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Zhang AY, Griffin GM, Karrington BA, Tamura GS. Case Report: A Child With Omental Infarction. J Emerg Med 2023; 64:638-640. [PMID: 37032205 DOI: 10.1016/j.jemermed.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/11/2022] [Accepted: 02/17/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Omental infarction (OI) is a rare cause of acute abdominal pain, which is benign and self-limited. It is diagnosed by imaging. The etiology of OI is either idiopathic or secondary and due to torsion, trauma, hypercoagulability, vasculitis, or pancreatitis. CASE REPORT Here, we present a case of OI in a child with acute severe right upper quadrant pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Correct diagnosis of OI via imaging can prevent unnecessary surgery.
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Affiliation(s)
- Angela Y Zhang
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Georgia M Griffin
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Baer A Karrington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Glen S Tamura
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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2
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Karaosmanoglu AD, Onder O, Kizilgoz V, Hahn PF, Kantarci M, Ozmen MN, Karcaaltincaba M, Akata D. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings. Abdom Radiol (NY) 2023; 48:2167-2195. [PMID: 36933024 PMCID: PMC10024022 DOI: 10.1007/s00261-023-03877-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Volkan Kizilgoz
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
- Department of Radiology, Atatürk University School of Medicine, 25240, Erzurum, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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3
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Muacevic A, Adler JR, Al Awa A. Idiopathic Omental Infarction Presenting With Recurrent Abdominal Pain. Cureus 2023; 15:e33796. [PMID: 36819437 PMCID: PMC9927794 DOI: 10.7759/cureus.33796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/16/2023] Open
Abstract
Omental infarction is a rare cause of acute abdominal pain, and its rarity is mainly due to its relatively rich blood supply by multiple collateral vessels. It usually presents with right lower quadrant pain, as left-sided torsion is infrequent and is usually diagnosed intraoperatively. Since omental infarction is frequently diagnosed by CT scan, conservative management should be considered in most patients to avoid subjecting the patients to unnecessary surgical intervention. We present a rare case of idiopathic omental infarction in which the patient was initially radiologically diagnosed with Meckel's diverticulitis but was later found to have omental infarction on diagnostic laparoscopy.
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Di Nardo G, Di Serafino M, Gaglione G, Mercogliano C, Masoni L, Villa MP, Parisi P, Ziparo C, Vassallo F, Evangelisti M, Vallone G, Esposito F. Omental Infarction: An Underrecognized Cause of Right-Sided Acute Abdominal Pain in Children. Pediatr Emerg Care 2021; 37:e1555-e1559. [PMID: 33170567 DOI: 10.1097/pec.0000000000002114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the prevalence of omental infarction (OI) in children with suspected appendicitis, the role of ultrasonography (US) in its diagnosis and management and the efficacy of conservative management. METHODS Consecutive children with suspected acute appendicitis were prospectively enrolled. Ultrasonography was performed at baseline, during follow-up, before the discharge, and at 15-day intervals until US findings of OI disappeared. All children with a diagnosis of OI were treated conservatively. RESULTS One hundred ninety-nine children (91 male; age range, 3-15 years) were evaluated. Eighty-four patients had acute appendicitis. Omental infarctions were found in 14 children (8 male; mean age, 9.8 ± 2.6 years), with an incidence of 7%. Ultrasonography depicted an echogenic mass consistent with OI in all children. Ultrasonography detected in 8 patients a normal-looking appendix, whereas in other 6 patients, it identified neither appendix nor indirect signs of acute appendicitis. A normal appendix has been detected by US during follow-up in 2 of these 6 patients. During follow-up, US finding of OI disappeared in all cases and no signs of acute appendicitis or other disease occurred. All 14 OIs were treated conservatively, with no reported complications. CONCLUSIONS Omental infarction is an underestimated cause of abdominal pain in children accounting for 7% of patients with suspected appendicitis. Ultrasonography is a useful method for the diagnoses and to guide clinical management of OI. Conservative therapy is a safe option for the management of OI.
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Affiliation(s)
- Giovanni Di Nardo
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | | | | | - Carmela Mercogliano
- Pediatric Gastroenterology Units, Santobono-Pausilipon Children Hospital, Naples
| | - Luigi Masoni
- General Surgery Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Maria Pia Villa
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Pasquale Parisi
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Chiara Ziparo
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Francesca Vassallo
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Melania Evangelisti
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
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5
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Bianchi F, Leganés Villanueva C, Brun Lozano N, Goruppi I, Boronat Guerrero S. Epiploic Appendagitis and Omental Infarction as Rare Causes of Acute Abdominal Pain in Children. Pediatr Rep 2021; 13:76-85. [PMID: 33562670 PMCID: PMC7931071 DOI: 10.3390/pediatric13010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
Omental infarction and epiploic appendagitis are rare causes of acute abdominal pain in the pediatric population. Radiological evaluation is necessary to establish a specific diagnosis and to differentiate appendicitis from these conditions as they can be often managed conservatively without surgical intervention.
