Akut karýnýn nadir nedenleri ve literatür incelemesi: Primer/sekonder omental torsiyon, izole segmental omental nekroz ve epiploik apandisit

AMAÇ: Primer/sekonder omental torsiyon (POT/SOT), izole segmental omental nekroz (ÝSON) ve primer epiploik apandisit (PEA), sýklýkla tanýsal yanýlgýlara neden olan nadir akut karýn aðrýsý nedenleridir. Bu patolojilerde tutulum yerine ve hastalýðýn þiddetine baðlý olarak aðrý lokalizasyonu, þiddeti, bulantý-kusma, ateþ gibi eþik eden semptomlar ve bunlara baðlý olarak da ayýrýcý tanýlarý deðiþiklik göstermekle birlikte aðrý karakteri genellikle benzer ve devamlý tarzdadýr. Lokalizasyonlarýna baðlý olarak akut apandisit, akut divertikülit, ovaryan patolojiler, üriner sistem taþlarý ve akut kolesistit gibi farklý klinik tablolarý taklit edebilir ve sýklýkla cerrahi eksplorasyon sonrasý taný alýrlar. Geliþen teknoloji, bu hastalýklara dair farkýndalýðýn artmýþ olmasý ve belirgin olarak artan bilgisayarlý tomografi kullanýmý ile artýk daha fazla hastada preoperatif süreçte taný konulabilmekte ve gereksiz operasyonlardan kaçýnýlabilmektedir. Özellikle PEA kendi kendini sýnýrlayan lokal enflamatuvar bir hastalýk olup sýklýkla konservatif olarak yönetilebilir. Cerrahi tedavi seçeneði ise tüm tanýlar için ilgili epiploik appendiks veya omental segmentin, tercihen laparoskopik olarak lokal eksizyonudur. En sýk cerrahi endikasyon tanýsal karýþýklýk, ikinci en sýk neden ise persistan aðrý yakýnmasýdýr.
GEREÇ VE YÖNTEM: 2006–2021 yýllarý arasýnda kliniðimizde, primer/sekonder omental torsiyon, izole segmental omental nekroz veya primer epiploik apandisit tanýsý ile takip ve tedavi ettiðimiz hastalarýn verileri geriye dönük olarak toplandý. Hastalarýn demografik verileri, taný ve tedavileri, hastanede yatýþ süreleri deðerlendirilerek literatür eþliðinde sunuldu.
BULGULAR: Çalýþmaya alýnan 42 hastanýn 12’sinin yatýþ ve tedavi nedeni omentumun bir bölümünün nekrozu idi. Bu hastalardan 4’ü POT, 3’ü SOT, 5’i ÝSON ve 30’u PEA tanýsý ile takip ve tedavi edildi. Hastalarýn 33’ü preoperatif, 9’u intraoperatif taný aldý. 22 hasta opere edildi ve PEA’lý 20 hasta konservatif olarak tedavi edildi. Cerrahi veya týbbi tedavi sonrasýnda tüm hastalar komplikasyonsuz olarak taburcu edildi. Hastalar arasýnda yapýlan karþýlaþtýrmada klinik ve laboratuvar bulgularý açýsýndan anlamlý farklýlýk gözlenmedi.
TARTIÞMA: Akut karýn bulgularý olan hastalarýn ayýrýcý tanýsýnda POT, SOT, ISON ve PEA düþünülmelidir. Preoperatif dönemde PEA tanýsý konan hastalarda öncelikle konservatif yaklaþým düþünülmelidir. POT, SOT ve ÝSON tanýsý alan hastalarda hastanýn kliniðine göre cerrahi veya konservatif yaklaþým deðerlendirilmelidir.

Rare causes of acute abdomen and review of literature: Primary/secondary omental torsion, isolated segmental omental necrosis, and epiploic appendagitis

BACKGROUND: Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain.
METHODS: The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature.
RESULTS: The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings.
CONCLUSION: POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient’s clinical condition.