	Elevated beta-human chorionic gonadotropin levels; ultrasound shows an adnexal mass
Ovarian torsion	Sudden onset of severe lower abdominal pain	Lower abdominal tenderness	Ultrasound demonstrates absent blood flow in the ovarian pedicle

CT: Computed tomography.

Table 2 Literature-review table

Characteristic	Clinical features and diagnostic-treatment key points of omental torsion
Etiology	Primary due to obesity, anatomical variants (e.g., tongue-like or bifid omentum), and sudden increases in intra-abdominal pressure. Secondary due to hernias, tumors, cysts, and surgical adhesions
Presenting symptoms	Abdominal pain, low-grade fever or normal body temperature, nausea and vomiting, and localized abdominal tenderness
Age range	Fourth to sixth decade
Imaging examination	Ultrasound: Hyperechoic, noncompressible ovoid mass near the peritoneum with no blood flow signal
	CT: Swirl sign
Treatment	Some can be treated conservatively. Laparoscopy is the preferred surgical approach
Outcome	Good specially if surgically treated
Potential modifying factors	The degree, duration, and vascular compromise of the torsion

CT: Computed tomography.