Sudden Onset Of Abdominal Pain Research Articles

Hepatoblastoma: Multidiscplinary management and our experience

S 21 ANNUAL CONFERENCE—2013 H ep a to cllu la r C a cin o m a a 22% and 43% decrease in the QLQ-C30 score was observed in each group respectively. Conclusion: Nexavar administration has shown to improve the survival and quality of life in cirrhotic, stage AB, Greek patients with advanced HCC. Corresponding author: Dimitrios Dimitroulopoulos. E-mail: dimdim@otenet.gr HEPATOBLASTOMA: MULTIDISCPLINARY MANAGEMENT AND OUR EXPERIENCE Gururaj Deshpande, Sudhir Chandana, Sumit Kumar, Vijay Yadav, Sudhir Das Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India Introduction: Hepatoblastoma is the most common liver tumor in children and comprise of 79% of all liver tumor in children. Its incidence is 1.5 per million and it constitutes 1% of all paediatric malignancies. Surgical techniques and adjuvant chemotherapy have markedly improved the prognosis of children with Hepatoblastoma. Significant data now support a role for preoperative neoadjuvant chemotherapy if the tumor is inoperable or if the tumor is unlikely to achieve gross total resection at initial diagnosis. Liver is playing an increasing role in cases in which the tumor is deemed unresectable after chemotherapy is administered or in rescue transplantation when initial surgery and chemotherapy are not successful. Rarely hepatoblastoma has presented with rupture, hemoperitonuem and shock. We would also discuss about how we managed a case of ruptured hepatoblastoma. Method: This is a retrospective Study of 30 patients of hepatoblastoma at our centre in last 10 years from 2001-2011.Their presentation, prevalence, treatment offered surgical and medical, complications and follow up were analysed. Median age of presentation in our study was 38.3 month with M:F ratio of 1.72:1.Neoadjuvant chemotherapy was given in 26 out of 30 patients in the form of Cisplatin + Adriamycin and reassessment was done after 1-3 cycles. In case of inadequate response maximum of 6 cycles were given. Each Patient was assigned PRETEXT stage I-IV. Almost every patient received chemotherapy pre operatively &/or post operatively. After 3 cycles if the tumour was found inoperable a few more cycles are given maximum of 6 cycles and the patient was reviewed again. Follow up is completed up to October 2012 and results were analysed by Kaplan-Meier method. Patient with ruptured tumor with hemoperitonuem and shock was resuscitated and was taken up for emergency hepatic resection in the form of right hepatectomy. Results: Follow up varied from 6 months – 114 months with a mean follow up is 25.8 months. Survival at 2 year is 96.3%. S106 Conclusion: Our study concluded that multidisciplinary approach to hepatoblastoma is justified as it decreases the resection margin, increase tolerance to surgery, decrease morbidity and improves the outcome of patient. Serum Alfa Feto Protein is a good prognostic indicator. Corresponding author: Gururaj Deshpande. E-mail: drgururajdeshpande@gmail.com EMERGENCY HEPATIC RESECTION: A LIFE SAVING PROCEDURE IN RUPTURED HEPATOBLASTOMA: A RARE CASE REPORT Gururaj Deshpande, Devendra Parikh, Mahesh D. Patel Gujarat Cancer and Research Institute (GCRI), Ahmedabad, India Hepatoblastoma is the most common primary hepatic tumor of children. However, only a very few cases have been reported in adults. Most studies support treatment with chemotherapy followed by surgical resection. We present the first reported survival of paediatric ruptured hepatoblastoma in India. A seven year-old boy suffered from sudden onset of abdominal pain and general weakness progressing to shock. Internal bleeding leading to hemorrhagic shock was suspected on abdominal imaging due to a mass lesion in the right lobe of liver. Patient underwent emergency exploratory laparotomy and hepatic resection. Right hepatectomy was performed with successful outcome. Final histopathology was reported as mixed hepatoblastoma. Corresponding author: Gururaj Deshpande. E-mail: drgururajdeshpande@gmail.com RADIOFREQUENCY ABLATION FOR LIVER TUMORS: OUR EXPERIENCE Naresh Kumar Bansal, Arun Gupta, Vikash Singla, Praveen Sharma, Ajit Yadav, Pankaj Tyagi, Ashish Kumar, Anil Arora Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi Background and Aims: The majority of patients with primary or metastatic hepatic tumors are not candidates for resection. Radiofrequency ablation (RFA) is used to treat patients with unresectable primary and metastatic hepatic cancers and is gaining popularity as the ablative therapy of choice for liver tumors. RFA produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify tumors and guide placement of the RFA needle electrode.

