Omental infarction—a mimicker of acute appendicitis in children

Abstract

Purpose The aim of this study was to review the presenting features of pediatric patients found to have omental infarction with a normal appendix at surgery. Methods A retrospective review was conducted of all patients with surgically proven omental infarction treated at KK Women's and Children's Hospital between May 1997 and January 2004. Results Twelve children (10 boys and 2 girls) were treated for primary omental infarction. The mean age was 9.0 ± 1.42 years. The mean weight was 41.3 ± 9.65 kg, with 6 (50%) above the 97th percentile and the remainder were between the 50th and 97th percentile. All 12 children presented with right-sided abdominal pain. At presentation, 9 had low-grade fever of 37.3°C or higher, with the maximum temperature recorded at 37.9°C. The mean total white blood cell count was 13.3 ± 2.66. Significant neutrophilia (relative percentage, >70%; absolute neutrophils, >8000) was noted in 9 children. Eight children underwent radiological imaging, which included ultrasonography (n = 3) and/or computed tomography (CT) (n = 7) of the abdomen. Preoperative diagnosis was made on 4 CT scans. Surgical resection resulted in immediate resolution of symptoms. Conclusion Omental infarction often mimics acute appendicitis preoperatively, although CT may be diagnostic. Surgical resection of the affected omentum expedites clinical recovery.