1
|
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.
Collapse
Affiliation(s)
| | | | | | - Colin Powell
- Emergency Department, Cardiff University, Cardiff, UK
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Omran K, Al Tamr WJ. Omental infarction and anterior wall adhesion presenting as surgical abdomen in a pediatric patient. Clin Case Rep 2022; 10:e6604. [PMID: 36415712 PMCID: PMC9675865 DOI: 10.1002/ccr3.6604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/30/2022] [Indexed: 11/21/2022] Open
Abstract
Omental infarction is a rare cause of acute abdomen that can present in both the pediatric and adult populations causing adhesions or abscesses. Presentation may mimic appendicitis; however, ultrasonography may not be sufficient. We discuss the importance of CT imaging for the pre‐surgical diagnosis to avoid serious port‐site injuries.
Collapse
Affiliation(s)
- Kareem Omran
- GKT School of Medical EducationKing's College LondonLondonUK
| | | |
Collapse
|
4
|
Hofmann P, Barth BK, Bächli AE. An Uncommon Cause of Abdominal Pain: What Is Your Diagnosis? PRAXIS 2022; 111:719-720. [PMID: 36221967 DOI: 10.1024/1661-8157/a003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Patrick Hofmann
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | | |
Collapse
|
5
|
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.
Collapse
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
| | | | | |
Collapse
|
6
|
Kaya A, Kaya SY, Baydar H, Bavunoğlu I. Omental infarction in mild Covid-19 infection. J Infect Chemother 2021; 28:326-328. [PMID: 34802890 PMCID: PMC8595348 DOI: 10.1016/j.jiac.2021.11.004] [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: 06/12/2021] [Revised: 10/12/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
COVID-19 is an infection which can present with various clinical manifestations. While it affects respiratory tract primarily, several other manifestations including gastrointestinal involvements have been reported. The prevalence of all gastrointestinal complaints is approximately 17 percent and diarrhea, nausea/vomiting and abdominal pain are the most common symptoms. In COVID-19, acute abdominal pain requiring surgical evaluation and abdominal imaging is uncommon and there is also a lack of knowledge about COVID-19 related gastrointestinal complications. Here, we report a case of mild COVID-19 infection complicated by omental infarction during the course of the illness.
Collapse
Affiliation(s)
- Abdurrahman Kaya
- Department of Infectious Disease, Department of Emergency Medicine, Istanbul Training and Research Hospital, Turkey.
| | | | - Hakan Baydar
- Department of Infectious Disease, Department of Emergency Medicine, Istanbul Training and Research Hospital, Turkey
| | - Işıl Bavunoğlu
- Department of Internal Medicine, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, İstanbul, Turkey
| |
Collapse
|
7
|
Owedah RJ, Alshehri OA, Alfneekh NI, Alasmari AH, Hafiz DW, Alburayh YA, Alabdullah MA, Altarteer AA, Alharbi MF, Almutairi MF, Aljohani SS, Boudal IS, Alshammari MA. Acute Omental Infarction Mimicking Acute Appendicitis. Cureus 2021; 13:e18053. [PMID: 34671532 PMCID: PMC8520696 DOI: 10.7759/cureus.18053] [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] [Accepted: 09/17/2021] [Indexed: 11/08/2022] Open
Abstract
Acute abdominal pain is a common cause of visits to the emergency department. Acute appendicitis remains the most common indication for abdominal surgical intervention in the pediatric age group. However, several conditions may present with a clinical picture similar to that of acute appendicitis. We report the case of a 7-year-old girl with a history of right lower quadrant abdominal pain of two days in duration. The pain was associated with vomiting and was exacerbated by movement. Abdominal examination revealed a localized tenderness in the right iliac fossa with guarding, giving the impression of acute appendicitis. After a thorough investigation, the patient was diagnosed as having acute omental infarction given the radiological findings seen in the computed tomography scan. The patient was successfully managed conservatively with analgesics and anti-inflammatory drugs. Physicians should keep a high index of suspicion for this condition when encountering a patient presenting with an acute right lower quadrant abdominal pain. Imaging modalities play a pivotal role in making the diagnosis.
