Omental infarction: a case of a whole omental infarct

Ong, Wei Ming; Matheson, Julia; Chandra, Raaj; Stella, Damien

doi:10.1111/ans.13215

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…In more complex patients, such as obese children where USG may be technically difficult or patients presenting with left-sided abdominal pain, CT scan will help the diagnosis. Typical CT findings of a subsegmental OI include a clear demarcation between normal and aberrant omental fat with great attenuation of the latter, a mesenteric vascular swirl sign indicative of torsion with surrounding fat stranding, a slight thickening of the visceral peritoneum and a mass effect on the neighbouring intra-abdominal structures without bowel abnormalities 13…”

Section: Discussionmentioning

confidence: 99%

“…Accurate diagnosis of OI by CT scanning has reduced the need for diagnostic laparoscopy, and the great majority of patients have recovered without surgery 7 13. Although CT is the diagnostic gold standard, early use of USG is a good approach for identifying OI in children, saving patients from needless surgery or ionising radiation exposure 11…”

Section: Discussionmentioning

confidence: 99%

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Omental infarction in an overweight child: conservative treatment is a safe approach

Aralihond,

Aniapravan,

Abdelgadir

et al. 2023

BMJ Case Rep

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A previously healthy but overweight (body mass index (BMI) of 24.4) adolescent boy presented with fever and significant right-sided abdominal pain. An abdominal ultrasound scan revealed an omental infarction (OI), which was treated conservatively. OI has been described in overweight teenage children with abdominal trauma but can be missed if not considered. A missed diagnosis could result in an unnecessary laparotomy or laparoscopic surgery. Although CT is the gold standard for diagnosis, ultrasonography is an effective approach to identifying OI in children. The benefits of early diagnosis of OI by abdominal ultrasound include a shorter hospital stay and a reduction in unnecessary investigations and surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Omental infarction in an overweight child: conservative treatment is a safe approach

Aralihond,

Aniapravan,

Abdelgadir

et al. 2023

BMJ Case Rep

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show abstract

“…Balthazar et al have reported a case of left-sided omental torsion leading to infarction and abscess formation that needed open surgical debridement [11]. Infarction of the whole omentum has also been documented in the 27-year-old male patient secondary to torsion around right inguinal hernia [12]. He was successfully managed conservatively.…”

Section: Discussionmentioning

confidence: 99%

Omental Infarction Imitating Acute Appendicitis

Gaba

Gupta

2020

Cureus

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A 26-year-old male patient with no significant past history presented with a two-day illness of nausea and abdominal pain, mimicking acute appendicitis. The appendix was poorly visualized on the ultrasound scan so a CT scan was done which revealed infarction of the omentum on the right side of the abdomen. The patient was closely monitored and managed conservatively with analgesics, fluids and antibiotics. Spontaneous improvement occurred in a day, and oral feeding was resumed. The clinical course was uncomplicated, and the patient was discharged, circumventing unnecessary surgery. Literature search has revealed that omental infarction is a rare cause of acute abdomen and it can mimic acute appendicitis or cholecystitis. The treatment needs to be individualized, and surgery may or may not be required.

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Re: Omental infarction: a case of a whole omental infarct

McCusker

Goh

2018

ANZ Journal of Surgery

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Re: Omental infarction: a case of a whole omental infarctWe note with interest the recent publication of a case report by Ong et al. 1 describing a 27-year-old man with an omental infarction. We have recently published a series of 30 cases of children with omental infarction, where the diagnosis was made on ultrasound, and hope to add to this described case. To our knowledge, ours is the largest case series of omental infarction in children in the literature. 2 We identified 30 children who presented to our hospital over a 10-year period, ranging from 3 to 17 years of age. Obesity appears to be a critical factor in the pathogenesis, with 36.6% of patients having a weight-for-age Z-score of greater than 2, 83.3% were heavier than the mean for their age, and only one patient (3.3%) was significantly underweight.Gastrointestinal symptoms were common in our series, in contrast to previous literature, with 70% of patients describing anorexia, 53.3% suffering nausea, 26.6% having at least one vomit and 23.3% with at least one episode of diarrhoea. Pain was most often right sided (86%). Only 36.6% of our patients had a temperature greater than 37.5 C, which is also in contrast to the 'typical' presentation described by Ong et al. and other series. Laboratory markers were not helpful, with 56.7 and 36.6% of patients having an elevated CRP and white cell count, respectively.Omental infarction was diagnosed in every case on ultrasound, either in the initial scan or in a repeat ultrasound at least 24 h later. In 18 of the 30 cases, an appendix was identified, ruling out appendicitis. Only one patient underwent a CT scan to aid in confirming the diagnosis.In our series, 17 cases were managed operatively, and 13 managed with analgesia alone. The conservatively managed group had a shorter length of stay than the operative group, but four patients were readmitted for further analgesia. There were no serious complications in either group. Most significantly, we did not identify any cases of incorrect diagnosis of omental infarction on ultrasound, or missed appendicitis. If the diagnosis is made with confidence, it is safe to manage non-operatively. Although CT is considered the gold standard for diagnosis, we believe that ultrasound is a useful tool in the diagnosis of omental infarction in children, thereby sparing patients from unnecessary surgery or ionizing radiation.

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Omental infarction: a case of a whole omental infarct

Cited by 3 publications

References 8 publications

Omental infarction in an overweight child: conservative treatment is a safe approach

Omental infarction in an overweight child: conservative treatment is a safe approach

Omental Infarction Imitating Acute Appendicitis

Re: Omental infarction: a case of a whole omental infarct

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