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Background
The omentum is a layer of peritoneum that surrounds several abdominal organs. It is divided into the greater and the lesser omentum, which is formed mainly by the gastrohepatoduodenal ligament. The greater omentum connects to the stomach extending from the gastric greater curvature, passing behind the small intestines and reaching the dorsal wall of the abdomen. It contains several hematic and lymphatic vessels. 1 Omental torsion is a rare cause of abdominal pain in human beings and animals. It was first described in human medicine by Eitel in 1899. 2 Since then, fewer than 300 cases have been reported. In veterinary medicine, it has only been reported in a guinea pig, 3 a rabbit, 4 a polar bear 5 and an American badger. 6 To the authors' knowledge, this is the first case report of a canine omental torsion.
Case presentation
A five-year-old female intact German shepherd was presented with a history of hyporexia, vomiting, polyuria and polydipsia of 48hours of duration. It had been five months since her last heat, which was uneventful. The dog had been diagnosed with leishmaniasis two years ago, and it had been treated with antimoniate-methylglucamine (Glucantime; Merial) and allopurinol (Alopurinol; Normon). Leishmania titre was within normal limits at the time of presentation. It had never undergone former abdominal surgery, had no other relevant medical history and was not receiving any medication.
Investigations
Physical examination only revealed severe abdominal pain. Owing to the dog's aggressive behaviour, sedation with acepromazine (0.03mg/kg/intramuscular; Calmo Neosan; Boehringer Ingelheim) and methadone (0.3mg/kg/intramuscular; Metasedin; Lab. Esteve) was required for manipulation. Complete blood count (CBC), biochemistry and electrolytes were within normal limits. Urine-specific gravity was 1.016. No abnormalities were seen on native abdominal radiographs. Abdominal ultrasound revealed a 5-cm encapsulated, heterogeneous structure with hypoechoic patches, located near the right aspect of the right pancreatic lobe ( Fig 1 ).
Differential diagnosis
Based on the ultrasound examination, differential diagnoses included a pancreatic abscess, necrotising pancreatitis or a neoplastic process.
Treatment
Considering the clinical and echographic findings, an exploratory laparotomy was recommended. Anaesthesia was induced an hour later with propofol (4mg/kg/intravenous; Lipuro; Braun) and midazolam (0.3mg/kg/intravenous; Midazolam; Normon) and maintained with isoflurane (Isovet; Braun) and oxygen during the procedure. A midline coeliotomy was performed. Inspection of the abdominal...