Primary omental torsion in children: ten-year experience

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.

Omental Infarction: a Reappraisal of Conservative Management in Children

“…A clinical picture of 'atypical appendicitis' in a well-being obese child should lead to consider this diagnosis; a palpable mass in the right quadrant strongly suggests OI but it is an infrequent finding. 2,6,11,13,14 Laboratory exams are unremarkable; as we found, WBC count and C-RP are usually within normal range or lightly elevated. The widespread availability and use of high-quality imaging techniques in the setting of acute abdominal pain has been the main reason for increasing and confident diagnosis.…”

A Rare eth�ology of acute abdomen syndrome �n ch�ldhood: Pr�mary Tors�on of the Greater Omentum � A Case Report

“…Lökositoz genellikle görülmektedir. 2 Bizim hastamızda lökositoz mevcuttu ve ağrısı sağ alt kadrandaydı. Primer omentum torsiyonu tanısı genellikle tanısı laparoskopi veya laparatomi sırasında koyulmaktadır.…”

Caso Clinico Radiologico Para Diagnostico

“…Respecto del manejo del infarto segmentario del omento mayor, la mayoría de la literatura radiológica lo describe como un cuadro benigno, autolimitado y susceptible de manejo conservador (1,9) . Algunas publicaciones recientes recomiendan cirugía laparoscópica, que permitiría disminuir la duración del dolor y posibles complicaciones, como abscedación del infarto (7,10) .…”

“…Los hallazgos quirúrgicos descritos en la literatura incluyen un omento mayor congestivo y hemorrágico, líquido libre serosanguinolento intraperitoneal y apéndice normal (10) .…”