omentum torsion
Introduction
Introduction to omental torsion The greater omentum is the largest peritoneal fold in the abdominal cavity, and the proximal side starts from the big curvature of the stomach and the transverse colon, and merges into each other when extending downward. The distal side is free from the lower edge of the abdominal cavity and has a skirt-like shape, covering the surface of the internal organs, and the degree of activity is large. The omentum has a large difference in length, width, thickness and morphology. It is rich in blood vessels and lymphatic vessels, and has a large amount of fat deposition. TorsionoftheOmentum is rare. Males and females, aged 3 to 75 years old. More common in 25 to 50 years old, more obese people, this disease can cause obvious abdominal pain and gastrointestinal symptoms, difficult to distinguish from other acute abdomen. basic knowledge The proportion of illness: 0.0035% Susceptible people: no specific population Mode of infection: non-infectious Complications: nodular polyarteritis
Cause
Omental torsion cause
(1) Causes of the disease
Omental torsion can be divided into primary and secondary.
1. Primary omental torsion: quite rare, the cause is not very clear, generally considered to be related to the following factors:
(1) Morphological abnormalities such as a tongue-shaped protrusion on the omentum, a subretinal membrane, a double-layer omentum, a large and thick omentum with a narrow pedicle, and irregular fat deposition on the omentum of an obese person.
(2) varicose veins on the retina and normal arteries.
(3) Factors sufficient to cause the movement of the greater omentum, such as strenuous exercise, sudden change of body position, causing peristalsis after persatusion, coughing, etc., causing intra-abdominal pressure, etc., primary omental torsion is unipolar, only 1 fixed point.
2. Secondary omental torsion: more common than primary, mostly due to a large omentum and a certain lesion in the abdominal cavity such as a tumor, inflammatory lesions, or even a hernia sac, adhesion between the incision or scar after surgery, so Two fixed factors (ie bipolar) were formed, and the retina of the central part was twisted between the two fixed points. This is common in patients with inguinal hernia, accounting for about 2/3 of all cases, secondary. The cause of the large omental torsion is the same as the primary third factor.
(two) pathogenesis
Whether it is primary or secondary omental torsion, the omentum always rotates around a central point, usually in a clockwise direction, which can be completely or partially twisted for the omentum. .
Omental torsion is mostly acute, and there are few cases of multiple torsion. The consequences are related to the degree of torsion, time and blood supply disorders.
1. Acute circulatory disorder: After the torsion occurs, the venous return is blocked first, and the distal omentum will appear hyperemia and edema, which may cause bleeding, which may lead to serous bloody exudate. If the lesion persists for a long time, acute hemorrhagic infarction or even omentum will occur. Segmental necrosis.
2. Chronic circulatory disorders: Because the degree of torsion is light, and the torsion is slow, the blood supply to the omentum is slowly reduced, and the fibrosis of the omentum is gradually occurring, and the acute abdomen may not be caused.
3. Ocular resection of the omentum: necrosis of the omentum segment failed to be removed in time, and some of the strangled omentum gradually atrophied and formed a fibrous mass, and even fell off into the peritoneal free mass.
Prevention
Omental torsion prevention
The disease has a good prognosis at present, but lacks specific preventive measures, and should pay attention to the adhesion and sputum of the abdominal viscera.
Complication
Omental torsion complications Complications nodular polyarteritis
It is easy to have nodular polyarteritis, intra-abdominal inflammation, adhesion or postoperative adhesion, tumor, omentum and sac adhesion.
Symptom
Omental torsion symptoms Common symptoms Nausea abdominal mass Abdominal tenderness Plate-shaped abdominal abdomen has local or wide... Low fever
1. Main symptoms: mainly abdominal pain, often sudden and rapid progress, abdominal pain is first located in the umbilical cord, and later limited to the right lower abdomen, similar to the characteristics of metastatic abdominal pain in acute appendicitis, the nature of abdominal pain is generally severe, often persistent Sexual colic, with paroxysmal aggravation, activity or change of body position is more obvious, about 50% of patients with nausea, vomiting, bloating and low fever.
2. Main signs: Peritoneal irritation signs in the right lower abdomen or lower abdomen, ie tenderness, rebound tenderness and muscle tension. When the torsion of the omentum is too large, sometimes the mass may be touched in the right lower abdomen, with tenderness, but the boundary is not It is clear that secondary omental torsion caused by inguinal hernia sometimes hits a tender mass in the peritoneal sulcus.
Examine
Omental torsion examination
1, blood routine examination: there may be a moderate increase in white blood cell count.
2, imaging examination: abdominal B-ultrasound and CT, can only provide the presence of the right lower abdomen mass.
3, diagnostic abdominal puncture: can extract a little serous bloody exudation, has a certain significance for diagnosis; and laparoscopic examination can get a correct diagnosis.
Diagnosis
Omental torsion diagnosis
Because this disease is rare, it is difficult to accurately diagnose the clinical manifestations before surgery. If a tender mass is encountered in the groin and there are no other symptoms of intestinal diseases, the disease should be suspected, and the laparotomy should be performed in time. If the venous engorgement is found and there is a small amount of bloody ascites in the abdominal cavity, and no other organ lesions are found, the possibility of the disease should be considered; sometimes the torsion of the greater omentum with congestion, edema or necrosis can establish a diagnosis. .
Note the differentiation from acute appendicitis, strangulated intestinal obstruction, cholecystitis and other acute abdomen.
