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Nikolovski A, Lazarova A, Mojsilovic D, Ristovski G, Argirov I, Ulusoy C. Spontaneous omental infarction in an obese young female patient treated with laparoscopy: a case report. J Surg Case Rep 2024; 2024:rjae392. [PMID: 38832056 PMCID: PMC11146213 DOI: 10.1093/jscr/rjae392] [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: 03/11/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
Partial infarction of the great omentum is a rare cause of abdominal pain and may present as a surgical emergency. Omental infarction might occur due to its torsion, but cases without obvious cause are reported. Risk factors related to this condition are overweight, obesity, abdominal trauma, recent abdominal surgery, hypercoagulability, postprandial vascular congestion and an increase in intra-abdominal pressure. Because of the condition's rarity, most patients are treated with surgery and the diagnosis is established intraoperatively. Preoperative diagnosis allows successful conservative treatment with analgesics and anti-inflammatory drugs. This case reports a young female patient with class III obesity presented with spontaneous partial infarction of the great omentum treated with laparoscopy.
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Affiliation(s)
- Andrej Nikolovski
- Department of Visceral Surgery. University Surgery Hospital “St. Naum Ohridski”, 1000 Skopje, North Macedonia
- Medical Faculty in Skopje, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, North Macedonia
| | - Ana Lazarova
- Department of Radiology, University Surgery Hospital “St. Naum Ohridski”, 1000 Skopje, North Macedonia
| | - Dino Mojsilovic
- Department of Radiology, University Surgery Hospital “St. Naum Ohridski”, 1000 Skopje, North Macedonia
| | - Gligor Ristovski
- Medical Faculty in Skopje, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, North Macedonia
- Institute of Pathology, Medical Faculty in Skopje, 1000 Skopje, North Macedonia
| | - Ivan Argirov
- Department of General Surgery, General Hospital Kumanovo, 1300 Kumanovo, North Macedonia
| | - Cemal Ulusoy
- Department of General Surgery, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, 34384 Şişli/Istanbul, Turkey
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Hwang JK, Cho YJ, Kang BS, Min KW, Cho YS, Kim YJ, Lee KS. Omental infarction diagnosed by computed tomography, missed with ultrasonography: A case report. World J Clin Cases 2023; 11:972-978. [PMID: 36818623 PMCID: PMC9928693 DOI: 10.12998/wjcc.v11.i4.972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Omental infarction (OI) is a surgical abdominal disease that is not common in adults and is very rare in children. Similar to various acute abdominal pain diseases including appendicitis, diagnosis was previously achieved by diagnostic laparotomy but more recently, ultrasonography or computed tomography (CT) examination has been used.
CASE SUMMARY A 6-year-old healthy boy with no specific medical history visited the emergency room with right lower abdominal pain. He underwent abdominal ultrasonography by a radiologist to rule out acute appendicitis. He was discharged with no significant sonographic finding and symptom relief. However, the symptoms persisted for 2 more days and an outpatient visit was made. An outpatient abdominal CT was used to make a diagnosis of OI. After laparoscopic operation, his symptoms resolved.
CONCLUSION In children’s acute abdominal pain, imaging studies should be performed for appendicitis and OI.
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Affiliation(s)
- Jae Kyoon Hwang
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Yu Jeong Cho
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Kyueng-Whan Min
- Department of Pathology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Young Seo Cho
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, South Korea
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si 11923, Gyeonggi-do, South Korea
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Wang Y, Huang R, Li C, Li W. Acute abdomen caused by torsion of the omentum: A pediatric case report. Medicine (Baltimore) 2022; 101:e29184. [PMID: 35475804 PMCID: PMC9276294 DOI: 10.1097/md.0000000000029184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/09/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Torsion of the omentum and infarction are rare and unusual disorders that often present as acute abdominal pain in the population. The diagnosis of omental torsion is based on clinical and imaging examinations. PATIENT CONCERNS A 7-year-old girl presented with acute right lower quadrant abdominal pain, with symptoms resembling acute appendicitis. DIAGNOSIS The patient was diagnosed with omental torsion based on imaging and laparoscopy. INTERVENTIONS Laparoscopic exploration was performed. OUTCOMES The patient was discharged seven days after satisfactory postoperative recovery. LESSONS Omental torsion should be included in the differential diagnosis of acute abdominal pain, particularly in patients with free hemorrhagic fluid in the abdominal cavity and pelvis.
