Always think about omental torsion when the appendix looks normal

Background: Omental torsion is a rare cause of acute abdomen that is quite difficult to diagnose preoperatively. We aim to stress that the surgeon should be aware of this pathological condition when suspecting a different pathology.
Case Report: We present a case of an 8-year-old male patient who underwent a laparotomy with the diagnosis of acute appendicitis, though his clinical presentation was not totally convincing. Our patient was admitted to the Emergency Department [ER] complaining of strong and persistent pain in his right abdomen. The white blood cell count was normal and C-reactive protein was slightly elevated. Physical examination revealed tenderness in the entire right abdomen, in both quadrants, and with severe abdominal defence. Ultrasound did not reveal any pathological signs, while abdominal computed tomography was not performed because of the patient’s age. We initially performed a classical appendectomy, but since the appendix seemed normal, we searched the abdomen for another pathology that would explain our patient’s clinical presentation. A segment of the greater omentum - almost necrotic - was rotated around its longitudinal axis in the upper quadrant of the right abdomen. Omentectomy of the ischemic segment was performed through the same McBurney skin incision, only by extending our access through the muscle layer. The patient had an uneventful recovery.
Conclusions: In our case the surgeon’s suspicion and awareness of this unusual abdominal pathology led to a successful treatment.

Keywords: omental torsion, primary, secondary, acute abdomen