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[Primary torsion of the greater omentum]
R Escartín Villacampa1, J Elías Pollina, J A Esteban Ibarz
1Servicio de Cirugía Pediátrica. Hospital Infantil Universitario Miguel Servet. Zaragoza. ricardoescartin@ctv.es
Insights
Primary omental torsion is a rare cause of acute abdomen in children, often misdiagnosed as appendicitis. Early surgical intervention leads to satisfactory outcomes for this condition.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Context:
- Acute abdomen in children presents diagnostic challenges.
- Omental torsion is an uncommon but significant cause of pediatric abdominal pain.
Purpose:
- To determine the prevalence and clinical characteristics of omental torsion in children.
- To analyze diagnostic and therapeutic aspects of childhood omental torsion.
Summary:
- A 25-year retrospective review of 15 pediatric surgical cases of omental torsion.
- Clinical presentation often mimics acute appendicitis, with key differences in symptom duration, temperature, and white blood cell count.
- Primary torsion accounted for 13 cases; secondary torsion was associated with inguinal hernia and cystic lymphangioma.
- Surgical treatment resulted in satisfactory patient outcomes.
Impact:
- Highlights the importance of considering omental torsion in pediatric acute abdomen differential diagnoses.
- Suggests that clinical features, while similar to appendicitis, may offer diagnostic clues.
- Emphasizes the need for prompt surgical evaluation and treatment for favorable prognoses.
Objective:
Primary torsion of the greater omentum is an infrequent cause of acute abdomen in children. A retrospective review was conducted to establish the prevalence and clinical features of omental torsion as a cause of acute abdominal pain in childhood.
Patients And Methods:
We reviewed the clinical histories of the children given surgical treatment for torsion of the greater omentum in our hospital in the last 25 years. The following data were studied: age at presentation, sex, predisposing factors, symptomatology, complementary investigations, treatment and evolution.
Results:
The male:female ratio among the 15 patients who underwent surgery was 2:1. Symptomology was similar to that of acute appendicitis with certain peculiarities such as a longer period of evolution at the moment of diagnosis, lower temperature and leucocytosis lower than would be expected in appendicitis at the same time of evolution and, in 12 patients, absence of vomiting. After surgical treatment evolution was satisfactory. Torsion was primary in 13 patients, secondary to inguinal hernia in 1 and secondary to cystic lymphangioma of the omentum in 1. The etiology and pathogenesis, as well as the diagnostic and therapeutic problems of this process, are discussed.
Conclusions:
In all the patients with primary torsion the clinical diagnosis was of acute appendicitis. Although primary torsion is classically associated with obesity, only 1 of the 13 patients weighed significantly more than the average for the same age and sex in our region and none of the patients showed a clearly associated anatomic malformation.