INTRODUCTION: Omental torsion (OT), caused by twisting of the greater omentum around its axis, leading to reduced blood supply to the distal aspect of the omentum and tissue infarction, is a rare disease that manifests clinically as acute abdominal pain. Accurate preoperative diagnosis is difficult. Here, we present 2 pediatric patients diagnosed and treated using computed tomography (CT). CASE PRESENTATION: Case 1, a 14-year-old boy, had abdominal pain for 3 days. Upon referral to our hospital due to worsening pain, CT revealed an intra-abdominal fatty mass extending into high-density lesions in the fat tissue. Due to severe peritoneal irritation, emergency single-incision laparoscopic surgery was performed. Secondary OT was diagnosed as the greater omentum was twisted by the cord-like tissue, continuing from the greater omental infarction to the lesser omentum. Partial omentectomy, including the ischemic portion, was performed. Case 2, an 11-year-old boy, was referred with suspected appendicitis due to right lower abdominal pain for 2 days. CT revealed a whirling sign in the greater omentum and high-density lesions in the fat tissue. The patient was in good condition, and the peritoneal irritation was unclear
therefore, conservative treatment was initiated. However, symptoms did not improve after 48 h and single-incision laparoscopic surgery was performed, revealing a twisted necrotic omental mass diagnosed as primary idiopathic greater OT. Partial omentectomy, including the ischemic portion, was performed. CONCLUSIONS: CT scan aids in preoperative diagnosis of OT, for which single-incision laparoscopic surgery is a less invasive and useful therapy. Early surgical intervention is warranted when conservative treatment fails.