TWO CASES OF PRIMARY TORSION OF THE GREATER OMENTUM WITH A PREOPERATIVE DIAGNOSIS OF ACUTE APPENDICITIS

Torsion of the greater omentum is a relatively rare entity in which the greater omentum twists with ischemic change of its periphery. Two cases of primary torsion of the greater omentum which were preoperativly diagnosed as acute appendicitis are reported. The patient 1 was a 40-year-old man complaining of right lower abdominal pain. With a preoperative diagnosis of acute appendicitis, a laparotomy was perfomed. At laparotomy, it was found that the greater omentum was twisted clockwise by 5 terns with serous bloody ascites. The definitive diagnosis was made as primary torsion of the greater omentum, and the patient underwent a resection of the necrosed part of the omentum and an appendectomy. The patient 2 was a 70-year-old woman complaining of right lower abdominal pain after taking a laxative for her constipation. With a preoperative diagnosis of acute appendicitis, and operation was perfomed. At laparotomy, it was found that the greater omentum was twistwd clockwise by 3 terns without ascites. She underwent a resection of the necrosed part of the omentum and an appendectomy. Their postoperative courses were uneventful. It is etiologically thought that abrupt change in patient's posture might cause the torsion, because the patient 1 was apt to twist the body on busines; and in patient 2, accelration of bowel movement due to taken laxative for constipation might cause the condition. The disease presents difficulty in differential diagnosis from acute appendicitis, but we must consider the disease in the case of acute abdomen complaiing of right lower abdominal pain. Pathogenesis of the disease is discussed with a brief survey of the literatures.