Collapse
Affiliation(s)
| | | | | | | | - Dina W Hafiz
- Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | | | - Maram F Almutairi
- Family Medicine, Ministry of National Guard - Health Affairs, Riyadh, SAU
| | | | | | | |
Collapse
|
8
|
Diab J, Badiani S, Berney CR. Diagnosis and Management of Adult Omental Infarction: 10-Year Case Series. World J Surg 2021; 45:1734-1741. [PMID: 33721073 DOI: 10.1007/s00268-021-06043-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Omental infarction is a rare cause of an acute abdomen with nonspecific signs that can be easily mistaken with other more common intra-abdominal pathologies. The increased use of radiological imaging has brought this diagnosis to attention with respect to management plan. We present the experience of an Australian hospital network with the diagnosis and management of omental infarction to raise awareness of this uncommon pathology. METHODS A retrospective review of medical records of adult patients diagnosed with omental infarction from 2010 to 2020 was conducted across four major hospitals in South Western Sydney. Data relating to clinical presentation, investigations, management and outcomes were obtained. RESULTS Omental infarction was diagnosed in 61 patients (mean 51.1 years, range: 19-76 years old). All patients presented with nonspecific abdominal pain with the most common sites being the right iliac fossa followed by the right upper quadrant, respectively, over an average period of 2.7 days. Computed tomography and/or diagnostic laparoscopy identified omental infarction in all cases. Forty-two patients (68.9%) had successful conservative management, six failed conservative management and 19 patients had emergency laparoscopic omentectomy. The average hospital length of stay was 3.4 days with no significant morbidity or mortality. CONCLUSION Omental infarction generally presents with nonspecific clinical signs often masquerading as other more common abdominal diagnosis like cholecystitis or appendicitis. A trial of conservative management initially coupled with appropriate imaging should be recommended within the first 24-48 h before considering surgical treatment in refractory cases.
Collapse
Affiliation(s)
- Jason Diab
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia. .,School of Medicine, University of Sydney, Sydney, Australia. .,School of Medicine, University of Notre Dame, Sydney, Australia.
| | - Sarit Badiani
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Christophe R Berney
- Bankstown-Lidcombe Hospital, Eldridge Rd, Bankstown, NSW, 2200, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
9
|
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.
Collapse
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;
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Fatty-falciform ligament appendage torsion (F-FLAT): Diagnosis and management in a pediatric patient. Radiol Case Rep 2020; 15:181-185. [PMID: 31890064 PMCID: PMC6923463 DOI: 10.1016/j.radcr.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022] Open
Abstract
Fatty-falciform ligament appendage torsion (F-FLAT) is a rare condition manifested by torsion of the extraperiotoneal fat within the falciform ligament. It is similar to intraperitoneal focal fatty infarctions, including omental infarction and epiploic appendagitis. We report herein the first case of F-FLAT in a pediatric patient that failed conservative management. Ultrasound and CT scan facilitated prompt diagnosis of this rare finding and expedited a quick trial of conservative management. Despite conservative treatment, symptoms persisted for 4 weeks, but resolved after laparoscopic single-site surgical resection. In this report, we discuss the clinical features, key radiographic findings, and treatment options for this unique condition. This is only the third reported pediatric case of F-FLAT in the literature, and the first pediatric case to require surgical resection.
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
|
15
|
Abstract
Primary omental torsion is a rare cause of acute abdominal pain with a clinical presentation resembling acute appendicitis. Here, we report the case of a 7-year-old child presenting with right lower quadrant pain. Primary omental torsion was discovered upon laparoscopy, and the torsed omentum was excised without postoperative complications. Potential causes, contributing factors, diagnosis, and treatment are discussed.
