Abstract
Omental torsion is an underdiagnosed cause of acute abdomen in children. Most cases occur in adults, with only 15% presenting in children. It is estimated that omental infarct is found in approximately 0.1 to 0.5% of children undergoing operations for appendicitis. It may present with various signs and symptoms, although the clinical presentation usually mimics that of acute appendicitis. Definitive diagnosis is often established during surgery. We report a case of a 9-year-old boy who came to our attention for acute abdomen. We performed a laparoscopy-assisted procedure suspecting acute appendicitis. We therefore identified a secondary omental torsion associated with patency of the right inguinal duct and herniated omentum. Laparoscopy allowed a correct diagnosis and therapy.
Highlights
Omental torsion is a rare cause of acute abdomen
It is estimated that omental infarct is found in approximately 0.1 to 0.5% of children undergoing operations for appendicitis
We report the case of a male patient with secondary omental torsion diagnosed and treated through a laparoscopy-assisted procedure
Summary
It is due to a twist of the greater omentum around its axis leading to perfusion defects and vascular impairment and later to edema, ischemia, and gangrene.[1,2] Omental torsion can be either primary (idiopathic) or secondary.[3,4] This condition was first described in 1851.5 Since only a few cases have been reported in children,[1,2,3,4,5,6,7,8,9,10] and even fewer reported cases were associated with inguinal hernia. A 9-year-old boy came to our attention for a 24-hour history of lower and constant abdominal pain The involved omentum was first reduced and removed with the LigaSure (Covidien Italia S.p.A., Segrate - MI, Italy) (►Fig. 1) After this maneuver, a minimal patency of the inguinal duct was identified. The boy is doing well 3 months after surgery (►Fig. 1a–d)
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