Primary torsion of the greater omentum.

CASE HISTORY A 10-year-old boy was admitted with pain in the right iliac fossa for two days, which was made worse by movement and coughing. He was not nauseated and he did not vomit. He had not eaten for two days. Pulse rate was 70 oer min and temperature 37.4°C. There was marked tenderness with rebound in the right iliac fossa. On rectal examination he was very tender on the right side. White cell count was 8,300 per ml. A diagnosis of acute appendicitis was made. At operation a small piece of greater omentum which had undergone torsion was found lying directly beneath the incision. The twisted omentum measured 5 x 4 x 4 cm and formed part of the right lower quadrant of the greater omentum (Fig). The appendix was not inflamed. The terminal ileum appeared normal and a Meckel's diverticulum was not found. The piece of twisted omentum was ligated and excised and the appendix was removed. Histology revealed infarction of the greater omentum due to primary torsion and a normal aDDendix. "I /.