Omental infarction--a mimicker of acute appendicitis in children

The aim of this study was to review the presenting features of pediatric patients found to have omental infarction with a normal appendix at surgery.

A retrospective review was conducted of all patients with surgically proven omental infarction treated at KK Women's and Children's Hospital between May 1997 and January 2004.

Twelve children (10 boys and 2 girls) were treated for primary omental infarction. The mean age was 9.0 +/- 1.42 years. The mean weight was 41.3 +/- 9.65 kg, with 6 (50%) above the 97th percentile and the remainder were between the 50th and 97th percentile. All 12 children presented with right-sided abdominal pain. At presentation, 9 had low-grade fever of 37.3 degrees C or higher, with the maximum temperature recorded at 37.9 degrees C. The mean total white blood cell count was 13.3 +/- 2.66. Significant neutrophilia (relative percentage, > 70%; absolute neutrophils, > 8000) was noted in 9 children. Eight children underwent radiological imaging, which included ultrasonography (n = 3) and/or computed tomography (CT) (n = 7) of the abdomen. Preoperative diagnosis was made on 4 CT scans. Surgical resection resulted in immediate resolution of symptoms.

Omental infarction often mimics acute appendicitis preoperatively, although CT may be diagnostic. Surgical resection of the affected omentum expedites clinical recovery.