Collapse
|
16
|
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
|
17
|
Idrissa S, Oukhouya MA, Tazi M, Mahmoudi A, Elmadi A, Khattala K, Bouabdallah Y. Unusual cause of acute scrotum in children: a case report. J Surg Case Rep 2017; 2017:rjx172. [PMID: 28928927 PMCID: PMC5597894 DOI: 10.1093/jscr/rjx172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/01/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
A 13-year-old boy was presented in the pediatric emergency with a 2-week history of swelling of the right scrotal contents of simple evolution, which was worsened by the appearance of an acute scrotal pain 48 h prior to his consultation. The doppler ultrasound and computed tomography (CT) scan revealed an incarceration of the omentum in an inguinal hernia. Acute scrotal pain and swelling is a common reason for surgical consultation in the emergency department of children. However, omentum is a rare content of inguinal hernia in children and infarct is exceptional. It should be included in the differential diagnosis of an acute scrotum.
Collapse
Affiliation(s)
- Salahoudine Idrissa
- Department of Pediatric Surgery, University hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, BP 1893, Km 2.200, Sidi Harazem Road, Fez 30000, Morocco 246, Avenue Ibn el Khatib, Immeuble 46, Lotissement Ghazali, Quartier elAzhar, Fez, Morocco
| | - Mohamed Amine Oukhouya
- Department of Pediatric Surgery, University hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, BP 1893, Km 2.200, Sidi Harazem Road, Fez 30000, Morocco 246, Avenue Ibn el Khatib, Immeuble 46, Lotissement Ghazali, Quartier elAzhar, Fez, Morocco
| | - Mohamed Tazi
- Department of Pediatric Surgery, University hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, BP 1893, Km 2.200, Sidi Harazem Road, Fez 30000, Morocco 246, Avenue Ibn el Khatib, Immeuble 46, Lotissement Ghazali, Quartier elAzhar, Fez, Morocco
| | - Abdelhalim Mahmoudi
- Department of Pediatric Surgery, University hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, BP 1893, Km 2.200, Sidi Harazem Road, Fez 30000, Morocco 246, Avenue Ibn el Khatib, Immeuble 46, Lotissement Ghazali, Quartier elAzhar, Fez, Morocco
| | - Aziz Elmadi
- Department of Pediatric Surgery, University hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, BP 1893, Km 2.200, Sidi Harazem Road, Fez 30000, Morocco 246, Avenue Ibn el Khatib, Immeuble 46, Lotissement Ghazali, Quartier elAzhar, Fez, Morocco
| | - Khalid Khattala
- Department of Pediatric Surgery, University hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, BP 1893, Km 2.200, Sidi Harazem Road, Fez 30000, Morocco 246, Avenue Ibn el Khatib, Immeuble 46, Lotissement Ghazali, Quartier elAzhar, Fez, Morocco
| | - Youssef Bouabdallah
- Department of Pediatric Surgery, University hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, BP 1893, Km 2.200, Sidi Harazem Road, Fez 30000, Morocco 246, Avenue Ibn el Khatib, Immeuble 46, Lotissement Ghazali, Quartier elAzhar, Fez, Morocco
| |
Collapse
|
18
|
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.
Collapse
|
19
|
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.
Collapse
|
20
|
Abstract
Primary omental infarction (POI) is a rare cause of acute abdomen. Most patients have aggravating abdominal pain without gastrointestinal symptoms. Here, we report a case of omental infarction in a 50-year-old woman, who had left abdominal pain and intestinal obstruction. Preoperative computed tomography (CT) of the abdomen showed a left ovarian cyst measuring 6.0 cm × 4.5 cm but otherwise seemed normal initially. The white blood cell count was 9.71 × 109/L, and D-dimer was 1.58 mg/L. Laparoscopic exploration was performed 1 day after admission because of peritonitis and intestinal obstruction. During the exploration, a segment of congested necrotic omentum was found adhering to the abdominal wall with a segment of small intestine. Bloody ascites was also observed in the abdominal cavity. We resected the nonviable segmental omentum, and the ovarian cyst was removed by the gynecologist using laparoscopic procedures. Final pathological findings confirmed POI. While reanalyzing the preoperative CT, a segmental fat mass with an increased density was noted in the left lower quadrant, which was consistent with the intraoperative view 6 days after surgery. The patient recovered uneventfully and was discharged.
