acute torsion of the greater omentum is an uncommon cause of acute abdominal pain in adults . preoperative diagnosis is difficult because of the rarity of the disease and the absence of specific clinical manifestations . we report a retrospective review of the management of acute torsion of the greater omentum in adults and compare the outcomes between patients who underwent laparoscopic or open resection . data for 9 patients with a clinicopathologic diagnosis of torsion of the greater omentum and treated at pamela youde nethersole eastern hospital , hong kong , between january 1994 and march 2004 were retrieved from a computer database , and the medical records of these patients was reviewed systematically . . demographics and clinical data of all patients ( n = 9 ) all patients presented with acute abdominal pain . their median body mass index ( bmi ) was 24 kg / m ( range , 22 to 24 ) . they were apyrexial on admission with a median oral temperature of 36.8 c ( range , 36.5 to 37.2 ) . median white cell count was 9.5 x 10 ( range , 7.4 to 15.1 x 10/l ) . localized abdominal tenderness was elicited at the right lower quadrant ( 4 patients ) , right upper quadrant ( 3 ) , both right upper and lower quadrant ( 1 ) , and left lower quadrant ( 1 ) . three examinations revealed no abnormality , and 2 suggested right ovarian pathology and acute appendicitis , respectively . the preoperative diagnoses after clinical assessment with or without ultrasonography of the abdomen were acute appendicitis ( 4 patients ) , acute cholecystitis ( 3 ) , acute diverticulitis ( 1 ) , and right ovarian pathology ( 1 ) . routine diagnostic laparoscopy has been used in our unit in all patients who have presented with acute abdomen since 1995 . the subsequent treatment approach ( laparoscopic or open resection of the infarcted omentum ) depended on the laparoscopic experience of the surgeons . regarding the laparoscopic technique , a 10-mm infraumbilical trocar was inserted by the open technique . two other 5-mm trocars were then inserted under vision into the right and left side of the abdomen , depending on the location of the pathology . the infarcted omentum was resected by a 5-mm ultrasonic dissector ( figure 1 ) and then delivered through the infraumbilical port by use of a plastic bag . open resection was defined as resection of the infarcted omentum through any traditional skin incision . oral dolpocetmol ( synco ltd , hong kong ) ( dextroproxyphene hcl 32.5 mg + acetaminophen 320mg)(1 tablet every 4 hours ) and pethidine ( martindale pharmaceuticals , uk ) injection ( 1mg / kg intramuscularly every 4 hours ) were given on demand for postoperative pain control . one patient who presented early in 1994 received an immediate midline laparotomy and resection of the infarcted omentum . diagnostic laparoscopy was performed on the subsequent 8 patients , and laparoscopic resection of the infarcted omentum was accomplished in 5 . three patients underwent open resection ( 2 midline incisions and 1 gridiron incision ) after diagnostic laparoscopy because the surgeons involved were less experienced in therapeutic laparoscopic procedures . three patients had associated indirect inguinal hernias seen with the tip of the omentum stuck into the hernial orifices . all the associated hernias were treated electively 6 to 8 weeks later by formal mesh repair . the overall median time from admission to operation was 23 hours ( range , 2 to 98 ) . the overall median operating time was 70 minutes ( range , 38 to 105 ) . the overall median postoperative hospital stay was 3 days ( range , 1 to 6 ) . no difference existed in age , sex , temperature , and wbc on admission , body mass index and operating time between patients undergoing laparoscopic or open resection . their postoperative outcomes are shown in table 2 . in the laparoscopic group , patients required less pethidine ( martindale pharmaceuticals , uk ) injection ( median , 0 mg vs 136 mg ) and oral dolpocetmol ( synco ltd , hong kong ) [ ( dextroproxyphene hcl 32.5 mg + acetaminophen ( 320 mg ) ] consumption ( median , 1 vs 6 tablets ) . the laparoscopic group had a shorter postoperative hospital stay ( median , 2 vs 4 days ) . comparison between patients having laparoscopic or open resection of the infarcted omentum no postoperative complications occurred . with a median follow - up of 4 months ( range , 1 to 63 ) , no recurrent symptom was detected in either group of patients . the abdominal pain was mainly located on the right side of the abdomen , a finding consistent with other reports . the reason is that the greater length and mobility of the right portion of the greater omentum makes it easier to twist along the vascular pedicle . this compromises