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Aralihond A, Aniapravan R, Abdelgadir I, Powell C. Omental infarction in an overweight child: conservative treatment is a safe approach. BMJ Case Rep 2023; 16:e256232. [PMID: 37945275 PMCID: PMC10649688 DOI: 10.1136/bcr-2023-256232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
A previously healthy but overweight (body mass index (BMI) of 24.4) adolescent boy presented with fever and significant right-sided abdominal pain. An abdominal ultrasound scan revealed an omental infarction (OI), which was treated conservatively. OI has been described in overweight teenage children with abdominal trauma but can be missed if not considered. A missed diagnosis could result in an unnecessary laparotomy or laparoscopic surgery. Although CT is the gold standard for diagnosis, ultrasonography is an effective approach to identifying OI in children. The benefits of early diagnosis of OI by abdominal ultrasound include a shorter hospital stay and a reduction in unnecessary investigations and surgery.
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Affiliation(s)
| | | | | | - Colin Powell
- Emergency Department, Cardiff University, Cardiff, UK
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Cirimele V, D'Amone G, Ricci M, Casati R, Ragone R, Redi A, Faiella E. A rare cause of right-upper quadrant abdominal pain: Epiploic appendagitis of the hepatic flexure. Radiol Case Rep 2023; 18:3434-3437. [PMID: 37502488 PMCID: PMC10369382 DOI: 10.1016/j.radcr.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
Epiploic appendagitis (EA) is an uncommon cause of acute abdominal pain that may mimic other causes of acute abdomen. Epiploic appendages are outpouching of fat tissue located on the external wall of the colon, being more numerous in the descending and sigmoid colon that account for up to 80% of EA cases. We present the case of a 59-year-old woman with right upper quadrant pain. Abdominal ultrasound and contrast-enhanced computed tomography suggested the diagnosis of epiploic appendagitis of the right colonic flexure. Our case highlights the fact that epiploic appendagitis may occur in unusual locations and must be included in the differential diagnosis of acute abdominal pain, in order to avoid unnecessary medical and surgical treatment.
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Hwang JK, Cho YJ, Kang BS, Min KW, Cho YS, Kim YJ, Lee KS. Omental infarction diagnosed by computed tomography, missed with ultrasonography: A case report. World J Clin Cases 2023; 11:972-978. [PMID: 36818623 PMCID: PMC9928693 DOI: 10.12998/wjcc.v11.i4.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Omental infarction (OI) is a surgical abdominal disease that is not common in adults and is very rare in children. Similar to various acute abdominal pain diseases including appendicitis, diagnosis was previously achieved by diagnostic laparotomy but more recently, ultrasonography or computed tomography (CT) examination has been used.
CASE SUMMARY A 6-year-old healthy boy with no specific medical history visited the emergency room with right lower abdominal pain. He underwent abdominal ultrasonography by a radiologist to rule out acute appendicitis. He was discharged with no significant sonographic finding and symptom relief. However, the symptoms persisted for 2 more days and an outpatient visit was made. An outpatient abdominal CT was used to make a diagnosis of OI. After laparoscopic operation, his symptoms resolved.
CONCLUSION In children’s acute abdominal pain, imaging studies should be performed for appendicitis and OI.
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Affiliation(s)
- Jae Kyoon Hwang
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Yu Jeong Cho
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Kyueng-Whan Min
- Department of Pathology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Young Seo Cho
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, South Korea
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
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Subasinghe D, Jayasinghe R, Ranaweera G, Kodithuwakku U. Spontaneous omental infarction: A rare case of acute abdomen. SAGE Open Med Case Rep 2022; 10:2050313X221135982. [PMID: 36388636 PMCID: PMC9647286 DOI: 10.1177/2050313x221135982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/12/2022] [Indexed: 07/11/2024] Open
Abstract
Omental infarction is a rare but a sinister cause of acute abdomen. Preoperative diagnosis is challenging due to its rare nature. It poses nonspecific abdominal signs that can be easily mistaken with other more common intra-abdominal pathologies. We report a case of a 37-year-old male patient presented with right lower quadrant abdominal pain with an elevation of inflammatory markers. His cross-sectional imaging did not a reveal specific diagnosis; therefore, a diagnostic laparoscopy was performed which revealed a non-inflamed appendix and an inflammatory mass formed by the ischemic omentum attached to the ascending colon. Diagnostic laparoscopy and subsequent laparotomy revealed spontaneous omental infarction. The histology of the resected specimen was in keeping with the omental necrosis. This case reflects the importance of considering omental infarction in patients presenting with abdominal pain and raised inflammatory markers. He made an uneventful recovery following surgery.
