Acute abdomen for omental volvulus

A 38-year-old man was admitted to our unit with right inferior quadrant pain, nausea, vomiting, diarrhea and fever (temperature 38.5°C). His clinical history was positive for medically treated gastritis. No previous surgical operations were referred. The physical examination was remarkable for diffuse tenderness and small right reducible inguinal hernia. The white blood cell count was 15.1 ×109 L, hemoglobin was 14.4 g/dL. The biochemical tests were within the normal limits, in particular lactate dyhydrogenase was 351 UI/L and creatinine kinase was 106 UI/L. Abdominal plain X-ray films revealed no abnormalities. The ultrasonography was negative for free fluid, mass, and signs of cholecistitis. The patient was observed for 12 hours with no improvement and, for persisting pain and increasing white blood cell count (up to 20.8 ×109 L), he underwent surgical operation. Under general anesthesia and complete myorelaxation, a right inferior abdominal mass was noted, and the surgeon decided for a median laparotomy. Signs and symptoms suggested an intrabdominal localized abscess for acute appendicitis. A partial laparotomy was performed, and immediately a moderate amount of intraperitoneal serohemorragic fluid was evident. At the intraperitoneal exploration a hemorragic mass (Fig. 1) with apparent omental adhesion was found in the lower right quadrant. When the incision was extended and an omental volvulus was documented, the complete omental resection was performed. The macroscopic examination showed an omental twist with eight complete clockwise rounds (Fig. 2). The histologic workup reported aspects of infarction and chronic inflammation. The recovery was uneventful, and the patient was discharged on the fifth postoperative day.