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Affiliation(s)
- Federica Bianchi
- Pediatric Surgery Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.L.V.); (N.B.L.); (I.G.)
| | - Carlos Leganés Villanueva
- Pediatric Surgery Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.L.V.); (N.B.L.); (I.G.)
| | - Núria Brun Lozano
- Pediatric Surgery Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.L.V.); (N.B.L.); (I.G.)
| | - Ilaria Goruppi
- Pediatric Surgery Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.L.V.); (N.B.L.); (I.G.)
| | - Susana Boronat Guerrero
- Pediatric Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
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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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7
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Esposito F, Ferrara D, Schillirò ML, Grillo A, Diplomatico M, Tomà P. "Tethered Fat Sign": The Sonographic Sign of Omental Infarction. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1105-1110. [PMID: 32035686 DOI: 10.1016/j.ultrasmedbio.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/21/2019] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
Our purpose is to describe the ultrasound sign for a correct non-invasive diagnosis of omental infarction in children. From January 2014 to December 2018, a total of 234 children (109 boys and 125 girls, age range 3-15 y) with acute right-sided abdominal pain, admitted to our hospital with a presumptive diagnosis of acute appendicitis, were prospectively evaluated. In all patients, abdominal ultrasound was performed, and the omental fat was always evaluated. In 228 patients, the omental fat resulted to be normal or hyperechogenic, never tethered, and they results affected by other causes of abdominal pain different from omental infarction (such as appendicitis, pancreatitis, urolithiasis and others). In the remaining 6 children, we found a hyperechoic mass between the anterior abdominal wall and the ascending or transverse colon in the right abdomen quadrant, suggesting the diagnosis of omental infarction. This subhepatic mass was always tethered to the abdominal wall, motionless during respiratory excursions. We named this finding the "tethered fat sign." The diagnosis was confirmed with laparoscopy in 4 children. The other 2 children were treated with conservative therapy. In these 2 patients, a sonographic follow-up was performed, showing a progressive reduction in size of the right-sided hyperechoic mass. In conclusion, our study suggests that the presence of the "tethered fat sign" may be an accurate sonographic sign for non-invasive diagnosis of omental infarction in children.
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Affiliation(s)
- Francesco Esposito
- Division of Emergency Radiology, "Santobono" Children Hospital, Naples, Italy
| | - Dolores Ferrara
- Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Assunta Grillo
- Department of Radiology, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Mario Diplomatico
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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8
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Cankorkmaz L, Özer H, Tekin YK. A RARE CAUSE OF ACUTE ABDOMINAL PAIN: THE OMENTAL TORSION. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2019. [DOI: 10.33706/jemcr.609076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Phalke N, Mehta Z, Das S. Utilization of Imaging to Identify a Benign Condition Mimicking Acute Appendicitis in a Child. J Investig Med High Impact Case Rep 2018; 6:2324709618797989. [PMID: 30186884 PMCID: PMC6120172 DOI: 10.1177/2324709618797989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/20/2018] [Accepted: 08/05/2018] [Indexed: 11/17/2022] Open
Abstract
One of the most concerning causes of abdominal pain affecting children is acute appendicitis. However, there are benign conditions that can closely mimic appendicitis in children. In this article, we present a case of a child admitted for possible acute appendicitis and determined to have a condition known as omental infarction. The patient was managed medically and made a full recovery without surgical intervention. The aim of this case report is to review omental infarction and present a way of differentiating this disease from appendicitis, utilizing imaging, with the goal of avoiding surgical intervention. We also discuss the presentation and imaging findings of and another closely related condition—epiploic appendagitis. It is important to differentiate appendicitis from these 2 conditions as they can be often managed medically without surgical intervention.
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Affiliation(s)
- Neelam Phalke
- University of Nevada, Reno, NV, USA.,Current affiliation: Department of Otolaryngology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | | | - Samrat Das
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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10
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Diagnosis and management of omental infarction in children: Our 10 year experience with ultrasound. J Pediatr Surg 2018; 53:1360-1364. [PMID: 29550035 DOI: 10.1016/j.jpedsurg.2018.02.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/24/2018] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
AIM To review children with Omental Infarction (OI) and the role of Ultrasound Scan (US) in its diagnosis and management. METHODS Cases of OI were identified retrospectively from 2004 to 2014 through screening of admission coding, pathology databases and radiology records. Demographic, clinical and pathological data were extracted from case records. MAIN RESULTS 30 cases were identified (17 male, 13 female). Mean age was 10.7years (range 3.5-17.2). The majority of the patients were grossly overweight, with 83.3% of patients weighing greater than the mean for their age. All patients underwent at least one US, 4 had a repeat US and 1 patient also had a CT to rule out appendicitis after a US demonstrating OI. OI was demonstrated in 26 initial USs; in 4 cases initial USs were negative but repeat USs correctly detected OI. In 34 USs the appendix was identified on 20 occasions (15 normal, equivocal in 5). 13 patients underwent surgery, while 17 were managed nonoperatively; 7 underwent omentectomy only, 5 had omentectomy plus appendicectomy and 1 underwent appendicectomy only. All 12 omentectomy specimens were confirmed as OI histologically while none of the 6 appendices showed inflammation histologically. There were no postoperative complications. CONCLUSION In a large series we have demonstrated the efficacy of US in the diagnosis and management of OI in children. To our knowledge this is the largest series of its kind to date. No patient with OI was incorrectly diagnosed with acute appendicitis or vice versa. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Retrospective Case Series.
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11
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Tepeneu N, Tarmann R, Sinzig M, Fasching G. Primary segmental omental infarction as a rare cause of acute abdominal pain in childhood. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Abstract
The normal peritoneal structures, including the mesenteries and the omenta, are only a few cell layers thick and are visible on imaging based upon the tissues (e.g., fat) and structures (e.g., blood vessels and lymph nodes) contained within them. These structures become more visible and change in appearance when involved by pathological processes. In this pictorial essay, we discuss the normal anatomy of the various abdominopelvic peritoneal structures and illustrate numerous developmental and acquired diagnoses that involve these structures in the pediatric and young adult population.