Acute Abdomen Syndrome Caused by a Perforated Gastrointestinal Stromal Tumor - A Case Report

Gastrointestinal stromal tumors (GIST) are frequently observed in the stomach and intestines. Although they may be presented with various symptoms depending on their location and diameter, acute abdomen syndrome is a rare presentation form for GIST. A 54-year-old male patient was evaluated with the complaint of sudden onset abdominal pain at the urology clinic. In examination; fever (38.5 ̊C), abdominal distension and peritoneum irritation signs were detected. A mass that contained localized necrotic areas thought to have mesentery origins and intraabdominal free-fluid were detected on abdominal computed tomography. The patient was operated with the diagnosis of acute abdomen syndome. In operation; extensive intestinal content in the abdomen, a perforated tumoral mass which was 7x5 cm in diameter, and anti-mesenterically localized at the ileum segment were detected. Segmental ileum resection-end ileostomy operation was performed, and the patient was discharged as uneventful on post-operative tenth day. As a result of a histopathological analysis, a GIST (<5/50 mitotic growth) was detected. By means of this finding, we want to remind that GISTs may be presented with acute abdomen symptoms due to perforation, though rarely.

Spontaneous Rupture of the Adrenal Artery Successfully Treated Using the Endovascular Approach

Adrenal artery rupture is a rare cause of retroperitoneal hemorrhage. We describe 2 cases of spontaneous rupture of the adrenal artery successfully treated using endovascular coil embolization. Two patients presented with sudden onset abdominal pain and hemodynamic compromise. In both the cases computed tomography (CT) showed a large retroperitoneal hemorrhage. Aortography confirmed bleeding from the right inferior adrenal artery in the first patient and the left inferior adrenal artery in the second patient. Both patients were treated with endovascular coil embolization. Subsequent CT scans demonstrated a reduction in the size of the retroperitoneal hematoma with no active bleeding. Endovascular treatment of a ruptured adrenal artery is effective, safe, and permits organ preservation.

Endometrioid Adenocarcinoma of Caecum Causing Intussusception

Malignant transformation of endometriosis is rare and is usually seen in ovarian endometriosis. The colon and rectum are the most common sites for extragonadal endometriosis, and although serosal involvement is commonly seen, mucosal involvement is rare. Malignant transformation of endometriosis is a rare but a well-known complication of endometriosis. We report an unusual presentation of endometrioid adenocarcinoma with lymph node metastasis, arising from endometriosis in the caecal wall and causing ileocaecal intussusception. The patient presented with sudden onset of abdominal pain with features suggestive of acute appendicitis. Diagnostic laparoscopy revealed an ileocaecal intussusception. Conversion to open surgery confirmed a caecal mass causing ileocaecal intussusception, and a radical right hemicolectomy was performed. Histology revealed endometrioid adenocarcinoma arising in a focus of endometriosis in the muscularis propria and involving the mucosa, with one regional metastatic lymph node.

A Rare Case of Clostridium septicum Causing an Abdominal Aortic Endograft Leak

The authors report a case of an African American female, status post-EVAR one and a half years prior, who presented to the emergency department with sudden onset of abdominal pain. Computed tomography revealed a type I endoleak and the presence of periaortic gas. The patient underwent an emergent open abdominal aortic endograft explant with in situ tube graft replacement. Blood and endograft tissue cultures grew Clostridium septicum. The patient died perioperatively of systemic multiple organ failure. C. septicum is a rare infection with lethal propensities and has a strong association with paraneoplastic syndromes. The underlying etiology of this patient’s bacteremia was likely associated with an immunodeficiency secondary to myelodysplastic syndrome. Importantly, if periaortic gas is present, the disease is far advanced and the prognosis is poor regardless of treatment; however, a combination of antibiotics and surgery should be initiated immediately. J Med Cases. 2013;4(12):816-819 doi: https://doi.org/10.4021/jmc1608e

