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Omental Torsion, COVID-19, Conservative management, Pandemic outbreak
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.
2) Charieg A., Ben Ahmed Y., Nouira F. A diagnosis to keep in mind: primary omental torsion in children. EC Paediatrics. 2016;2:245–249.
3) 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
4) Vagholkar K., Chougle Q., Agrawal P. Omental torsion: a rare cause of acute abdomen. Int. Surg. J. 2016;3:1711–1713
5) 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.
6) 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.
7) 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.
8) 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.
9) Kerr S.F., Hyland R., Rowbotham E. Postoperative omental infarction following colonic resection. Clin. Radiol. 2012;67:134–13911.
10) Bachar G.N., Shafir G., Postnikov V. Sonographic diagnosis of right segmental omental infarction. J. Clin. Ultrasound. 2005;33(2):76–79
11). 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)
12) 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
13) 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