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13
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Elgharbawy F, Salameh K, Al Rayes T, Abdelgadir IS. Pediatric case of acute right-sided abdominal pain: diagnosis is not always appendicitis. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:69-71. [PMID: 29388616 PMCID: PMC5774598 DOI: 10.2147/phmt.s133409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Omental infarction (OI) is a rare cause of acute abdominal pain occurring in 0.1% of children, which is typically diagnosed during surgery for suspected appendicitis. We present the case of a 7-year-old Pakistani girl. She presented with acute, severe, progressive, right-sided abdominal pain, which was present for 12 hours before presentation. No constitutional symptoms such as fever, anorexia, nausea or vomiting were present. Clinical examination revealed an adequately growing child following the 50th centile. She had severe generalized abdominal tenderness with rebound tenderness and guarding, mainly on the right lower abdominal quadrant, with all other system examinations normal. She had mildly increased inflammatory markers, and her initial abdominal ultrasound scan result was within normal limits. She had laparoscopic surgery following a diagnosis of suspected acute appendicitis; however, an intraoperative diagnosis of OI was made. This was later confirmed by histopathology. This case report highlights the importance of including OI in the differential diagnosis list of acute abdominal pain in children, in addition to the importance of computed tomography (CT) as the gold standard tool to aid diagnosis. In the presence of typical symptoms and signs of OI, a CT scan can assist and guide the management of similar cases. This course of action is suggested for the reason that OI typically runs a self-limited course and conservative care may be the most appropriate recommended course of action. Consequently, unnecessary operations could be avoided due to the diagnosis confirmation of studying images.
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14
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Tannoury J, Yaghi C, Gharios J, Abboud B. Omental ischemia. Presse Med 2016; 45:824-828. [PMID: 27614536 DOI: 10.1016/j.lpm.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022] Open
Abstract
Omental ischemia is a rare cause of acute abdomen. Clinical diagnosis is usually difficult because clinical signs and symptoms are similar to other common causes of abdominal pain. The most common differential diagnosis is acute appendicitis. Diagnosis is mainly based on ultrasound, and especially computed tomography scan analysis. There is, at present, no standard treatment modality for omental ischemia. When diagnosed by radiological imaging, omental ischemia can be managed conservatively. We hereby review incidence, etiology, pathology, clinical presentation, differential diagnosis, biological anomalies, radiological features, and treatment options of omental ischemia.
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Affiliation(s)
- Jenny Tannoury
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of Gastroenterology and Hepatology, Beirut, Lebanon
| | - Cesar Yaghi
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of Gastroenterology and Hepatology, Beirut, Lebanon
| | - Joseph Gharios
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of General Surgery, Beirut, Lebanon
| | - Bassam Abboud
- Faculty of Medicine, Saint-Joseph University, Hôtel Dieu de France Hospital, Department of General Surgery, Beirut, Lebanon.
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Arigliani M, Dolcemascolo V, Nocerino A, Pasqual E, Avellini C, Cogo P. A Rare Cause of Acute Abdomen: Omental Infarction. J Pediatr 2016; 176:216-216.e1. [PMID: 27289499 DOI: 10.1016/j.jpeds.2016.05.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Michele Arigliani
- Department of Clinical and Experimental Medical Sciences, University Hospital of Udine, Udine, Italy
| | - Valentina Dolcemascolo
- Department of Clinical and Experimental Medical Sciences, University Hospital of Udine, Udine, Italy; University of Trieste, Trieste, Italy
| | - Agostino Nocerino
- Department of Clinical and Experimental Medical Sciences, University Hospital of Udine, Udine, Italy
| | - Enrico Pasqual
- Department of Surgery, University Hospital of Udine, Udine, Italy
| | - Claudio Avellini
- Institute of Pathology, University Hospital of Udine, Udine, Italy
| | - Paola Cogo
- Department of Clinical and Experimental Medical Sciences, University Hospital of Udine, Udine, Italy
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Gupta L, Saxena AK, Sodhi KS, Mahajan JK, Khandelwal N. Omental infarction: An unusual cause of right iliac fossa pain in children. J Indian Assoc Pediatr Surg 2016; 21:33-5. [PMID: 26862293 PMCID: PMC4721126 DOI: 10.4103/0971-9261.164637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Omental infarction is an uncommon cause of acute abdomen in the pediatric population. We report a case of a 4-year-old male child with right iliac fossa pain. The final diagnosis was made on ultrasound and computed tomography findings. This entity needs to be differentiated from acute conditions like appendicitis, avoiding surgery.
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Affiliation(s)
- Laxmikant Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay K Saxena
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jai K Mahajan
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- Joanne Johnson
- Paediatric Ultrasound, Division of Medical Imaging; Women's and Children's Hospital; Adelaide South Australia Australia
| | - Lino Piotto
- Paediatric Ultrasound, Division of Medical Imaging; Women's and Children's Hospital; Adelaide South Australia Australia
| | - Roger Gent
- Paediatric Ultrasound, Division of Medical Imaging; Women's and Children's Hospital; Adelaide South Australia Australia
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19
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Segmental omental infarction: a rare cause of acute abdominal pain in children. Surg Laparosc Endosc Percutan Tech 2014; 24:e38-40. [PMID: 24487175 DOI: 10.1097/sle.0b013e3182900e2a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Segmental omental infarction (SOI) is an unusual and rare cause of abdominal pain in children and is often mistaken for acute appendicitis preoperatively. SOI once diagnosed preoperatively should be treated conservatively. Surgical intervention, however, may be necessary in order to establish definitive diagnosis and treatment. We present 2 children with SOI diagnosed as acute appendicitis preoperatively. Laparoscopy established the diagnosis and treatment. Laparoscopy should be the procedure of choice in children presenting with right-sided abdominal pain that is not well established preoperatively. This is especially so in obese children. Laparoscopy not only establishes the diagnosis of SOI but laparoscopic omentectomy results in resolution of symptoms and faster recovery.