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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: 0.5] [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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Laparoscopic Management of Primary Omental Torsion. Case Rep Surg 2021; 2021:5536178. [PMID: 33708451 PMCID: PMC7932802 DOI: 10.1155/2021/5536178] [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: 01/12/2021] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/18/2022] Open
Abstract
Primary omental torsion is an unusual condition, known for its rarity and for the particularity of being intraoperatively diagnosed, in nearly all cases. At the clinical evaluation, this pathology commonly mimics other etiologies of acute abdomen. Hemoperitoneum and necrosis of the omentum are rarely associated with the omental torsion, but when the association is found, then it means that the vascular injuries are irreversible and the required surgical procedure may be far more complex than simple devolvulus. In search of the treatment of choice, laparoscopy proved its effectiveness as a diagnostic and therapeutic tool, while the open surgery approach can be described in many cases as being too invasive. A 37-year-old female patient presented with the generic symptoms of acute appendicitis. Surgical treatment was initiated. During laparoscopy, the abdomen was attentively explored, highlighting the presence of a twisted omentum with hemoperitoneum and necrosis. Omental excision and peritoneal drainage were performed. The evolution was favorable. Another check-up was done at 6 months postoperatively, displaying no signs or symptoms of relapse.
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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: 0.5] [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, 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: 0.8] [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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Yang Q, Gao Y. Incarcerated recurrent inguinal hernia as a cause of secondary torsion of the greater omentum: a rare case report and literature review. J Int Med Res 2019; 47:5867-5872. [PMID: 31578894 PMCID: PMC6862910 DOI: 10.1177/0300060519878372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Torsion of the greater omentum is a rare condition with a low incidence. However, secondary torsion of the greater omentum caused by an incarcerated recurrent inguinal hernia is extremely rare. Such torsion is fairly difficult to diagnose preoperatively because the symptoms are not typical and can mimic those of other causes of acute abdominal disease. If only the incarcerated inguinal hernia is treated, associated torsion of the greater omentum may be missed. We herein report a case of secondary torsion of the greater omentum caused by an incarcerated recurrent inguinal hernia. Exploratory laparotomy was performed because the preoperative computed tomography findings suggested torsion of the greater omentum. The diagnosis of torsion of the greater omentum was confirmed intraoperatively. The patient developed no recurrence throughout the 5-year follow-up.
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Affiliation(s)
- Qian Yang
- Department of General Surgery, Chongqing Emergency Medical Center (Central Hospital of Chongqing University), Chongqing, China
| | - Yunhan Gao
- Department of General Surgery, Chongqing Emergency Medical Center (Central Hospital of Chongqing University), Chongqing, China
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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: 2.1] [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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Garcia‐Pertierra S, Catala Puyol C, Vizcaino Reves N, Closa JM. Omental torsion in a dog. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2017-000564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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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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Acute Abdomen due to Primary Omental Torsion and Infarction. Case Rep Surg 2014; 2014:208382. [PMID: 25431726 PMCID: PMC4241260 DOI: 10.1155/2014/208382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/08/2014] [Indexed: 12/29/2022] Open
Abstract
Background. Torsion of greater omentum is a quite uncommon cause of acute abdomen. It can be primary or secondary but in both cases omentum twists upon itself and causes omental segmentary or diffuse necrosis. Symptoms are unspecific and preoperative diagnosis is difficult. The widespread and increasing use of computer tomography (CT) in differential diagnosis of acute abdomen can be useful for making a specific diagnosis. Objectives. This work aims to describe primary omental torsion in order to help avoid misdiagnosis, especially with acute appendicitis, which is eventually based solely on a physical examination. Case Report. We present a case of primary omental torsion in a young man and discuss contemporary methods in diagnosis and management of the condition. Conclusions. When a right diagnosis has been posed, possible treatments for omental torsion and necrosis are two: conservative or surgical. Conservative treatment had been rarely carried out because of frequent and important sequelae just like abdominal abscesses. Nowadays, surgical treatment, laparoscopic or laparotomic, is preferred because it is a safe method in diagnosis and management of this condition.