the vascular supply and causes infarction of the omentum distal to the site of torsion . the patients are generally less septic than those with other common causes of acute abdomen , such as acute appendicitis or cholecystitis , because they rarely have fever or leucocytosis on admission . obesity ( bmi  25 kg / m ) does not seem to be a predisposing factor in our patients as postulated by others . secondary torsion associated with adhesion , cysts , tumors , and hernias is much more common . three of the torsions in our series were secondary to incarceration of the tip of the omentum into the inguinal hernial orifices , but none of them could be detected during physical examination . interval hernia repair several weeks later was chosen for fear of the potential septic complication related to the infarcted omentum . resection of the infarcted omentum is the only acceptable treatment because the recovery is usually rapid . ultrasonographic and computed tomographic ( ct ) scan features of the condition have been described , which makes preoperative diagnosis and conservative treatment possible . however , a conservative approach may prolong hospital stay of the patients , and complications like abscess formation may occur if the infarcted omentum is left behind . in the long - term we do not think a preoperative ct scan is necessary because it is not a routine investigation in our practice for patients who present with common acute emergencies like acute appendicitis and cholecystitis . in fact , diagnostic laparoscopy is becoming a routine procedure for patients who present with acute abdominal pain in our department . chung et al reported the first laparoscopic management of acute torsion of the omentum in 1992 . thereafter , laparoscopic resection is increasingly recognized as a preferred treatment modality for this rare condition , because it is minimally invasive and the patients recover quickly from the operation . the laparoscopic approach probably caused less pain in these patients as suggested by the decrease in postoperative analgesic requirements and hence shortened their postoperative hospital stay . the first patient in our series presented in 1994 and underwent immediate laparotomy because diagnostic laparoscopy was not routinely used for acute abdomen at that time . the reason for the 3 open resections after diagnostic laparoscopy was that the surgeons responsible were less experienced in therapeutic laparoscopy . in retrospect , we believe that all those patients who underwent open resection could be treated laparoscopically provided that both the expertise and instruments are available . acute torsion of the greater omentum is an uncommon cause of acute abdomen in adults . diagnosis is often made during surgery , and surgical resection results in rapid recovery of the patients . under expert hands , laparoscopy is not just a good diagnostic tool but a safe and minimally invasive technique for the treatment of this rare clinical entity .
background : acute torsion of the greater omentum is a rare cause of acute abdomen in adults . 
 we report our experience on the clinical presentation , diagnosis , treatment , and outcome of this condition.method:this is a retrospective review of 9 patients who had a clinicopathologic diagnosis of acute torsion of the greater omentum and were treated at the department of surgery , pamela youde nethersole eastern hospital from january 1994 to march 2004 . 
 eight patients were male and 1 was female with a median age of 43 years ( range , 24 to 65 ) . 
 median body mass index was 24 kg / m2 ( range , 22 to 24 ) . 
 all presented with acute abdominal pain with a median temperature of 36.8 c(range , 36.5 to 37.2 ) and a median white cell count of 9.5 x 109/l ( range , 7.4 to 15.1 x 109 ) . 
 preoperative ultrasound was done in 5 patients.results:all diagnoses were made during surgery . 
 resection of the infarcted omentum was performed for all patients ( 5 laparoscopic resections and 4 open resections ) . 
 no postoperative complications occurred . 
 the overall median time from admission to operation was 23 hours ( range , 2 to 98 ) . 
 the overall median operating time and postoperative stay were 70 minutes ( range , 38 to 105 ) and 3 days ( range , 1 to 6 ) , respectively . 
 the median oral and parenteral analgesic requirement for postoperative pain control was less and the median hospital stay was shorter in patients who underwent laparoscopic resection.conclusion:acute torsion of the greater omentum is an uncommon cause of acute abdomen in adults , and preoperative diagnosis is usually difficult . 
 laparoscopy seems a safe and minimally invasive technique for both diagnosis and treatment of this rare disease entity .