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Affiliation(s)
- Duminda Subasinghe
- Department of Surgery, Faculty of
Medicine, University of Colombo, Colombo, Sri Lanka
- The University Surgical Unit, The
National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Ravindri Jayasinghe
- Department of Surgery, Faculty of
Medicine, University of Colombo, Colombo, Sri Lanka
| | - Gayani Ranaweera
- Department of Pathology, Faculty of
Medicine, University of Colombo, Colombo, Sri Lanka
| | - Uditha Kodithuwakku
- Department of Radiology, The National
Hospital of Sri Lanka, Colombo, Sri Lanka
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Omental Infarction in a Child-Conservative Management as an Effective and Safe Strategy in Diagnosis and Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158057. [PMID: 34360347 PMCID: PMC8345747 DOI: 10.3390/ijerph18158057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
Omental infarction (OI) is a rare disease occurring in children. Important risk factors include overweight and obesity. The clinical presentation is often non-specific, and the main symptom is acute abdominal pain. In addition, infarcted omentum may present with fever, anorexia, nausea, vomiting, diarrhea and dysuria. Due to the localisation of the pain, OI should be differentiated from acute appendicitis. The diagnosis of OI is sometimes made intraoperatively, during appendectomy for suspected acute appendicitis. Hence, it is important to state a correct preoperative diagnosis, which is commonly based on abdominal ultrasound and computed tomography. The treatment of OI is still inconclusive. Both conservative and surgical treatments are used. Both methods have their advantages and disadvantages. The decision of which treatment to follow should be multifactorial and include the patient’s clinical condition at the time of admission, the progression or regression of symptoms during hospitalization and laboratory and imaging findings. We present a clinical case of a 9-year-old overweight girl with OI, whose diagnosis was based on imaging diagnostics and enabled conservative treatment with no complications. The case we have described confirms that the conservative treatment is an effective and safe therapy.
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Esposito F, Di Serafino M, Mauro A, Mercogliano C, Cocco C, Zenzeri L, Ferrara D, Iacobellis F, Evangelisti M, Ziparo C, Di Nardo G. Not only fat: omental infarction and its mimics in children. Clinical and ultrasound findings: a pictorial review. J Ultrasound 2020; 23:621-629. [PMID: 32623635 PMCID: PMC7588577 DOI: 10.1007/s40477-020-00492-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022] Open
Abstract
Acute abdominal pain in children is the most common cause of emergency department admissions. Omental infarction is a rare cause of acute abdominal pain in this age group, accounting for approximately 15% of cases in children and 0.024-0.1% of cases of surgery for suspected appendicitis at the same age. Its clinical presentation may mimic similar diseases such as acute appendicitis, epiploic appendagitis, and mesenteric panniculitis. Ultrasound is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients and it can be used with confidence in the diagnosis and management of omental infarction in children. In this brief review, we focus on the main ultrasound findings and their diagnostic clue for omental infarction and its mimics.
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Affiliation(s)
- Francesco Esposito
- Department of Emergency Radiology, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy.
| | - Angela Mauro
- Department of Pediatric Emergency, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Carmela Mercogliano
- Department of Pediatric 2nd Unit, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Chiara Cocco
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Letizia Zenzeri
- Department of Pediatric Emergency, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Dolores Ferrara
- Department of Emergency Radiology, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Chiara Ziparo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
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