Thoracic Disc Herniation Presenting with Predominant Abdominal Pain

Introduction: The incidence of symptomatic thoracic disc herniation (TDH) is quite low, and most patients present with either radiculopathy as pain in the chest wall or thoracic myelopathy involving the lower extremities. However, not only these typical symptoms, but also various other symptoms pointing to other general diseases can be the sole presenting complaints. We describe a rare case in which a patient presented with predominant abdominal pain caused by thoracic disc herniation. Materials andMethods: Retrospective data analysis and review of the literature. Results: A 45-year-old man experienced sudden onset of abdominal pain and presented to our internal medicine outpatient clinic. Due to obvious concomitant paraplegia, he was referred to our department. Physical examination revealed spastic paraplegia below the T10 dermatome level. Thoracic magnetic resonance imaging showed disc herniation at the T9-10 level. Herniotomy was performed, and abdominal pain completely disappeared immediately postoperatively. Conclusions: Although the anatomical location within a given axial cross-section of the spinal cord where visceral pain is processed is still controversial, some reports have defined the visceral nociceptive pathway as ascending in the midline of the dorsal columns, particularly in the nucleus gracilis. Damage to this pathway seems to represent a cause of abdominal pain with TDH. Further investigations in this area are required to elucidate the exact mechanisms involved. Surgeons should be aware of atypical presentations of TDH, to prevent misdiagnosis and progression to irreversible myelopathy.

A Case of Gastric Cancer with Perforation Caused by Chemotherapy with Docetaxel and S-1

We treated a patient who had gastrointestinal perforation during chemotherapy with docetaxel and S-1 which was successfully treated with percutaneous drainage. A 66-year-old man was admitted to our hospital with complaints of abdominal pain. Gastric cancer (T3N1M0) had been diagnosed 3 years earlier, and distal gastrectomy had been performed. Two years later, intrapelvic recurrence of the cancer was diagnosed. We administered docetaxel and S-1. After 3 courses of chemotherapy, he complained of abdominal pain of sudden onset. Computed tomography showed free air and limited ascites, and gastrointestinal perforation was diagnosed. We performed percutaneous drainage. The abdominal pain improved 3 days later, and he was able to eat meals 15 days after the onset of abdominal pain. He was discharged 27 days after admission. Because the patient's general condition was poor, we started providing best supportive care only. He died 10 months after the perforation was found.

Unusual causes of Hematuria in dialysis patients: Diagnostic dilemma, risks and management

Two male patients with end-stage renal disease (ESRD) developed a spontaneous hemorrhage of one of their native kidneys and were referred to our institution. Symptoms included sudden onset abdominal pain, hematuria and shock. Symptoms were associated with a hemoglobin decrease. Computerized tomography (CT) was done and nephrectomy undertaken in both the cases. Histologic findings confirmed bleeding and there was no abnormality other than those related to renal insufficiency (cysts and atrophy). In chronic hemodialysis (HD) patients with hematuria, if other common causes are not identified spontaneous subcapsular or renal cyst rupture should be kept in mind. Surgery is our preferred treatment because of the diagnostic dilemma of tumors and the potential mortality of massive hematomas in morbid patients.

A Mysterious Cause of a Surgical Abdomen

BackgroundEpiploic appendagitis is a rare cause of acute-onset abdominal pain. The severity of pain at presentation and the infrequency with which it is encountered make it a diagnostic challenge. ObjectivesTo present a case report exemplifying a diagnostic challenge posed by acute-onset abdominal pain that eventually led to the diagnosis of epiploic appendagitis. Case ReportA 50-year-old woman presented to the Emergency Department complaining of excruciating, sudden-onset lower abdominal pain. All routine laboratory investigations were within normal limits, as were an acute abdominal X-ray series. Computed tomography scan of the abdomen and pelvis with contrast showed a focal fatty infiltration in the left lower quadrant with fat-stranding towards the colon, representing the classical radiological presentation of epiploic appendagitis. The patient was admitted and successfully managed conservatively with intravenous fluids and ibuprofen. The patient made a full recovery and was discharged 3 days after admission. ConclusionsDue to its benign, self-limited course, it is important to recognize this disease process to avoid unnecessary surgical and medical interventions. Epiploic appendagitis should be suspected in patients presenting with acute onset abdominal pain localized to the left lower quadrant or right lower quadrant with no associated systemic manifestations. Improvements in imaging technology have enabled confirmation of the diagnosis with non-invasive methods.