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Omental Infarction: An Unusual Cause of Left-Sided Abdominal Pain. ACG Case Rep J 2014; 1:223-4. [PMID: 26157883 PMCID: PMC4435328 DOI: 10.14309/crj.2014.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/10/2014] [Indexed: 11/17/2022] Open
Abstract
Left-sided omental infarction (OI) is rare in both the adult and pediatric patients. To our knowledge, only 2 pediatric cases of a left-sided OI have been reported in the literature. We report a case of an obese 13-year-old male who presented with a 6-day history of intermittent, colicky, left upper quadrant abdominal pain.
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Radiological, clinical and histological correlations in a right segmental omental infarction due to primary torsion in a child. Diagn Interv Imaging 2014; 95:325-31. [DOI: 10.1016/j.diii.2013.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Borgaonkar V, Deshpande S, Rathod M, Khan I. Primary Omental Torsion Is a Diagnostic Challenge in Acute Abdomen-a Case Report and Literature Review. Indian J Surg 2014; 75:255-7. [PMID: 24426445 DOI: 10.1007/s12262-013-0807-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 01/02/2013] [Indexed: 11/30/2022] Open
Abstract
Torsion of greater omentum is a rare cause of acute abdominal pain. It can be primary or secondary. Secondary omental torsions are associated with a number of preexisting conditions like inguinal hernia (most common), tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting along its long axis resulting in impaired blood supply. This condition is rare and predominant in males. Most patients are middle-aged adults. It clinically mimics acute appendicitis. If evaluated properly and diagnosed in time, good results can be achieved. We are presenting herewith a case of primary greater omental torsion and review of available literature.
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Affiliation(s)
- Vijay Borgaonkar
- Department of Surgery, Seth Nandalal Dhoot Hospital, A-1, MIDC, Chikalthana, Aurangabad, 431005 Maharashtra India
| | - Sushil Deshpande
- Department of Surgery, Seth Nandalal Dhoot Hospital, A-1, MIDC, Chikalthana, Aurangabad, 431005 Maharashtra India
| | - Mukesh Rathod
- Department of Surgery, Seth Nandalal Dhoot Hospital, A-1, MIDC, Chikalthana, Aurangabad, 431005 Maharashtra India
| | - Imran Khan
- Department of Surgery, Seth Nandalal Dhoot Hospital, A-1, MIDC, Chikalthana, Aurangabad, 431005 Maharashtra India
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Tsironis A, Zikos N, Bali C, Pappas-Gogos G, Koulas S, Katsamakis N. Acute Abdomen Due to Primary Omental Torsion: Case Report. J Emerg Med 2013; 44:e45-8. [DOI: 10.1016/j.jemermed.2011.06.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 05/22/2011] [Accepted: 06/11/2011] [Indexed: 10/15/2022]
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A case report of idiopathic omental infarction in an obese child. Case Rep Pediatr 2012; 2012:513634. [PMID: 22953142 PMCID: PMC3431046 DOI: 10.1155/2012/513634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 07/30/2012] [Indexed: 11/18/2022] Open
Abstract
Omental infarction (OI) is a rare cause of acute abdomen in children. A 9-year-old girl was presented with sudden-onset intermittent right lower quadrant abdominal pain and fever (37.9°C). Physical examination revealed abdominal tenderness in the right lower quadrant with localized rebound tenderness which resembled acute appendicitis. She was obese and her BMI was on the 99th percentile. Computed tomography (CT) revealed a 5 cm ill-defined heterogeneous fatty mass with hyperattenuating streaks just beneath the abdominal wall. She was diagnosed as OI and treated conservatively with reduced meals and antibiotics. Her symptom resolved gradually and she was discharged on day 7 without complications. OI should be considered as a differential diagnosis for acute right-sided abdominal pain, especially in obese children. Enhanced CT is useful for differentiating OI from other conditions presenting with acute abdomen.
