Surgeons are reporting a twist in the case of a man diagnosed with appendicitis, after surgery revealed the real culprit was primary omental torsion.

The 38-year-old had presented to a hospital in Ethiopia with typical signs of appendicitis — a two-day history of constant and progressively worsening acute abdominal pain with anorexia, nausea and two episodes of non-bilious vomiting.

The pain began in the periumbilical region and later localised to the right lower quadrant, the authors from Yirgalem Hospital Medical College reported.

The patient had no history of abdominal trauma or previous abdominal surgery.