Spontaneous splenic rupture in patient with metastatic melanoma treated with vemurafenib

BackgroundBRAF inhibitors such as vemurafenib are a new family of biological drugs, recently available to treat metastatic malignant melanoma.MethodsWe present the case of a 38-year-old man affected by metastatic melanoma who had been under treatment with vemurafenib for a few days. The patient suffered from sudden onset of abdominal pain due to intra-abdominal hemorrhage with profuse hemoperitoneum. An emergency abdominal sonography confirmed the clinical suspicion of a splenic rupture.ResultsThe intraoperative finding was hemoperitoneum due to splenic two-step rupture and splenectomy was therefore performed. Histopathology confirmed splenic hematoma and capsule laceration, in the absence of metastasis.ConclusionsThis report describes the occurrence of a previously unreported adverse event in a patient with stage IV melanoma receiving vemurafenib.

Spontaneous splenic vein bleeding during pregnancy: consequences of a missed diagnosis

To the Editor: Spontaneous splenic vein bleeding is a rare complication during pregnancy. In a recent case, it mimicked premature labor [1] or a twisted adnexal cyst and remained undiagnosed until the cesarean section was already underway. A woman at 32 weeks gestation presented with a 1-h history of abdominal pain. She also had a left adnexal dermoid cyst. Upon admission, her vital signs were: pulse 114/min, blood pressure (BP) 119/87 mmHg, temperature 36 C, hemoglobin 11.9 g/dl, white cell count 19.44 9 10/L, and blood oxygen saturation (SpO2) 98 % breathing room air, and she was mentally alert. The fetus was in satisfactory condition. Obstetric ultrasound scan was normal. Tocolytic treatment and pethidine had no effect on pain relief. Six hours after her admission, a category II emergency cesarean section was performed due to her abdominal pain. The patient was slightly tachycardiac on arrival at the operating room (pulse 114/min); however, no other feature of hypovolemia was present. The tachycardia was assumed to be due to abdominal pain. She was unable to lie flat for the induction of general anesthesia and, as there was no obvious contraindication, spinal anesthesia was administered in the left lateral position. The spinal block was effective, and the abdominal pain was relieved, but her hemodynamics became very unstable. A normal fetus was delivered but the patient was suffering from severe bleeding. An extensive laparotomy under general anesthesia revealed a spontaneous splenic vein bleed. Hemostasis was achieved without splenectomy. Blood loss of 3 L resulted in a hemoglobin drop to 5.5 g/dl because cross-matched blood products were not readily available due to the exclusion of hemorrhage in the differential diagnosis. Her postoperative course remained uneventful. Spontaneous bleeding during pregnancy can arise from utero-ovarian vessels or distant sources, such as the splenic, hepatic, superior mesenteric, or celiac arteries [2, 3]. Arterial bleeds are dramatic, with rapid cardiovascular collapse [2]. Venous bleeding may be dramatic [3] or may present only with subtle features of hemoperitoneum. Spontaneous bleeding, including splenic bleeding, is a rare complication during pregnancy, so it can be misdiagnosed because the ‘‘eyes do not see what the mind does not know’’. Sudden-onset abdominal pain of uncertain origin in a parturient should raise the suspicion of non-obstetric abdominal pathology, e.g., spontaneous abdominal bleeding, and should be evaluated appropriately such as with a computed axial tomography (CT). Parturients do not show obvious features of hypovolemia unless 30–40 % of blood volume is lost. Failure to recognize such a condition is dangerous for anesthetic intervention. The responsibility for diagnosis in such cases may rest primarily on obstetricians, but anesthesiologists are equally responsible for identifying such a potentiality. Ultimately, it is the anesthesiologist who is responsible for ensuring patient safety. This case report is presented with written consent of the patient. M. Ajmal Department of Anesthesia, Letterkenny General Hospital, Letterkenny, Ireland

