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Omental infarction: preoperative diagnosis and laparoscopic management in children
Ankush Gosain1, Martin Blakely, Thomas Boulden
1Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center , Le Bonheur Children's Medical Center, Memphis, Tennessee 38105, USA.
Insights
Omental infarction (OI) predominantly affects obese males and can be distinguished from appendicitis using preoperative assessments. Laparoscopic omentectomy effectively resolves symptoms and allows for prompt patient discharge.
Area of Science:
- Pediatric Surgery
- Abdominal Pain Management
- Surgical Pathology
Background:
- Omental infarction (OI) is an uncommon cause of pediatric abdominal pain, frequently misdiagnosed as appendicitis.
- Preoperative differentiation of OI from appendicitis is crucial for appropriate management.
Purpose of the Study:
- To review experience with pediatric omental infarction over a 5-year period.
- To identify preoperative factors aiding in the timely diagnosis and treatment of OI.
Main Methods:
- Retrospective review of medical records for children diagnosed with OI and treated with laparoscopic omentectomy.
- Analysis of patient demographics, clinical presentation, diagnostic imaging, and surgical outcomes.
Main Results:
- Ten pediatric patients (9 boys, 1 girl) with OI were identified, with a median age of 8.5 years.
- Obesity was prevalent (5/10 obese, 1/10 overweight).
- Right-sided abdominal pain (RUQ/RLQ) was the primary symptom; CT imaging correctly diagnosed OI in 90% of cases.
Conclusions:
- Omental infarction primarily affects obese preadolescent males but can occur in others.
- OI is distinguishable from appendicitis through comprehensive preoperative evaluation.
- Laparoscopic omentectomy provides rapid symptom relief and shortens hospital stays.
Background:
Omental infarction (OI) is an unusual, poorly characterized cause of abdominal pain in children and is often mistaken for appendicitis preoperatively. We present our experience with this disease process over a 5-year period to identify preoperative factors to aid in timely diagnosis and treatment.
Methods:
We retrospectively reviewed the medical records of all children that had OI and underwent laparoscopic omentectomy from November 2004 to June 2009.
Results:
Ten patients with the diagnosis of OI were identified. OI occurred in 9 boys and 1 girl, with a median age at presentation of 8.5 years (range, 7-11). Median body mass index at presentation was 23.7 (range, 17-29), with 1 child categorized as healthy weight for age, 1 child as overweight for age, and 5 children as obese for age, based on Centers for Disease Control and Prevention criteria. All patients complained of right-sided abdominal pain; 4 patients complained of predominantly right-upper quadrant (RUQ) pain, 3 patients of right-lower quadrant (RLQ) pain, and 3 of combined RUQ/RLQ pain. On examination, 6 patients had RUQ tenderness and 4 patients had RLQ tenderness. The median duration of symptoms prior to seeking medical attention was 3 days (range, 2-7). All patients underwent computed tomography and the preoperative diagnosis of OI was established in 9 of 10 cases. Operative time was 48 ± 14 minutes. All patients underwent resection of the infarcted omentum; 2 patients underwent concurrent appendectomy. Median length of stay was 2 days (range, 2-4).
Conclusions:
OI occurs predominantly, but not exclusively, in obese preadolescent males. OI can be reliably distinguished from appendicitis on preoperative history, physical examination, laboratory analysis, and imaging. Laparoscopic omentectomy results in prompt resolution of symptoms and discharge.
