Omental torsion

Introduction to omental torsion The torsionofomentulm is divided into the original hair style and the secondary hair style. The original hair style twist is the spontaneous reversal of the omentum without obvious lesions in the abdominal cavity, which may be related to the unrestricted free movement of the omentum edge. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: nausea and vomiting

Omental torsion cause

(1) Causes of the disease

Omental torsion can be divided into primary and secondary, primary torsion is rare, no obvious cause, may be related to anatomical variation, are unipolar, that is, a fixed point, can be complete or not Complete, secondary torsion is often due to large omentum and intra-abdominal lesions, such as tumors, inflammatory lesions, or even adhesions to the sac, slightly more common than primary torsion, often bipolar, that is, there are two fixed points The specific cause has 3 points:

Anatomical factors

(1) The greater omentum has great mobility. The omentum is divided into 3 types according to its lower edge: the free margin is on the umbilicus, which is upper abdominal type, accounting for (13.70±1.86)%, reaching the umbilicus and sputum. The anterior superior sinus line is called mid-abdominal type, accounting for (46.36±2.60)%, and the free margin is below the anterior superior iliac spine line, which is lower abdominal type, accounting for (39.4±2.64)%. The lower margins of the anterior superior iliac spine are longer and the mobility is greater, so the lower abdomen type is more likely to be twisted.

(2) Anatomical variation of the omentum: the right part of the omentum is thicker and longer, and some of the omentum is tongue-like, some large omentum is hypertrophy and pedicle, and there is a subretinal membrane. Fork mesh and so on.

(3) Large omentum during pregnancy: Due to the enlargement of the uterus, the small intestine and the greater omentum move up, and the omentum has different degrees of curl.

2. Pathological factors include large omental vein dilatation, uneven distribution of omental fat in obese patients, adhesion of omentum caused by intra-abdominal inflammatory lesions, adhesion of oblique hernia and postoperative omentum, omentum Cysts, omental teratoma, omental angiolipoma, retinal encapsulation after transplantation of the omentum.

3. The violent activity of the kinematic factors and the sudden change of body position may cause the retina to be reversed, especially in the omentum under pathological conditions. The omentum itself cannot move, but the peristalsis of the gastrointestinal tract can act on Large omentum, after the sudden change of position, not only the large omentum itself flips, the gastrointestinal peristalsis is also the cause of its torsion, most people are right, the greater omental torsion occurs on the right side, the main reason: Not only the right omentum is more hypertrophic and more active, the uneven force of the lower limbs movement, driving the bilateral lumbar muscles on the intra-abdominal intestine and omentum, imbalance, the result of the reverse action, It is the cause of the torsion of the omentum, and at the same time it is a clockwise twist.

(two) pathogenesis

Large omental torsion occurs mostly in the right part of the omentum, and a considerable part is in the middle and lower part of the omentum. There are also a small part of the left part of the omentum. Most of them are clockwise torsion, and the torsion can reach several weeks. There are necrosis in the posterior distal end, forming a mass, cyanosis, purple-red, slightly hard, hundreds of milliliters of pale red bloody exudate in the abdominal cavity. Postoperative pathological diagnosis is hemorrhagic necrosis of the omental tissue, neutral Leukocyte exudation, postoperative pathological diagnosis of hemorrhagic necrosis of the omental tissue, neutrophil and lymphocyte infiltration.

Omental torsion prevention

For some obesity and uneven distribution of omental fat; intra-abdominal inflammatory lesions caused by omental adhesion, omental adhesion after abdominal surgery and sudden strenuous exercise suddenly change the position of the retina, etc. The cause is the top priority of prevention.

Omental torsion complications Complications, nausea and vomiting

Can be combined with gastrointestinal symptoms such as nausea and vomiting. The body temperature is not high or slightly elevated, and a small amount is moderate heat. The longer the lesion lasts, the higher the body temperature.