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Park TU, Oh JH, Chang IT, Lee SJ, Kim SE, Kim CW, Choe JW, Lee KJ. Omental Infarction: Case Series and Review of the Literature. J Emerg Med 2012; 42:149-54. [DOI: 10.1016/j.jemermed.2008.07.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 05/16/2008] [Accepted: 07/12/2008] [Indexed: 11/29/2022]
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Omental infarction caused by laparoscopy-assisted gastrectomy for gastric cancer: CT findings. Clin Radiol 2011; 66:966-73. [PMID: 21684534 DOI: 10.1016/j.crad.2011.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 04/05/2011] [Accepted: 05/05/2011] [Indexed: 11/21/2022]
Abstract
AIM To investigate the computed tomography (CT) imaging features of omental infarction in patients who underwent laparoscopy-assisted gastrectomy (LAG) for gastric cancer. MATERIALS AND METHODS A retrospective study was performed on 390 patients who underwent LAG for gastric cancer. Two radiologists evaluated the CT images for the presence of omental infarction. The CT pattern was characterized at initial presentation and the evolutional changes were evaluated. The initial CT appearance of omental infarctions were categorized into the following four types: type 1 (ill-defined, heterogeneous, fat density lesion); type 2 (well-defined fat density lesion with rim enhancement); type 3 (well-defined heterogeneous lesion with fat component); and type 4 (well-defined heterogeneous lesion without a fat component). RESULTS Of the 390 patients involved, nine patients (2.3%; six male and three female with a mean age of 57 years) were diagnosed with omental infarction. Infarctions averaged 4.1 cm (range 2-7.3 cm) in diameter. Among nine patients with omental infarction, two patients had type 1 lesions, two had type 2, two had type 3, and three type 4. All infarctions became smaller and better defined with evolution. In two patients who presented with type 1 lesions on initial CT, each lesion was progressed to type 2 and type 3 on follow-up CT. In two patients with type 3 lesions on initial CT, the lesions changed to type 4 on follow-up CT. CONCLUSION An awareness of the various CT features and evolutional changes in omental infarction after LAG for gastric cancer can help ensure the correct diagnosis and to avoid misdiagnosis for omental implants.
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Kambouri K, Gardikis S, Giatromanolaki A, Tsalkidis A, Sivridis E, Vaos G. Omental infarction in an obese 10-year-old boy. Pediatr Rep 2011; 3:e22. [PMID: 22053266 PMCID: PMC3207310 DOI: 10.4081/pr.2011.e22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/04/2011] [Indexed: 11/30/2022] Open
Abstract
Primary omental infarction (POI) has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US) examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intra-operative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.
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Comparison of clinical characteristics and neutrophil values in omental infarction and acute appendicitis in children. Pediatr Neonatol 2010; 51:155-9. [PMID: 20675239 DOI: 10.1016/s1875-9572(10)60029-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 08/14/2009] [Accepted: 08/28/2009] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Omental infarction is a rare occurrence in children. It is often diagnosed during surgery for suspected appendicitis. This study investigated the use of clinical and laboratory data for distinguishing between omental infarction and acute appendicitis. METHODS Seven patients with surgically and pathologically proven omental infarction and 28 age- and sex-matched patients with acute appendicitis were included in this study. The clinical characteristics, imaging study results and laboratory data were analyzed. RESULTS All 35 patients had right lower quadrant abdominal pain at presentation. The frequency of nausea and fever were significantly lower in the omental infarction group compared with the acute appendicitis group (p< 0.001 and p= 0.018, respectively). In laboratory studies, the white blood cell count, C-reactive protein value and neutrophil percentage were all higher in the acute appendicitis group compared with the omental infarction group (p= 0.001, p< 0.001, and p= 0.008, respectively). It was possible to separate patients with omental infarction from those with acute appendicitis based on a neutrophil percentage of less than 77% (sensitivity 100%, specificity 100%). CONCLUSIONS Results of the current study suggest that omental infarction should be considered as a possible diagnosis in patients presenting with right lower quadrant abdominal pain without nausea or fever, and with a neutrophil percentage below 77%.
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Rimon A, Daneman A, Gerstle JT, Ratnapalan S. Omental infarction in children. J Pediatr 2009; 155:427-431.e1. [PMID: 19540514 DOI: 10.1016/j.jpeds.2009.03.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Revised: 02/12/2009] [Accepted: 03/19/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To analyze the clinical presentation, radiologic features, management, and outcome in children diagnosed with omental infarction. STUDY DESIGN This was a retrospective chart review of patients diagnosed with omental infarction in a tertiary care pediatric emergency department. Images and reports of the radiologic investigations were re-examined by a staff radiologist and analyzed for sensitivity. RESULTS A diagnosis of omental infarction was made in 19 children (mean age, 9.3 +/- 3.5 years). The presentation was acute right lower quadrant pain in 47% of the children and associated gastrointestinal symptoms in 63%. The sensitivity of abdominal ultrasound (US) to detect omental infarction at our institution was 64%, and the sensitivity of abdominal computed tomography was 90%. Fourteen children were treated conservatively without complications after an accurate diagnosis of omental infarction done by imaging examination. Only 5 children underwent surgery based on clinical suspicion of appendicitis. CONCLUSIONS Early identification of omental infarction by abdominal US appears to prevent unjustified surgical procedures and reduce the length of hospital stay.
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Affiliation(s)
- Ayelet Rimon
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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30
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Montiel-Jarquin A, Lopez-Colombo A, Nava A, Juarez-Santiesteban R, Leyva-Trejo H, Zamora-Ustaran A, García-Carrasco M, Munoz-Guarneros M. Clinical Characteristics of Torsion of the Omentum. Gastroenterology Res 2009; 2:220-223. [PMID: 27942278 PMCID: PMC5139745 DOI: 10.4021/gr2009.07.1303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2009] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this paper is to describe clinical aspects of the torsion of the omentum. Methods In this observational, retrospective study, the study group consisted of patients surgically managed for torsion of the omentum, between 1998 and 2008, in a second level medical facility in Mexico. Variables in the study included age, sex, signs and symptoms, body mass index (BMI), treatment and evolution time. Descriptive statistical analysis was employed. Results Eleven patients were confirmed torsion of omentum, 7 (63.63%) women and 4 (36.36%) men, median age 33 (20 to 58) years, BMI > 25.0 in 9 (81.81%), average evolution 6.54, SD 3.47 days. All presented with abdominal pain, 6 (54.54%) with abdominal distension, 4 (36.36%) with ambulatory difficulty, 3 (27.27%) with malaise, and 5 (45.45%) with previous surgery. In all cases diagnosis was made by means of laparotomy, treatment was the resection of the affected segment, and there were no further complications. Conclusions Torsion of the omentum resembles acute appendicitis; abdominal pain and abdominal distension are the most common symptoms. It is often discovered during surgery and it is treated surgically by removal of the affected segment of the omentum.