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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:bcr2014203614. [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] [Accepted: 02/18/2014] [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.
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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
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15
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Omental infarction complicated by internal hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2013.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Quigley AJ, Stafrace S. Ultrasound assessment of acute appendicitis in paediatric patients: methodology and pictorial overview of findings seen. Insights Imaging 2013; 4:741-51. [PMID: 23996381 PMCID: PMC3846936 DOI: 10.1007/s13244-013-0275-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/04/2013] [Accepted: 07/10/2013] [Indexed: 12/27/2022] Open
Abstract
Acute appendicitis is a common surgical emergency in the paediatric population. Computed tomography (CT) has been shown to have high accuracy and low operator dependence in the diagnosis of appendicitis. However, with increased concerns regarding CT usage in children, ultrasound (US) is the imaging modality of choice in patients where appendicitis is suspected. This review describes and illustrates the step-wise graded-compression technique for the visualisation of the appendix, the normal and pathological appearances of the appendix, as well as the imaging characteristics of the common differentials. • A step-wise technique improves the chances of visualisation of the appendix. • There are often several causes for the non-visualisation of the appendix in children. • A pathological appendix has characteristic US signs, with several secondary features also identified. • There are multiple common differentials to consider in the paediatric patient.
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Affiliation(s)
- Alan J. Quigley
- NHS Grampian, In-Patient Radiology Department, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN UK
| | - Samuel Stafrace
- NHS Grampian, Radiology Department, Royal Aberdeen Children’s Hospital, Aberdeen, AB25 2ZG UK
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Aguilar-García J, Alcaide-León P, Vargas-Serrano B. Necrosis grasa intraabdominal. RADIOLOGIA 2012; 54:449-56. [DOI: 10.1016/j.rx.2011.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 12/27/2022]
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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: 4.0] [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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Ubeda C, Vano E, Miranda P, Leyton F, Martinez LC, Oyarzun C. Radiation dose and image quality for paediatric interventional cardiology systems. A national survey in Chile. RADIATION PROTECTION DOSIMETRY 2011; 147:429-438. [PMID: 21148589 DOI: 10.1093/rpd/ncq463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Radiation dose and image quality for paediatric protocols in all five X-ray fluoroscopy systems used for interventional cardiology procedures existing in Chile have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object (TO) and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-16 cm of PMMA). Images from fluoroscopy (low (FL), medium and high) and cine (CI) modes have been archived in DICOM format. Signal-to-noise ratio (SNR), figure of merit (FOM) and high-contrast spatial resolution (HCSR) have been computed from the images. The ratio between the maximum and the minimum value of ESAK per frame for a given fluoroscopy mode between the five systems ranges from 2 to 5 and from 14 to 38 for CI mode. SNR, FOM and HCSR showed a great variability for the different acquisition modes (AMs) and PMMA thickness. In the near future, it is urgent to upgrade Chilean legislation on radiation protection to incorporate quality assurance programmes that will allow us to evaluate and optimise the X-ray systems used in medical applications. Increments in doses per frame when increasing phantom thickness and when used CI runs instead of FL runs can be considered by the cardiologist in the good management of patient dose and allow them to select the best imaging AM during clinical procedures.
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Affiliation(s)
- Carlos Ubeda
- Clinical Sciences Department, Health Sciences Faculty and CIHDE, Tarapaca University, Arica, Chile.
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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
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21
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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.
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Yang YL, Huang YH, Tiao MM, Tang KS, Huang FC, Lee SY. Comparison of clinical characteristics and neutrophil values in omental infarction and acute appendicitis in children. Pediatr Neonatol 2010; 51:155-159. [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] [MESH Headings] [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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Affiliation(s)
- Ya-Ling Yang
- Department of Anesthesiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center and the Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taiwan
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23
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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: 3.7] [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.
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Affiliation(s)
- Edwin Itenberg
- Department of Surgery, Metropolitan Hospital Center, New York Medical College, New York, New York 10029, USA.
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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: 2.4] [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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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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