Omental torsion

　　Omental torsion can be divided into primary and secondary types, and their etiologies are also different.

　　First, primary omental torsion

　　Primary omental torsion is quite rare, and its etiology is not very clear. It is generally believed to be related to the following factors:

　　8, Abnormal morphology, such as a lingual protrusion on the omentum, accessory omentum, double-layered omentum, large and thick omentum with a narrow pedicle, and irregular fat deposits on the omentum in obese individuals.

　　7, Varicose veins on the omentum while arteries are normal.

　　6, Factors that can cause omental movement, such as intense exercise, sudden changes in body position, increased peristalsis of the intestines after overeating, coughing, and others that increase intra-abdominal pressure.

　　Second, secondary omental torsion

　　Secondary omental torsion is more common than primary, often due to adhesions between the omentum and a specific abdominal lesion such as a mass, inflammatory lesion, or even a hernial sac, as well as between surgical incisions or scars. This forms two fixed factors (i.e., bipolar), and the omentum between the two fixed points twists. This condition is common in patients with inguinal hernias, accounting for about 2/3 of all cases. The causes of secondary omental torsion are the same as the third factor of primary torsion.

　　Omental torsion is generally treated with surgery. If treatment is not timely, it is often prone to complications such as nodular polyarteritis, peritonitis, adhesions after trauma or surgery, tumors, adhesions between omentum and hernial sac, and others.

　　Secondary omental torsion is more common than primary omental torsion. The main clinical manifestation is acute abdominal pain, located in the entire abdomen or around the umbilicus, persistent, mild at first, and gradually becoming more severe, finally transferring to lower right abdominal pain. Sometimes, a smooth, tender mass can be palpated in the abdomen, with rebound pain or mild abdominal muscle tension. Half of the patients have nausea and vomiting, and a few patients have a slight rise in body temperature.

　　Omental torsion currently has a good prognosis, but lacks specific preventive measures. Attention should be paid to adhesions and hernias of abdominal visceral organs; pay attention to not eating too greasy food in daily life; obese patients should pay attention to active weight loss, avoid overeating spicy foods, should actively participate in physical exercise to enhance physical fitness; avoid heavy physical labor immediately after a meal, especially labor that requires body forward bending and rotation; avoid intense exercise, sudden changes in body position, and overeating causing intestinal peristalsis, coughing, and other factors that increase intraperitoneal pressure.

　　Omental torsion is relatively rare and its clinical manifestations are difficult to diagnose. If a mass with tenderness is palpated in the inguinal area without symptoms of other intestinal diseases, this disease should be suspected.

　　1. Blood routine examination:There may be a moderate increase in white blood cell count.

　　2. Imaging examination:Abdominal ultrasound and CT can only provide the existence of a mass in the lower right abdomen.

　　3. Diagnostic abdominal puncture:A small amount of serous blood渗出 can be extracted, which is of certain significance for diagnosis; while laparoscopic examination can obtain an accurate diagnosis.

　　Patients with omental torsion often present with acute abdominal pain. After surgery, patients should pay attention to a light and nutritious diet in their daily life, pay attention to dietary balance, and avoid eating spicy foods.

　　For intestinal omentum torsion, surgical resection can achieve satisfactory therapeutic effects. Since torsion often causes infarction of omental blood vessels, the resection range should be larger, generally resection should be above 2-3 cm from the torsion site. For secondary torsion, it is also necessary to treat the etiological factors of the disease, such as hernia, abdominal and pelvic masses, and adhesions. It is also necessary to pay attention to symptomatic supportive treatment, including fasting, gastrointestinal decompression, maintaining water and electrolyte balance, anti-infection, and maintaining nutrition.