Endovascular Repair of a Ruptured Type II Renal Artery Aneurysm Using an Endograft

The purpose of this study was to describe a case of an endovascular exclusion of a ruptured type II renal artery aneurysm in a hemodynamically unstable patient using an endograft. A 73-year-old woman, with an extensive medical history, presented with a sudden onset of abdominal pain and hypovolemic shock. A computed tomography scan showed a massive right-sided retroperitoneal hematoma and a type II aneurysm of the right renal artery just proximal to the bifurcation. Angiography demonstrated active contrast extravasation from the aneurysm. The aneurysm was excluded using a 5-cm long, 6-mm wide endograft. After a 6-month interval, duplex ultrasonography showed a patent endograft and normal perfusion of the renal parenchyma in the lower and middle pole, with a glomerular filtration rate of 75 mL/min. Endovascular exclusion using an endograft may provide a safe and rapid alternative to surgery to treat ruptured renal artery aneurysms in a selected group of patients.

A rare, highly aggressive primitive neuroectodermal tumor of the kidney: Case report and literature review

We report a case of a 14-year-old boy who initially suffered from a sudden onset of abdominal pain for 2 weeks with a protrusive soft mass over the left upper abdomen. No obvious symptomatic symptoms or body weight loss were observed. However, early lung metastasis was detected after an initial computed tomographic examination. Even after we performed salvage en bloc resection of the huge retroperitoneal tumor after primary neoadjuvant chemotherapy, the final outcome was still poor. A diagnosis according to radiologic findings was uncharacteristic. Finally, a pathologic diagnosis based on histologic and immunohistochemical results revealed a rare renal peripheral primitive neuroectodermal tumor.

Escherichia coli O157:H7 causing hemorrhagic colitis

d r t a a c h i fl c s O c A 75-year-old man presented with a 3-day history of sudden-onset abdominal pain and bloody diarrhea. His abdomen was tender, with no signs of guarding or peritonitis. Laboratory test results showed a hemoglobin of 14 g/dL (normal 13-18 g/dL), with mean cell volume of 84 fL (normal 76-96 fL); platelet count of 313,000/mm (normal 150,000400,000/mm); white blood cell count of 29,700/mm (noral 4,000-11,000/mm) with a neutrophil count of 26,400/ mm (normal 2500-7500/mm); and C-reactive protein of 403 mg/L (normal 10 mg/L). Diverticulitis was suspected, and o-amoxiclav and metronidazole therapy was started. An bdominal CT scan demonstrated diffuse colon wall thickenng and mild pericolic stranding that involved the ascending,

A Rare Cause of Gastric Perforation-Candida Infection: A Case Report and Review of the Literature

Fungal microorganisms as a cause of gastric perforation, is very rare. Most of the cases of gastric perforation are seen as the complications of peptic ulcer disease, the intake of NSAIDs (Non Steroidal Anti-Inflammatory Drugs), neoplastic diseases, etc. We are reporting a case of a 50 year old male who presented with a sudden onset of abdominal pain and shock and was diagnosed as acute peritonitis which was caused by a gastrointestinal perforation. An emergency exploratory laporotomy was performed and a gastric perforation repair with omentoplexy was done. However, the patient died in the post operative period due to a sudden cardiac arrest. A gastric perforation edge biopsy revealed the presence of fungal hyphae. The peritoneal fluid culture revealed Candida albicans colonies.

Acute abdomen and ascites as presenting features of autosomal dominant polycystic kidney disease

We describe a patient with sudden onset of abdominal pain and ascites, leading to the diagnosis of autosomal dominant polycystic kidney disease (ADPKD). Her presentation was consistent with acute liver cyst rupture as the cause of her acute illness. A review of literature on polycystic liver disease in patients with ADPKD and current management strategies are presented. This case alerts physicians that ADPKD could occasionally present as an acute abdomen; cyst rupture related to ADPKD may be considered in the differential diagnoses of acute abdomen.

