A Case Report of Idiopathic Omental Infarction in an Obese Child

Tomoyuki Tsunoda,Ayano Inui,Tomoo Fujisawa,Haruki Komatsu,Tsuyoshi Sogo

doi:10.1155/2012/513634

Abstract

Omental infarction (OI) is a rare cause of acute abdomen in children. A 9-year-old girl was presented with sudden-onset intermittent right lower quadrant abdominal pain and fever (37.9°C). Physical examination revealed abdominal tenderness in the right lower quadrant with localized rebound tenderness which resembled acute appendicitis. She was obese and her BMI was on the 99th percentile. Computed tomography (CT) revealed a 5 cm ill-defined heterogeneous fatty mass with hyperattenuating streaks just beneath the abdominal wall. She was diagnosed as OI and treated conservatively with reduced meals and antibiotics. Her symptom resolved gradually and she was discharged on day 7 without complications. OI should be considered as a differential diagnosis for acute right-sided abdominal pain, especially in obese children. Enhanced CT is useful for differentiating OI from other conditions presenting with acute abdomen.

Highlights

Omental infarction (OI) is a rare cause of acute abdomen in children
We encountered a girl with primary OI whose body mass index (BMI) was in the 99th percentile and discussed the risk of obesity and the diagnostic usefulness of computed tomography (CT)
Park et al [1] collected 43 cases of OI over 10 years and reported that the male-to-female ratio was 2.58 : 1, the mean age was 31.7 years, and 32.6% of the cases occurred in children aged under 15 years

Summary

Introduction

Omental infarction (OI) is a rare cause of acute abdomen in children. The symptoms of OI are similar to those of acute appendicitis and more than 90% of cases present with rightsided abdominal pain, making it indistinguishable without radiological examination [1, 2]. OI is classically categorized into primary and secondary cases. Secondary cases are related to surgery, hypercoagulopathy, or vasculitis. Primary cases are supposed to be caused by anomalous arterial supply to the omentum, kinking of veins associated with increased intraabdominal pressure, or vascular congestion after large meals [3]. One of the known risk factors for OI is obesity. We encountered a girl with primary OI whose body mass index (BMI) was in the 99th percentile and discussed the risk of obesity and the diagnostic usefulness of computed tomography (CT)

Case Presentation

Findings

Discussion