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Affiliation(s)
- Alvaro Montiel-Jarquin
- Gastroenterologist and General Surgeon, at Instituto Mexicano del Seguro Social in Puebla, Mexico; Research Department, Instituto Mexicano del Seguro Social, Puebla and Benemérita Universidad Autónoma de Puebla, Mexico
| | - Aurelio Lopez-Colombo
- Research Department, Instituto Mexicano del Seguro Social, Puebla and Benemérita Universidad Autónoma de Puebla, Mexico
| | - Arnulfo Nava
- Research Department, Instituto Mexicano del Seguro Social, Puebla and Benemérita Universidad Autónoma de Puebla, Mexico
| | - Rayo Juarez-Santiesteban
- Research Department, Instituto Mexicano del Seguro Social, Puebla and Benemérita Universidad Autónoma de Puebla, Mexico
| | - Hugo Leyva-Trejo
- Gastroenterologist and General Surgeon, at Instituto Mexicano del Seguro Social in Puebla, Mexico
| | - Alfonso Zamora-Ustaran
- Research Department, Instituto Mexicano del Seguro Social, Puebla and Benemérita Universidad Autónoma de Puebla, Mexico
| | - Mario García-Carrasco
- Research Department, Instituto Mexicano del Seguro Social, Puebla and Benemérita Universidad Autónoma de Puebla, Mexico
| | - Margarita Munoz-Guarneros
- Research Department, Instituto Mexicano del Seguro Social, Puebla and Benemérita Universidad Autónoma de Puebla, Mexico
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Maxfield CM, Bayindir P. Fat-containing lesions revealed by CT in children with right lower quadrant pain. Pediatr Radiol 2009; 39:371-6. [PMID: 19142630 DOI: 10.1007/s00247-008-1110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 11/18/2008] [Accepted: 12/05/2008] [Indexed: 10/21/2022]
Abstract
Suspected appendicitis is the most common indication for emergent abdominal surgery in children. The clinical diagnosis of appendicitis can be challenging, and CT is playing an increasing role in the evaluation of right lower quadrant pain. Occasionally, alternative diagnoses to appendicitis can be suggested on CT. The appreciation of a fat-containing lesion in the right lower quadrant will often allow a specific diagnosis. Importantly, many of these lesions are self-limited and treated nonoperatively. The purpose of this pictorial essay is to illustrate the spectrum of fat-containing lesions that can present as alternative diagnoses to appendicitis on CT scans performed for the evaluation of right lower quadrant pain in children.
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Affiliation(s)
- Charles M Maxfield
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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Ramos CT, Sammartano R. Laparoscopic Omentectomy for Omental Infarction After Bicycle Handlebar Injury. J Laparoendosc Adv Surg Tech A 2008; 18:327-9. [DOI: 10.1089/lap.2007.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carmen T. Ramos
- Division of Pediatric Surgery, Children's Hospital and the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Robert Sammartano
- Division of Pediatric Surgery, Children's Hospital and the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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Mavridis G, Georgios M, Livaditi E, Evangelia L, Baltogiannis N, Nikolaos B, Vasiliadou E, Evi V, Christopoulos-Geroulanos G, Christopoulos-Geroulanos G. Primary omental torsion in children: ten-year experience. Pediatr Surg Int 2007; 23:879-82. [PMID: 17605020 DOI: 10.1007/s00383-007-1961-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2007] [Indexed: 11/28/2022]
Abstract
Primary omental torsion (POT), is a rare cause of acute abdomen commonly affecting obese male adults, whereas it is extremely rare in children. In this retrospective study, we present our experience regarding the management of five children with POT and discuss the diagnostic and therapeutic implications of this entity. We retrospectively reviewed the medical records of children diagnosed for POT, from January 1996 to July 2006 at our department. Among 2,734 children operated for acute appendicitis, five patients were diagnosed with POT (ratio 1:587 or 0.18%). Clinical presentation, laboratory findings, diagnostic imaging results as well as surgical and histological findings were reviewed. There were four boys and one girl, M/F ratio 4:1, with a mean age of 9.5 years (range 7.2-10.3). All subjects were obese and their weight percentages were over 85% for their age group. On admission the clinical symptoms and laboratory findings were similar to those of acute appendicitis. They were submitted to laparotomy and the surgical findings were; free serosanguineous fluid in the peritoneal cavity, normal appendix and an ischemic twisted mass of the omentum at the right side of the abdomen. The mass and the appendix were excised and the postoperative course was uneventful. The histological examination of the specimens revealed hemorrhagic ischemic necrosis of the omentum and normal appendix. POT is very rare in children. In the pediatric age group the clinical presentation and the laboratory findings are similar to those of acute appendicitis and it is extremely difficult to be diagnosed preoperatively. Obesity seems to be an important predisposing high-risk factor. Excision of the twisted omentum is the treatment of choice.
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Affiliation(s)
- George Mavridis
- 2nd Surgical Department, Aghia Sophia Children's Hospital of Athens, 79 Alevizatou Str, 15669, Papagou, Athens, Greece.