Collapse
Affiliation(s)
- Xiao-Wen Sun
- Department of General Surgery, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Bin Luo
- Department of General Surgery, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Hong-Wei Lin
- Department of General Surgery, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| |
Collapse
|
21
|
Watts A, Gupta SK. Swirling Fat. J Pediatr Gastroenterol Nutr 2016; 63:e204. [PMID: 25643022 DOI: 10.1097/mpg.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Abhishek Watts
- Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | | |
Collapse
|
22
|
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
| |
Collapse
|
23
|
Abstract
BACKGROUND Omental torsion is an infrequent cause of acute abdomen and its symptoms are non-specific, often presenting with pain at the right iliac fossa as the only symptom. Its aetiology remains unknown, but different risk factors have been associated with the disease, including obesity, congenital malformations, and tumours. These risk factors have been classified as predisposing or triggering, primary or secondary, and external or internal. CLINICAL CASE The is a case of a 24-year-old male who complained about pain in the right iliac fossa without any other symptoms. The diagnosis was acute appendicitis, but during the laparoscopic approach, omental torsion was found. CONCLUSION The diagnosis of omental torsion is is complex. However, computed tomography and ultrasound have been used successfully. The treatment for omental torsion is the resection of necrotised tissue by a laparoscopic approach.
Collapse
|
24
|
Pogorelić Z, Katić J, Gudelj K, Mrklić I, Vilović K, Perko Z. Unusual cause of acute abdomen in a child – torsion of greater omentum: report of two cases. Scott Med J 2015; 60:e1-e4. [PMID: 25838282 DOI: 10.1177/0036933015581129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction Torsion of the omentum is twisting along its long axis and a rare cause of acute abdomen. Depending on associated conditions, it is classified as primary and secondary. It may mimic different pathologies presenting as acute abdomen, most common of them being acute appendicitis. Current choice for management of omental torsion is laparoscopic surgery. Case presentation We present two cases of omental torsion of two boys who presented with abdominal pain, nausea and vomiting and underwent emergency laparoscopy. Conclusion Omental torsion is very rare, and its diagnosis is usually made only after surgery. At laparoscopy, omental torsion is suspected when the appendix is normal and the symptoms and findings of torsion are present. Laparoscopy is a safe and effective approach for the diagnosis and management of omental torsion, with the advantages of reduced postoperative pain and hospital stay.
Collapse
Affiliation(s)
- Zenon Pogorelić
- Attending Physician, Department of Pediatric Surgery, Split University Hospital Centre and Split University School of Medicine, Croatia
| | - Josip Katić
- Student, School of Medicine, University of Split, Croatia
| | - Karla Gudelj
- Student, School of Medicine, University of Split, Croatia
| | - Ivana Mrklić
- Attending Physician, Department of Pathology, Split University Hospital Centre and Split University School of Medicine, Croatia
| | - Katarina Vilović
- Attending Physician, Department of Pathology, Split University Hospital Centre and Split University School of Medicine, Croatia
| | - Zdravko Perko
- Chief Surgeon, Department of Surgery, Split University Hospital Centre and Split University School of Medicine, Croatia
| |
Collapse
|
25
|
|
26
|
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.
Collapse
|
27
|
Patel RV, Dawrant M, Scott V, Fisher R. Omental infarct in a hernia: an unusual cause of paediatric acute scrotum. BMJ Case Rep 2014; 2014:bcr-2014-203614. [PMID: 24632908 PMCID: PMC3962916 DOI: 10.1136/bcr-2014-203614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We report a case of paediatric acute scrotum due to segmental haemorrhagic infarct of the omentum secondary to strangulation in the left inguinal hernia in a toddler as initial presentation after hernia being noticed by mother once earlier. A 4-year-old boy with non-traumatic acute left scrotum who had a history of left inguinal swelling once earlier presented with massively swollen, painful and discoloured left hemiscrotum extending into the groin simulating acute testicular torsion. Interestingly, there was a segmental omental infarct which precipitated the emergency and had ipsilateral testicular ascent and atrophy as long-term sequelae. Strangulated segmental omental infarct is a rare cause of acute abdomen/scrotum in children. Omentum is a very rare content of inguinal hernia in a toddler and infarct is exceptional. The diagnosis is usually not established before surgery in children. It should be included in the differential diagnoses of acute scrotum, especially in patients with untreated inguinal hernia.
