Laparoscopic treatment of a greater omentum volvulus

This video presents the case of an acute abdomen in a patient with a past surgical history of two procedures for morbid obesity. Torsion of the omentum is a very uncommon cause of acute abdominal pain. This stepwise video is recommended for general surgeons.

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Laparoscopic treatment of a greater omentum volvulus

Authors

M Vix, C Solano, J Marescaux

Abstract

This video presents the case of an acute abdomen in a patient with a past surgical history of two procedures for morbid obesity. Torsion of the omentum is a very uncommon cause of acute abdominal pain. This stepwise video is recommended for general surgeons.

Classification

complex cases

Keywords

laparoscopy, treatment, greater omentum volvulus

Media type

Surgical video

Duration

05'31''

Publication

2008-10

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E-publication

WeBSurg.com, Oct 2008;8(10).
URL: http://www.websurg.com/doi-vd01en2429.htm

Laparoscopic treatment of a greater omentum volvulus

1. Clinical case presentation 00'25''

We present the case of a 52-year-old diabetic female patient. Her past surgical history consists of hysterectomy, appendectomy with associated peritonitis and a gastric banding in 2002 that had to be converted to a bypass 4 years later due to its clinical failure. The patient presented to emergencies with a non-specific acute pain, mainly localized at the right of the abdomen. The laboratory examination revealed a moderate leukocytosis. The ultrasound did not reveal any intra-abdominal pathology. The CT-scan only showed inflammation of the greater omentum. A diagnostic laparoscopy was decided upon.

2. Diagnostic laparoscopy 01'10''

During the laparoscopic exploration, free serosanguineous fluid was found in the abdominal cavity. Due to the past surgical history, the risk of an internal hernia had to be ruled out. We began by exploring the small bowel that did not appear dilated or ischemic. The gastric bypass’s jejunojejunal anastomosis was neither dilated nor volvulated.

3. Dissection of volvulated mass 01'48''

At the level of the upper right abdomen, a firm necrotic mass was found. As can be seen, it is volvulated and ischemic. The mass was progressively devolvulated using atraumatic bowel graspers. A window is created in the omentum’s transverse mesocolon and sharp dissection and coagulation are applied using the Ligasure Advance® device. As the dissection is continued, the colon also does not seem to be volvulated. Torsion of the omentum is a very uncommon cause of acute abdominal pain; this condition occurs when the omentum twists along its longitudinal axis, thus compromising its vascular supply. With the venous return compromised, the distal omentum becomes congested and edematous with hemorrhagic extravasation of serosanguineous fluid into the peritoneal cavity. The omentum has to be completely resected because no spontaneous vascular recovering seems possible.

4. Specimen extraction 05'22''

At the end of the procedure, the serosanguineous fluid is aspirated and the specimen is extracted into an Endobag. The postoperative recovery was uneventful and the patient was discharged a few days after the operation.