Pediatric Omental Torsion

  • Etiology:
    — Twist of omentum along its long axis leading to compromise of its vascular suppl
    — May be primary in nature or may be secondary to pre-existing hernia sacs or tumors or cysts
  • Imaging CT: Low density (fat density) lesion in the right paraumbilical region or right lower quadrant that can have a whirling appearance
  • DDX: Acute appendicitis, acute cholecystitis, ovarian torsion, mesenteric adenitis, epiploic appendagitis, omental infarction
  • Complications: Can progress to omental infarction distal to the point of the twist with subsequent develop of adhesion and bowel obstruction
  • Treatment: Surgical
  • Clinical: Presents as acute onset of right lower quadrant or right paraumbilical pain

Radiology Cases of Omental Torsion

CT of omental torsion
Axial CT with contrast of the abdomen shows a right-sided, round, low density inflammatory mass that is anteromedial to the liver, adherent to the anterior abdominal wall, connected to the omentum, with a target-sign appearance (on the image below).