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Primary omental torsion in children
D K Chew1, L O Holgersen, D Friedman
1Division of Pediatric Surgery, St Luke's-Roosevelt Hospital, New York, NY 10019, USA.
Insights
Primary omental torsion is a rare cause of acute abdominal pain, often mistaken for appendicitis. Obesity may be a predisposing factor in children, with surgical excision leading to full recovery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Abdominal Imaging
Background:
- Primary torsion of the omentum is an uncommon cause of acute abdomen.
- It frequently mimics acute appendicitis, leading to diagnostic challenges.
- Obesity is suggested as a potential predisposing factor.
Purpose of the Study:
- To report on cases of primary omental torsion in obese children.
- To highlight clinical features that may increase suspicion for this condition.
- To discuss diagnostic and management strategies.
Main Methods:
- Retrospective case review of four obese children diagnosed with primary omental torsion.
- Analysis of clinical presentation, diagnostic findings, and surgical outcomes.
- Intraoperative digital exploration through a muscle-splitting incision for diagnosis and management.
Main Results:
- Four cases of primary omental torsion in obese children are presented.
- Paucity of gastrointestinal symptoms, anorexia, nausea, and vomiting were noted.
- A relatively long duration of symptoms was observed in these cases.
- Diagnosis was confirmed intraoperatively in all cases.
- Excision of the torsed omentum through the surgical incision resulted in complete recovery.
Conclusions:
- Primary omental torsion is an unusual cause of acute abdomen in children.
- Obesity appears to be a significant predisposing factor.
- Increased clinical suspicion, considering atypical presentations and symptom duration, is crucial.
- Intraoperative diagnosis and surgical excision are effective management strategies.
Abstract:
Primary torsion of the omentum is an unusual cause of an acute abdomen and commonly mimics acute appendicitis. The following report of four obese children is supportive of obesity as a predisposing factor. The paucity of gastrointestinal symptoms, anorexia, nausea, vomiting, and the relatively long duration of symptoms, may increase the index of suspicion. In the majority of cases, the diagnosis is made intraoperatively by digital exploration through the muscle-splitting incision. The torsed omentum is easily delivered through the same incision, and excision results in complete recovery.