Laparoscopy: An Excellent Tool in the Management of Primary Omental Torsion in Children

Abstract

Primary omental torsion (POT) is an uncommon acute condition, often occurring in obese children. The clinical presentation usually mimics that of acute appendicitis, and preoperative radiologic imaging may not be helpful in the diagnosis. In this paper, we report our experience of using laparoscopy in diagnosing and treating POT in children. A retrospective review of all cases of POT from 1998 to 2006 was performed. The efficacy and safety of using the laparoscope in the management of omental torsion was assessed. There were 5 boys with a mean age of 8.8 years (range, 5-11) included in the study. The majority of the patients were overweight, and all presented with abdominal pain without other gastrointestinal symptoms. In all patients, there was marked localized tenderness at the right side but without rebound tenderness or guarding. Preoperative investigations did not help in the diagnosis in all cases. A laparoscopic examination was performed and, in all cases, the diagnosis of POT was accurately made. The omentum was either adherent to the anterior abdominal wall or to the ascending colon. In all cases, the twisted omentum was successfully removed by the laparoscopic technique. Rapid recovery was universally observed, with the disappearance of pain and a rapid resumption of diet and discharge from the hospital on the first postoperative day. Histology showed gangrenous omentum in all cases. All the patients were well and had good cosmetic results on the follow-up. Laparoscopy is an excellent tool for both diagnosing and treating omental torsion in children.