Collapse
Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Urology, Great Ormond Street Children Hospital NHS Trust, London, UK
| | - Michael Dawrant
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, UK
| | - Victoria Scott
- Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Brighton, UK
| | - Ross Fisher
- Department of Paediatric Surgery, Sheffield Children's Hospital, Sheffiled, UK
| |
Collapse
|
28
|
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]
|
29
|
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]
|
30
|
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.
Collapse
|
31
|
Roupakias S, Mitsakou P. Surgical morbidity in obese children. Asian J Surg 2012; 35:99-103. [DOI: 10.1016/j.asjsur.2012.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 04/18/2012] [Accepted: 05/31/2012] [Indexed: 12/22/2022] Open
|
32
|
Araújo JDAB, Martines JADS, Martines BMR, Lourenção RM, Pinto LEA, de Castro CC. Segmental omental infarction: an unusual cause of acute abdomen. AUTOPSY AND CASE REPORTS 2012; 2:43-47. [PMID: 31528571 PMCID: PMC6735552 DOI: 10.4322/acr.2012.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/03/2012] [Indexed: 11/23/2022] Open
Abstract
Omental infarction is a rare cause of acute abdominal pain, and the cause of omental infarction itself remains unknown. The diagnosis of omental infarction is occasionally made intra-operatively, because it is poorly known and presents no specific clinical features. Therefore omental infarction should always be considered in the differential diagnosis of abdominal inflammatory processes, mainly those affecting the right lower quadrant. The increasing use of computed tomography in cases of acute abdomen has facilitated the diagnosis of omental infarction in the pre-operative period. Here, we present the case of a 36-year-old, overweight female patient with clinical symptoms of acute abdomen. Computed tomography of the abdomen revealed indications of omental infarction. The patient was treated conservatively with analgesics and a nonsteroidal anti-inflammatory. The clinical evolution was favorable.
Collapse
Affiliation(s)
| | | | | | | | - Lorena Elaine Amorim Pinto
- Heart Institute - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Cláudio Campi de Castro
- Diagnostic Imaging Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil.,Department of Radiology - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
33
|
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]
|
34
|
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: 16] [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.
Collapse
|
35
|
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.
Collapse
|
36
|
The use of minimally invasive surgery in the management of idiopathic omental torsion: The diagnostic and therapeutic role of laparoscopy. Int J Surg Case Rep 2011; 2:125-7. [PMID: 22096703 DOI: 10.1016/j.ijscr.2011.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 02/24/2011] [Indexed: 11/23/2022] Open
Abstract
Omental torsion is an unusual and infrequently encountered cause of acute abdominal pain in adults. Computed tomography (CT) is a useful adjunct to clinical history and examination in establishing the diagnosis; however, definitive diagnosis is frequently established at the time of exploratory surgery. Treatment may be conservative or operative, with laparoscopic resection the surgical approach of choice. We report the case of a 60-year-old man who presented with a 3-day history of severe right-sided abdominal pain. Abdominal CT scan revealed a right upper quadrant mass with a whirl-like appearance, suspicious for omental infarction. Diagnostic laparoscopy was undertaken, the diagnosis confirmed and the diseased omentum resected. The patient was discharged the following day and made an uncomplicated recovery.
