Abstract
Introduction: Primary omental torsion represents one of the rare causes of acute abdomen. Its preoperative diagnosis is challenging owing to its unspecific symptoms and signs. There is no definite consensus for its best management approach. We present a case of primary omental torsion that was successfully managed non-operatively.
Case Presentation: A young male patient presented with recurrent attacks of abdominal pain in the right lower quadrant associated with nausea, and vomiting. He had rebound tenderness at the right iliac fossa and leukocytosis with elevated inflammatory markers. Computed tomography of the abdomen revealed a right-sided intraperitoneal mass of fat density suggestive of omental torsion. He was kept on conservative management and his abdominal pain gradually subsided. He was discharged home after seven days.
Conclusion: Primary omental torsion is a rare cause of acute abdomen especially in obese patients with inconsistent history, examination, and laboratory findings. Despite the controversy, the conservative approach, which depends on accurate radiological diagnosis, analgesia, prophylactic antibiotics and close follow up, should be attempted as a first line of management. Laparoscopic resection should be only considered after failure of conservative management.
Keywords: Omental torsion, acute abdomen, conservative management