title: Primary omental gangrene mimicking appendicular perforation peritonitis-A case report.
abstract: BACKGROUND
  Primary omental torsion is a rare cause of acute abdomen in adults and presents with variable signs and symptoms. Establishing a preoperative diagnosis may be difficult in the emergency setting. It is rarely diagnosed preoperatively as it mimics common surgical emergencies such as acute appendicitis, appendicular perforation, acute cholecystitis and perforated peptic ulcers and can lead to the clinical deterioration of patient if missed
  
  
  METHODS
  A 47 years old male was taken to the operating room with a diagnosis of appendicular perforation peritonitis and during surgery was found to have a primary omental gangrene with pyoperitoneum, for which omentectomy and peritoneal lavage was performed.
  
  
  CONCLUSIONS
  Torsion of the omentum is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Omental torsion can be primary (idiopathic) or secondary, depending on an underlying cause. Primary omental torsion was first described by Eitel in 1899. However, very few cases have been reported. Our case was a rare case presenting with omental gangrene with pyoperitoneum mimicking appendicular perforation peritonitis.
  
  
  CONCLUSIONS
  Primary omental torsion is a rare diagnosis. A high index of clinical suspicion is required for a preoperative diagnosis. In doubtful cases a CT scan may be helpful. Surgical excision of the omentum remains the treatment of choice; however, conservative management may be attempted in an uncomplicated omental torsion.
authors.affiliation: Department of Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal. Electronic address: adityakumar1@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal.
authors.forename: J
authors.initials: J
authors.lastname: Shah
authors.affiliation: Department of Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal.
authors.forename: P
authors.initials: P
authors.lastname: Vaidya
keywords: Appendicular perforation; Case report; Primary omental torsion