Collapse
|
37
|
Gosain A, Blakely M, Boulden T, Uffman JK, Seetharamaiah R, Huang E, Langham M, Eubanks JW. Omental Infarction: Preoperative Diagnosis and Laparoscopic Management in Children. J Laparoendosc Adv Surg Tech A 2010; 20:777-80. [PMID: 20704515 DOI: 10.1089/lap.2010.0204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee
| | - Martin Blakely
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee
| | - Thomas Boulden
- Division of Pediatric Radiology, Department of Radiology, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee
| | - John K. Uffman
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee
| | - Rupa Seetharamaiah
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee
| | - Eunice Huang
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee
| | - Max Langham
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee
| | - James W. Eubanks
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee
| |
Collapse
|
38
|
Conservative management of segmental infarction of the greater omentum: a case report and review of literature. Case Rep Med 2010; 2010. [PMID: 20886031 PMCID: PMC2945678 DOI: 10.1155/2010/765389] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 09/02/2010] [Indexed: 11/18/2022] Open
Abstract
Segmental omental infarction (SOI) is a rare cause of acute abdominal pain. Depending on the site of infarction, it mimics conditions like appendicitis, cholecystitis, and diverticulitis. Before the widespread use of Computed Tomography (CT), the diagnosis was usually made intraoperatively. SOI produces characteristic radiological appearances on CT scan; hence, correct diagnosis using this form of imaging may prevent unnecessary surgery. We present the case of a young woman who was treated conservatively after accurate radiological diagnosis.
Collapse
|
39
|
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%.
Collapse
|
40
|
Itenberg E, Mariadason J, Khersonsky J, Wallack M. Modern management of omental torsion and omental infarction: a surgeon's perspective. JOURNAL OF SURGICAL EDUCATION 2010; 67:44-47. [PMID: 20421090 DOI: 10.1016/j.jsurg.2010.01.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 01/19/2010] [Accepted: 01/25/2010] [Indexed: 05/29/2023]
Abstract
Omental infarction is a rare cause of acute abdomen that until recently was diagnosed only on exploratory surgery for presumed acute appendicitis or similar abdominal emergency. The increasing use of high-quality imaging, especially computerized tomography, in the diagnosis of appendicitis and the acute abdomen, has allowed preoperative diagnosis to be made much more often. Coupled with the increasing popularity of laparoscopic appendectomy, this finding has led to a spate of recent reports of omental infarction and omental torsion. It has also sparked a debate as to the best management of omental infarction, with strong support for both nonoperative management and definitive laparoscopic surgery. We present a case of omental torsion diagnosed preoperatively by the characteristic whirl sign and ultimately treated by laparoscopic surgery together with a brief review of the condition and our own recommendations.
Collapse
Affiliation(s)
- Edwin Itenberg
- Department of Surgery, Metropolitan Hospital Center, New York Medical College, New York, New York 10029, USA.
| | | | | | | |
Collapse
|
41
|
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.
Collapse
Affiliation(s)
- Ayelet Rimon
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
42
|
Nubi A, McBride W, Stringel G. Primary omental infarct: conservative vs operative management in the era of ultrasound, computerized tomography, and laparoscopy. J Pediatr Surg 2009; 44:953-6. [PMID: 19433177 DOI: 10.1016/j.jpedsurg.2009.01.032] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/15/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Primary omental infarct is a rare condition in children. The preoperative diagnosis can be accurately accomplished using ultrasound (US) and computerized tomography (CT). This study aimed to elucidate the efficacy of conservative vs operative management. METHODS Cases of omental infarction in children diagnosed preoperatively in our institution since laparoscopy became the standard of care were reviewed. RESULTS Ten cases of omental infarction in children were treated. There were 6 males and 4 females (age, 5-14 years). The diagnosis was made preoperatively by CT in all cases; in 2 cases, US was also diagnostic. Conservative nonoperative management was successful in 4 cases, and laparoscopic omentectomy and appendectomy done in the other 6. There was no mortality. All children recovered uneventfully. Average hospital stay was 4 days for patients treated nonoperatively. Average postoperative stay was 2 days for children treated with laparoscopy. Three patients initially treated conservatively had surgery because of intractable pain. The preoperative stay was 3 days in these patients. CONCLUSIONS Children with omental infarct can be treated conservatively, and a short trial period is warranted. The indications for surgery are uncertain diagnosis, intractable relentless pain, and persistent peritoneal findings. Children treated with laparoscopy have a shorter length of stay and decreased use of narcotics.
