Omental torsion is a rare cause of acute surgical abdomen from omental twisting leading to distal vascular compromise. Preoperative diagnosis has been a dilemma as clinical features, laboratory and radiographic findings are nonspecific and variable, closely mimicking acute appendicitis. Surgical excision has been suggested to offer rapid symptom relief and postoperative recovery. Presented here is a case of a 59-year-old male with omental torsion who presented with generalized abdominal tenderness and was preoperatively diagnosed as ruptured appendicitis who underwent laparotomy with uneventful post-operative course.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Abdomen, Acute ; Appendicitis

Introduction. The COVID-19 pandemic has not only resulted in a public health crisis but has also strained hospital services. The provision of surgical care should therefore also be guided by ethical, and whenever applicable, also legal, principles. Methods. An integrative approach that covers clinical and ethical dimensions, as well as spans the spectrum of surgical care, is therefore necessary. This action research involved three key steps: 1) identification of ethical dilemmas related to the provision of surgical care during the COVID-19 pandemic; 2) preparation of clinical scenarios that highlight these dilemmas; and 3) determination of the appropriate options for the said scenarios, based on the best available evidence as well as most applicable ethical principles. Results. Ethical theories included utilitarianism, human rights, and communitarianism. Ethical principles included non-maleficence, justice, autonomy, and beneficence. Values considered were duty, reciprocity, human life, efficiency, fairness, fidelity, ownership, social value, and fair innings. Also incorporated were informed consent, allocation principles, resource allocation, and triage. In terms of operational issues and surgical technical concerns, the following were considered: phased standards of care, categorization of interventions, prioritization, surgical approaches, infection control, diagnostics, patient welfare, staff welfare, operations protocols, surgical training, and communication. Key points derived from the ethical and technical considerations of surgical care delivery during the COVID-19 pandemic are presented. Conclusion. This action research involving a review of the literature and stakeholder engagement has provided a concise ethical and technical resource for surgical administrators, practitioners, and trainees.
COVID-19 ; Pandemics