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[Primary surgical pathology of the epiploon]
J M Angulo1, I Ruiz, A Villanueva
1Servicio de Cirugía Pediátrica, Hospital Materno-Infantil Ntra. Sra. de Aránzazu, San Sebastián.
Insights
Primary omental pathology in children is rare, often misdiagnosed as appendicitis. Surgical findings reveal diverse conditions including infarctions, epiploitis, and cystic lesions.
Area of Science:
- Pediatric Surgery
- Abdominal Pathology
Background:
- Primary omental pathology is an uncommon condition in pediatric patients.
- This study reviews surgical cases of primary omental pathology over nine years.
Observation:
- Ten children (8 males, 2 females) aged 5-11 years, plus one newborn with lymphangioma, underwent surgery for omental pathology.
- Patients presented with acute abdominal pain and right iliac tenderness, leukocytosis, and left shift.
- Initial diagnosis was acute appendicitis in all cases; omental masses were not preoperatively palpable.
Findings:
- Surgical findings included omental segmental infarctions (3), segmental epiploitis (3), cystic lesions (2 - lymphangioma, hydatid cyst), and one benign tumor (fibromatosis).
- Free intraperitoneal fluid (bloody, clear, or purulent) was noted in six operations.
- One patient experienced a recurrent acute clinical picture one year post-operation, with the omental mass identified preoperatively.
Implications:
- Highlights the challenge of diagnosing primary omental pathology in children, often mimicking appendicitis.
- Emphasizes the need for considering omental pathology in pediatric abdominal emergencies.
- Surgical intervention is crucial for accurate diagnosis and management of diverse omental conditions.
Abstract:
In the last nine years we have operated upon six children (eight males and two females) with primary omental pathology. The age of our patients ranged from five to eleven years with the exception of a newborn prenatally diagnosed of lymphangioma. All the remaining children had abdominal pain and right iliac tenderness for an average of two days. All had leukocytosis and left shift. Vomiting and fever were present only in one instance. In no case the mass was palpated preoperatively. The initial diagnosis was acute appendicitis in all cases. A patient suffered, one year after operation, a second acute clinical picture and the omental mass could be revealed [correction of decealed] preoperatively. At operation there was free intraperitoneal fluid in six instances (three times bloody, two times clear and one purulent). Surgical findings (nine operations) were: three omental segmental infarctions (primary in two cases and secondary to torsion in one), three segmental epiploitis in two patients (one acute, one chronic, one secondary to foreign body), two cystic lesions (one lymphangioma, one hydatic cyst) and one benign tumor (fibromatosis).