Collapse
Affiliation(s)
- Ayodeji Nubi
- Department of Surgery, Division of Pediatric Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA
| | | | | |
Collapse
|
43
|
Chan KW, Chow CS, Tam YH, Lee KH. Laparoscopy: an excellent tool in the management of primary omental torsion in children. J Laparoendosc Adv Surg Tech A 2008; 17:821-4. [PMID: 18158819 DOI: 10.1089/lap.2007.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Primary omental torsion (POT) is an uncommon acute condition, often occurring in obese children. The clinical presentation usually mimics that of acute appendicitis, and preoperative radiologic imaging may not be helpful in the diagnosis. In this paper, we report our experience of using laparoscopy in diagnosing and treating POT in children. MATERIALS AND METHODS A retrospective review of all cases of POT from 1998 to 2006 was performed. The efficacy and safety of using the laparoscope in the management of omental torsion was assessed. RESULTS There were 5 boys with a mean age of 8.8 years (range, 5-11) included in the study. The majority of the patients were overweight, and all presented with abdominal pain without other gastrointestinal symptoms. In all patients, there was marked localized tenderness at the right side but without rebound tenderness or guarding. Preoperative investigations did not help in the diagnosis in all cases. A laparoscopic examination was performed and, in all cases, the diagnosis of POT was accurately made. The omentum was either adherent to the anterior abdominal wall or to the ascending colon. In all cases, the twisted omentum was successfully removed by the laparoscopic technique. Rapid recovery was universally observed, with the disappearance of pain and a rapid resumption of diet and discharge from the hospital on the first postoperative day. Histology showed gangrenous omentum in all cases. All the patients were well and had good cosmetic results on the follow-up. CONCLUSIONS Laparoscopy is an excellent tool for both diagnosing and treating omental torsion in children.
Collapse
Affiliation(s)
- Kin Wai Chan
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
| | | | | | | |
Collapse
|
44
|
Agresta F, Bedin N. Primary Omental Infarction: Laparoscopic Approach in Two Pediatric Cases: A Case Review. J Laparoendosc Adv Surg Tech A 2007; 17:831-2. [DOI: 10.1089/lap.2006.0233] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Ospedale Civile, Vittorio Veneto (TV), Italy
| | - Natalino Bedin
- Department of General Surgery, Ospedale Civile, Vittorio Veneto (TV), Italy
| |
Collapse
|
45
|
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.
Collapse
Affiliation(s)
- George Mavridis
- 2nd Surgical Department, Aghia Sophia Children's Hospital of Athens, 79 Alevizatou Str, 15669, Papagou, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
|
47
|
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.
Collapse
Affiliation(s)
- Ana Catarina Fragoso
- Division of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. João, 4200-319 Porto, Portugal
| | | | | |
Collapse
|
48
|
Sung T, Callahan MJ, Taylor GA. Clinical and imaging mimickers of acute appendicitis in the pediatric population. AJR Am J Roentgenol 2006; 186:67-74. [PMID: 16357381 DOI: 10.2214/ajr.04.1380] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to present the imaging appearance of common mimickers of appendicitis in children with right lower quadrant pain. CONCLUSION The majority of children who undergo imaging for suspected appendicitis will end up having an alternative diagnosis. These mimickers can be gastrointestinal, genitourinary, or pulmonary. Familiarity with these alternative diagnoses can aid in the challenging task of imaging right lower quadrant pain in the pediatric population.
Collapse
Affiliation(s)
- Tammy Sung
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | | | | |
Collapse
|
49
|
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.
Collapse
Affiliation(s)
- Bruno Coulier
- Department of Diagnostic Radiology, Clinique St. Luc, Rue St. Luc 8, 5004 Bouge, Belgium.
| |
Collapse
|
50
|
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.
Collapse
Affiliation(s)
- May Han Loh
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore 229 899, Singapore.
| | | | | | | | | |
Collapse
|