Omental torsion symptoms Common symptoms Abdominal distension nausea Abdominal tenderness Abdominal local or wide... Mobile dullness Abdominal abdominal mass Low heat peritoneal irritation Symptoms

Regardless of the primary and secondary, the patient seeks medical treatment for abdominal pain in the early stage, and most of them are subacute, but about half of them are sudden abdominal pain, which is persistent and gradually intensified. The pain starts from the umbilical cord and then spreads throughout the abdomen. The early stage is mostly confined to the right abdomen. The activity can aggravate the pain. There is no relief after rest, and it is not relieved by the change of body position. This is because the root of the greater omentum is pulled in the early stage of the disease, and the autonomic nerve is stimulated. Uncertain pain around the umbilicus or under the xiphoid process. When the omental ischemic necrosis is reached, the pain is fixed at the torsion site, and the mass can be touched on the abdomen, but most of the pain is not touched, and there is no moving dullness and bowel sounds. Normal or weakened, a small number of bowel sounds are hyperactive.

Omental torsion examination

1. The normal or slightly elevated white blood cells in the blood routine showed a moderate increase.

2. After the omentum is reversed, the abdominal cavity may have bloody exudate, so the diagnostic abdominal puncture has its special diagnostic value.

3. CT and MRI showed that the omentum containing fibrous cord and fat was radially aggregated at the torsion, but the sensitivity and specificity were not high.

4. B-ultrasound or color Doppler ultrasound can show irregular masses with unclear borders in the abdominal cavity, while gallbladder, pancreas, ovary, appendix and other tissues are normal. Therefore, ultrasound can be used as the first choice for suspected omental torsion, but due to diagnostic techniques. The limitation of the limitations of the limitations is also not high.

Omental torsion diagnosis

Detailed medical history, whether there is a history of strenuous exercise or sudden change of body position before the onset, whether there is history of hepatobiliary, gastroduodenal, pancreatic disease, in order to identify, acute onset, abdominal pain appears early and intense, and in parallel with abdominal tender mass, The bowel sounds are normal or weakened, the abdomen is flat, no gastrointestinal type, diffuse peritonitis occurs earlier, but the abdominal muscle tension is not very heavy, non-plate-like abdomen, abdominal puncture sucks out a thin reddish exudate, abdomen Ultrasonography can detect irregular masses with unclear borders in the abdominal cavity and can rule out lesions in other organs or tissues.

Differential diagnosis

1. Identification of acute appendicitis, the main similarities can occur in the right lower abdomen pain, right lower abdomen fixed tenderness and rebound tenderness, the main identification points:

(1) Omentum torsion is urgent, for persistent abdominal cramps, the pain is more severe than acute appendicitis, and it is not relieved by the change of body position.

(2) The greater omentum is reversed and nausea, vomiting and other gastrointestinal symptoms are milder than acute appendix.

(3) The occurrence of diffuse peritonitis in patients with omental torsion is earlier than acute appendicitis.

(4) The greater omentum to reverse the mass in the right lower abdomen is generally earlier than the acute appendicitis.

(5) The amount of white blood cells in the retina of the greater omentum is generally lower than that of acute appendicitis and the fever is mostly low fever.

(6) Large omentum can be worn with a thin reddish exudate, but acute appendicitis is rare.

2. Identification with other diseases such as the gastrointestinal tract

(1) perforation of gastroduodenal ulcer, perforation of gastric duodenal ulcer, and a history of previous upper digestive ulcers. After perforation, there is a plate-shaped abdomen and there may be free gas under the armpit. The body temperature is increased, reaching a high level. Heat, white blood cells increased significantly, and the greater omental torsion did not have the above clinical manifestations.

(2) Intestinal torsion: Although the greater omental torsion and volvulus are often seen after exercise, the symptoms of volvulus are severe, the patient is in a state of shock, and the abdomen is asymmetrical and swollen. The typical clinical manifestations of intestinal obstruction, abdominal X-ray can also be clearly diagnosed.

3. Cholecystitis, cholelithiasis by inquiry history, physical examination and B-ultrasound can be clearly diagnosed.

4. Hepatocellular carcinoma mass rupture and hemorrhagic clinical manifestations, sudden pain in the right upper quadrant, abdominal perforating blood, B-ultrasound, CT can be clearly diagnosed.

5. Acute pancreatitis blood amylase increased >500U / dl, B-ultrasound, CT can be clearly diagnosed.

6. Ovarian cyst pedicles reverse the pain in the lower part of the pelvic cavity, B-ultrasound can be clearly diagnosed.

7. Abdominal hernia incarceration has a history of abdominal hernia, and painful mass can be reached in the inguinal region.

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