Greater Omental Torsion With Reactive Periappendicitis: A Case Report From a Second-Level Care Hospital

Greater omental torsion is an uncommon cause of acute abdomen that frequently mimics more prevalent surgical pathologies such as acute appendicitis, making preoperative diagnosis challenging. We present the case of a 34-year-old overweight man (BMI: 27.7 kg/m²) who presented with a one-week history of right lower quadrant abdominal pain exacerbated by physical exertion and accompanied by fever reaching 38.5°C. Laboratory studies showed mild leukocytosis, and appendiceal ultrasonography did not demonstrate findings consistent with acute appendicitis, prompting further evaluation with computed tomography (CT) due to persistent symptoms and suspicion of an alternative intra-abdominal pathology. Non-contrast abdominopelvic computed tomography (CT) demonstrated a characteristic whirl sign suggestive of omental torsion, along with peripheral inflammatory changes. Exploratory laparotomy confirmed the complete ischemic torsion of the greater omentum and reactive periappendicitis. Total omentectomy and appendectomy were performed. The postoperative course was complicated by transient ileus, which resolved with conservative management. Histopathological examination revealed acute-on-chronic omental inflammation with fat necrosis and periappendicitis. Greater omental torsion should be considered in the differential diagnosis of right lower quadrant pain, particularly in overweight male patients. CT plays a fundamental role in preoperative identification, with the "whirl sign" being a key imaging finding. Timely recognition and appropriate management are associated with favorable clinical outcomes.