Primary torsion of the greater omentum

OBJECTIVE: Primary torsion of the greater omentum is an infrequent cause of acute abdomen in children. A retrospective review was conducted to establish the prevalence and clinical features of omental torsion as a cause of acute abdominal pain in childhood. PATIENTS AND METHODS: We reviewed the clinical histories of the children given surgical treatment for torsion of the greater omentum in our hospital in the last 25 years. The following data were studied: age at presentation, sex, predisposing factors, symptomatology, complementary investigations, treatment and evolution. RESULTS: The male:female ratio among the 15 patients who underwent surgery was 2:1. Symptomology was similar to that of acute appendicitis with certain peculiarities such as a longer period of evolution at the moment of diagnosis, lower temperature and leucocytosis lower than would be expected in appendicitis at the same time of evolution and, in 12 patients, absence of vomiting. After surgical treatment evolution was satisfactory. Torsion was primary in 13 patients, secondary to inguinal hernia in 1 and secondary to cystic lymphangioma of the omentum in 1. The etiology and pathogenesis, as well as the diagnostic and therapeutic problems of this process, are discussed. CONCLUSIONS: In all the patients with primary torsion the clinical diagnosis was of acute appendicitis. Although primary torsion is classically associated with obesity, only 1 of the 13 patients weighed significantly more than the average for the same age and sex in our region and none of the patients showed a clearly associated anatomic malformation.