Surgical resection of late solitary locoregional gastric cancer recurrence in stomach bed

SummaryBackgroundLate-onset and solitary recurrence of gastric signet ring cell (SRC) carcinoma is rare. We report a successful surgical resection of late solitary locoregional recurrence after curative gastrectomy for gastric SRC carcinoma.Case ReportThe patient underwent total gastrectomy for advanced gastric carcinoma at age 52. Seven years after the primary operation, he visited us again with sudden onset of abdominal pain and vomiting. We finally decided to perform an operation, based on a diagnosis of colon obstruction due to the recurrence of gastric cancer by clinical findings and instrumental examinations. The laparotomic intra-abdominal findings showed that the recurrent tumor existed in the region surrounded by the left diaphragm, colon of splenic flexure, and pancreas tail. There was no evidence of peritoneal dissemination, and peritoneal lavage fluid cytology was negative. We performed complete resection of the recurrent tumor with partial colectomy, distal pancreatectomy, and partial diaphragmectomy. Histological examination of the resected specimen revealed SRC carcinoma, identical in appearance to the previously resected gastric cancer. We confirmed that the intra-abdominal tumor was a locoregional gastric cancer recurrence in the stomach bed. The patient showed a long-term survival of 27 months after the second operation.ConclusionsIn the absence of effective alternative treatment for recurrent gastric carcinoma, surgical options should be pursued, especially for late and solitary recurrence.

KOLELİTİYAZİSE SEKONDER OLARAK GELİŞEN AKUT PANKREATİTE BAĞLI PSÖDOKİST OLGUSU

ABSTRACT Acute pancteatitis is defined as sudden onset of abdominal pain and elevation of pancreatic enzymes in blood and/or urine, and radiographic changes of pancreas. Acute pancreatitis is uncommon in children when compared with adults. We reported the case of acute pancreatitis in a 12 years old boy with pseudocyst formation and pancreatic necrosis secondary to acute cholelithiasis. Key words: Acute pancreatit; child; cholelithiasis; pancreatic necrosis; pseudocyst. OZET Akut pankreatit ani baslangicli karin agrisi, kan ve/veya idrarda pankreatik enzimlerde artma ve pankreasta radyolojik degisiklikler seklinde tanimlanir. Eriskinlere kiyasla cocuklarda akut pankreatit sik gorulmez. Psodokist ve pankreatik nekroz bulgulari olan 12 bildirilmistir. Anahtar Kelimeler: Akut pankreatit; cocuk;karinagrisi;kolelitiyazis;p ankreatik nekroz; psodokist . INTRODUCTION Although paediatric pancreatitis is not common, the incidence of acute pancreatitis in children has increased over the past 10–15 years (1-4). Most children recover uneventfully, but some develop severe disease, and some die (5). Unlike acute pancreatitis in the adult population, paediatric pancreatitis is rarely to biliary stone disorders or alcoholism. Instead, the leading causes of pancreatitis tend to be idiopathic, trauma, infections, systemic diseases (e.g. HUS), drugs, congenital disorders (e.g. pancreatic divisum, choledochal cyst and cystic fibrosis) (2,3). Most of the cases are presented as abdominal pain or vomiting. Pain is usualy epigastric, in the right upper quadrant. Nausea and vomiting are

Spontaneous hemoperitoneum from hepatic metastatic trophoblastic tumor

Spontaneous hemoperitoneum (SP) is defined as the presence of blood within the peritoneal cavity that is unrelated to trauma. Although there is a vast array of etiologies for SP, primary hepatocellular carcinoma and hepatic adenoma are considered to be the most common causes. Hepatic metastatic tumor associated with spontaneous rupture is rare. SP from hepatic metastatic trophoblastic tumor may initially present with a sudden onset of abdominal pain. Abdominal computed tomography (CT) plays an important role in establishing the diagnosis of SP, indicating its origin and etiology, and determining subsequent management. Herein, we report an uncommon case of hemoperitoneum from spontaneous rupture of a hepatic metastatic trophoblastic tumor in a young female patient. Interestingly, the contrast-enhanced CT findings demonstrated hypervascular hepatic masses with persistent enhancement at all phases, which were completely different from the common appearances of hepatic metastases. For SP resulting from hepatic metastatic tumors, surgical intervention is still the predominant therapeutic method, but the prognosis is very poor.

A Case Report of Idiopathic Omental Infarction in an Obese Child

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.