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Foscolo S, Mandry D, Galloy MA, Champigneulles J, De Miscault G, Claudon M. Segmental omental infarction in childhood: an unusual case of left-sided location with extension into the pelvis. Pediatr Radiol 2007; 37:575-7. [PMID: 17404725 DOI: 10.1007/s00247-007-0443-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 02/16/2007] [Accepted: 02/25/2007] [Indexed: 11/30/2022]
Abstract
Segmental omental infarction (OI) is a rare cause of abdominal pain in children. It generally occurs in the right lower and upper quadrants of the abdomen and only a few cases of other locations have been described in adults. We report a unique paediatric case of OI with an unusual left-sided location extending into the pelvis in a 6-year-old non-obese girl. The diagnosis was suspected on US and CT based on imaging patterns previously described in adults and children. Laparoscopic resection should be balanced with nonsurgical management.
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Affiliation(s)
- Sylvain Foscolo
- Department of Radiology, Children's Hospital, University of Nancy, Allée du Morvan, 54511 Vandoeuvre les Nancy, France
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35
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Tawil MI. Pediatric Emergencies: Non-traumatic Abdominal Emergencies. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Abstract
Omental infarction is a rare entity in children that is usually diagnosed during surgery for suspected appendicitis. We report the clinical case of an obese boy presenting with abdominal pain and right-sided tenderness without fever, anorexia, or leukocytosis. Abdominal ultrasonography suggested omental infarction, and computed tomography confirmed the diagnosis. Nonoperative management was adopted with rapid and uneventful recovery. Nonoperative treatment of omental infarction is safe and effective; accurate diagnosis is therefore crucial to enable a conservative approach. Suggestive clinical features and diagnostic workup are addressed.
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Affiliation(s)
- Ana Catarina Fragoso
- Division of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. João, 4200-319 Porto, Portugal
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38
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Singh AK, Gervais DA, Lee P, Westra S, Hahn PF, Novelline RA, Mueller PR. Omental infarct: CT imaging features. ACTA ACUST UNITED AC 2006; 31:549-54. [PMID: 16465576 DOI: 10.1007/s00261-005-0251-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 09/21/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study is to describe contrast-enhanced computed tomographic (CT) features of acute omental infarction and to study the evolutionary changes on follow-up CT imaging. METHODS Fifteen cases of omental infarction were evaluated for their initial CT imaging features. The imaging features evaluated included size of the fatty lesion, location, peripheral rim, and relation to colon. CT findings were correlated with etiology, clinical presentation, and leukocytosis. Follow-up CT images were available in eight patients and the imaging features were studied. RESULTS Eight omental infarcts were of unknown etiology and seven were secondary to abdominal surgery. In 53% of patients (eight of 15), the location of the omental infarct was in the right lower, mid, or upper quadrants. These eight right-side infarcts occurred in six patients with primary omental infarcts. In 13 of 14 patients who underwent CT within 15 days of onset of omental infarct, the margin of the lesion was ill defined. Primary omental (n = 8) infarcts were seen in younger patients (p = 0.02) and were larger on CT (p = 0.02) compared with secondary omental infarcts. CT findings evolved from an ill-defined, heterogeneous fat-density lesion to a well-defined, heterogeneous fat-density lesion with a peripheral hyperdense rim in all six secondary omental infarctions for which acute stage and follow-up CT images were available for interpretation. CONCLUSION There is a significant difference in the age distribution and CT findings in terms of size of the omental infarction between primary and secondary etiologies. On follow-up CT, secondary omental infarcts progressively shrank and developed a well-defined, hyperdense rim around a fatty core.
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Affiliation(s)
- A K Singh
- Division of Abdominal Imaging and Interventional Emergency Radiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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39
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Affiliation(s)
- Brian Lugo
- Division of Pediatric Surgery, UCI Medical Center, University of California, Irvine, CA 92868, USA
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40
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Coulier B. Segmental omental infarction in childhood: a typical case diagnosed by CT allowing successful conservative treatment. Pediatr Radiol 2006; 36:141-3. [PMID: 16328324 DOI: 10.1007/s00247-005-0025-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 08/29/2005] [Indexed: 02/03/2023]
Abstract
Segmental omental infarction (SOI) is an uncommon cause of right lower quadrant pain in children that is often misdiagnosed as appendicitis. During the last decade, imaging findings of SOI have proved to be sufficiently typical to avoid unnecessary surgery in the majority of reported adult patients. The condition has a spontaneous favourable evolution under medical treatment. In children the surgical option remains controversial. We report a typical case of SOI in a 10-year-old boy. The diagnosis was suspected by sonography, unambiguously confirmed by multidetector CT and successfully treated conservatively. This report emphasizes the use of CT in selected acute abdominal situations, peculiarly in obese children, to avoid unnecessary surgery.
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Affiliation(s)
- Bruno Coulier
- Department of Diagnostic Radiology, Clinique St. Luc, Rue St. Luc 8, 5004 Bouge, Belgium.
