Omental Infarction in a Child—Conservative Management as an Effective and Safe Strategy in Diagnosis and Treatment

Abstract

Omental infarction (OI) is a rare disease occurring in children. Important risk factors include overweight and obesity. The clinical presentation is often non-specific, and the main symptom is acute abdominal pain. In addition, infarcted omentum may present with fever, anorexia, nausea, vomiting, diarrhea and dysuria. Due to the localisation of the pain, OI should be differentiated from acute appendicitis. The diagnosis of OI is sometimes made intraoperatively, during appendectomy for suspected acute appendicitis. Hence, it is important to state a correct preoperative diagnosis, which is commonly based on abdominal ultrasound and computed tomography. The treatment of OI is still inconclusive. Both conservative and surgical treatments are used. Both methods have their advantages and disadvantages. The decision of which treatment to follow should be multifactorial and include the patient’s clinical condition at the time of admission, the progression or regression of symptoms during hospitalization and laboratory and imaging findings. We present a clinical case of a 9-year-old overweight girl with OI, whose diagnosis was based on imaging diagnostics and enabled conservative treatment with no complications. The case we have described confirms that the conservative treatment is an effective and safe therapy.

Omental infarction diagnosed by computed tomography, missed with ultrasonography: A case report

“…Abdominal pain is a common cause of emergency department visits and appendicitis is the most common cause of abdomen surgery in children[ 2 ]. OI was reported in about 0.1% to 0.5% of children undergoing surgery for appendicitis[ 3 ]. Therefore, it is common for many doctors to initially suspect OI as appendicitis or other diseases, and many cases have been diagnosed intraoperatively[ 2 ].…”

“…Therefore, it is common for many doctors to initially suspect OI as appendicitis or other diseases, and many cases have been diagnosed intraoperatively[ 2 ]. Currently, because of advances in imaging technologies, the number of cases diagnosed by abdominal ultrasound and computed tomography (CT), rather than surgery, is increasing[ 3 - 5 ]. Although abdominal ultrasound and CT have high accuracy, CT has higher sensitivity for OI diagnosis[ 6 ].…”

Omental infarction and anterior wall adhesion presenting as surgical abdomen in a pediatric patient

“… 1 It occurs in 0.1%–0.5% of children undergoing surgery for suspected appendicitis. 2 Omental infarction is caused by two main pathological mechanisms: either secondary to vascular pedicle torsion on its own axis, or due to hypercoagulable states. One third of torsion cases can be idiopathic, with two thirds being due to the presence of intra‐abdominal pathology causing distal anchorage of the omentum.…”

“…Omental infarction is an uncommon cause of acute abdomen often mimicking the presentation of acute appendicitis in the pediatric population 1 . It occurs in 0.1%–0.5% of children undergoing surgery for suspected appendicitis 2 . Omental infarction is caused by two main pathological mechanisms: either secondary to vascular pedicle torsion on its own axis, or due to hypercoagulable states.…”

Omental infarction and anterior wall adhesion presenting as surgical abdomen in a paediatric patient.

“…Omental infarction is an uncommon cause of acute abdomen often mimicking the presentation of acute appendicitis in the pediatric population 1 . It occurs in 0.1% to 0.5% of children undergoing surgery for suspected appendicitis 2 . Omental infarction is caused by two main pathological mechanisms either secondary to vascular pedicle torsion on its own axis or hypercoagulable states.…”