Primary torsion (Idiopathic Auto Torsion) of Greater Omentum is a fairly uncommon condition. It is clinical presentation, symptoms and signs mink the common causes of acute abdomen i.e. appendicitis, mesenteric adenitis, cholecystitis, U.T.I. twisted ovarian cyst etc.
Case 1: A 30 years old obese male, section officer by profession, presented to the accident and emergency department with history of over 12 hours duration, of right lower abdominal pain. The pain was fairly sharp, and constant from the start. It was made worse by movement. There was also feeling of nausea, and the patient felt somewhat feverish. There was no past history of similar pain and no history of previous hospitalisation or operation. There was no family history of appendicitis or any other chronic illness. On general physical examination there was slight pyrexia of 99°F and the positive abdominal findings were tenderness with rebound in right iliac fossa. Bowel sounds were present and the rectal examination was negative. Radiological/and Laboratory Investigation: Skiagrams of chest and abdomen were normal. TLC was marginally high 9,500/cmm, urea electrolytes, blood sugar and serum amylase were all normal. Urine examination was normal. Ultrasound examination was essentially normal. ECG was also normal. With a presumptive diagnosis of acute appendicitis the patient was admitted for observation. He was put on IN. fluids and kept N.P.O. On review a few hours later the abdominal tenderness and rebound had increased. The rest of the clinical findings were the same Surgery was decided and the patient shifted to the operation theater. Under general anaesthesia the abdomen was opened through a grid-iron incision. On entering the peritoneal cavity, there was a small gush of reddish tinged glairy fluid. The appendix, caecum, terminal ileum and the mesentery were all normal. The gridiron incision was extended for proper exploration of the abdomen. The entire small bowel was explored and was normal. On further exploration of the large bowel a rolled up mass was encountered. On delivering it out it turned out to be twisted and gangrenous segment of greater omentum 12 cm by 4 cm The incision was further extended and the rest of the omentum, the large and small bowel, alongwith mesenteric vessels were thoroughly examined. All these structures were found normal.
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