Hemorrhagic necrosis of omental cysts misdiagnosed as torsion of ovarian cysts: a case report and literature review

Abstract

Background: Omental cysts are extremely rare intra-abdominal lesions that are typically benign and asymptomatic. When hemorrhagic necrosis occurs, it may mimic other acute abdominal emergencies, such as adnexal torsion. Omental cysts are easily misdiagnosed as other diseases because of their lack of specific clinical symptoms and signs, thus posing a diagnostic challenge. Case introduction: We report a 32-year-old woman presenting with acute lower abdominal pain and fever, initially diagnosed with ovarian cyst torsion. Imaging revealed a large pelvic cystic mass; however, laparoscopic exploration identified a hemorrhagic omental cyst with necrosis and inflammatory adhesion. Complete excision was performed, and histopathology confirmed a benign omental cyst with hemorrhage and necrosis. The patient recovered uneventfully and showed no recurrence over 11 months of follow-up. Conclusion: Analyzing this case allowed us to delve into the causes of misdiagnosis of omental cysts. This case emphasizes the diagnostic difficulty posed by complicated omental cysts and highlights the necessity of considering omental cyst in women presenting with acute abdomen and pelvic masses. Imaging aids diagnosis, but surgical exploration is the most direct and reliable method for confirming the cause of abdominal pain. Timely laparoscopic intervention facilitates accurate diagnosis and effective management.