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Abstract
PURPOSE The aim of this study was to review the presenting features of pediatric patients found to have omental infarction with a normal appendix at surgery. METHODS A retrospective review was conducted of all patients with surgically proven omental infarction treated at KK Women's and Children's Hospital between May 1997 and January 2004. RESULTS Twelve children (10 boys and 2 girls) were treated for primary omental infarction. The mean age was 9.0 +/- 1.42 years. The mean weight was 41.3 +/- 9.65 kg, with 6 (50%) above the 97th percentile and the remainder were between the 50th and 97th percentile. All 12 children presented with right-sided abdominal pain. At presentation, 9 had low-grade fever of 37.3 degrees C or higher, with the maximum temperature recorded at 37.9 degrees C. The mean total white blood cell count was 13.3 +/- 2.66. Significant neutrophilia (relative percentage, > 70%; absolute neutrophils, > 8000) was noted in 9 children. Eight children underwent radiological imaging, which included ultrasonography (n = 3) and/or computed tomography (CT) (n = 7) of the abdomen. Preoperative diagnosis was made on 4 CT scans. Surgical resection resulted in immediate resolution of symptoms. CONCLUSION Omental infarction often mimics acute appendicitis preoperatively, although CT may be diagnostic. Surgical resection of the affected omentum expedites clinical recovery.
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Affiliation(s)
- May Han Loh
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore 229 899, Singapore.
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Baldisserotto M, Maffazzoni DR, Dora MD. Omental infarction in children: color Doppler sonography correlated with surgery and pathology findings. AJR Am J Roentgenol 2005; 184:156-62. [PMID: 15615967 DOI: 10.2214/ajr.184.1.01840156] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our report is to describe color Doppler sonography findings of omental infarction and correlate them with surgical and pathology findings. Ten children underwent preoperative gray-scale and color Doppler sonographic examinations; omental infarction was confirmed at surgery. CONCLUSION Color Doppler sonography findings were reviewed and correlated with surgical and pathology findings. Color Doppler sonography features of idiopathic omental infarction differ from those of infarction secondary to omental torsion.
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Affiliation(s)
- Matteo Baldisserotto
- Departamento de Radiologia, Hospital da Criança Conceição, Ministério da Saúde-Brazil, Rua Francisco Trein, 596, Porto Alegre, RS, CEP 91350-200, Brazil.
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Abadir JS, Cohen AJ, Wilson SE. Accurate Diagnosis of Infarction of Omentum and Appendices Epiploicae by Computed Tomography. Am Surg 2004. [DOI: 10.1177/000313480407001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Segmental infarction of the omentum and epiploic appendages presents with acute abdominal findings that may be confused with a surgical illness. Computed tomography, however, demonstrates a consistent and well-recognized pattern that allows safe, nonoperative treatment. Infarction of omental or mesenteric fat may present clinically as localized peritonitis, mimicking appendicitis, diverticulitis, or cholecystitis. Spontaneous recovery without operation is to be expected if an accurate diagnosis is established. We describe the diagnosis, treatment, and outcome of 15 patients who had infarction of the greater omentum (eight) and epiploic appendage (seven) and presented with localized abdominal pain and tenderness, with six demonstrating regional peritonitis and fever. All underwent CT imaging during their initial evaluation, and 12 of the 15 patients were diagnosed with focal omental or mesenteric fat infarction radiographically and managed nonoperatively. Three patients who had characteristic CT. findings nevertheless underwent operation. All patients had complete resolution of their abdominal pain regardless of treatment. The clinical presentation of infarction of the omental or epiploic appendages may be difficult to differentiate from surgical causes of acute abdominal pain. The characteristic findings on computed tomography are diagnostic and allow safe, conservative management in the majority of patients.
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Affiliation(s)
- Janet S. Abadir
- Department of Surgery, University of California-Irvine, Orange, California
| | - Allen J. Cohen
- Department of Radiology, University of California-Irvine, Orange, California
| | - Samuel E. Wilson
- Department of Surgery, University of California-Irvine, Orange, California
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Montiel-Jarquin A, Sanabria-Macias ., Sanchez-Turati J, Iturbide-Garcia J, Sandoval-Cruz M, Ramos-Alvarez G. VASCULAR PATHOLOGY OF THE GREATER OMENTUM: Report of two cases. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2004. [DOI: 10.29333/ejgm/82204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Since the introduction of minimal access surgery to general surgeons in the 1980s, pediatric surgeons have been employing this innovative technology to perform surgery on children. Video technology and miniaturized instruments have brought the laboratory to the operating room; in many cases several small incisions are the only access necessary to perform complicated procedures that would otherwise require a large wound. Additional benefits of minimal access surgery may include reduced postoperative analgesic requirements, shortened length of stay, and faster resumption of normal activities. Increased operative costs offset some of these gains. The pediatric surgical community has embraced minimal access techniques for some operations; others remain controversial.
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Affiliation(s)
- Jeffrey L Zitsman
- Children's Hospital of New York Presbyterian, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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Benizri EI, Iannelli A, Fabiani P, Karimdjee BS, Gugenheim J. [Idiopathic infarction of the left segment of the greater omentum]. ANNALES DE CHIRURGIE 2002; 127:711-3. [PMID: 12658832 DOI: 10.1016/s0003-3944(02)00868-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Idiopathic infarction of the greater omentum is a rare cause of acute abdominal pain whose diagnosis remains difficult. Most of the cases reported in the literature concern the right segment of the greater omentum, simulating appendicitis or cholecystitis. We report a case of an idiopathic leftsided segmental infarction of the greater omentum, in a previously healthy 59 years old woman. Laparoscopy permitted to confirm the diagnosis and to remove the infarcted omentum.
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Affiliation(s)
- E I Benizri
- Service de chirurgie digestive et transplantation hépatique, hôpital Archet 2, 151, route de St Antoine-de-Ginestière, BP 3079, 06202 Nice, France
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