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Primary omental torsion in a 9 year old girl: a case report.

Anyfantakis D, Kastanakis M, Karona V, Symvoulakis EK, Fragiadakis G, Katsougris N, Bobolakis E - J Med Life (2014)

Bottom Line: The infarcted segment was resected and the girl's clinical recovery was uneventful without any complication.In this case report, a presumed diagnosis of acute appendicitis urgently induced the decision of a surgical approach.Physicians involved in the acute pediatric care have to include this rare condition in the differential diagnosis of acute onset right-sided abdominal pain.

View Article: PubMed Central - PubMed

Affiliation: Primary Health Care Centre of Kissamos, Chania, Crete, Greece.

ABSTRACT
Primary torsion of the omentus is an extremely unusual cause of acute abdomen in the pediatric population. This condition occurs from twist of the pedicle of the omental apron around its longer axis, leading to edema, ischaemia and necrosis. Here we present a rare case of a 9 year old girl referred by her general practitioner due to severe right lower quadrant abdominal pain with a presumed diagnosis of acute appendiceal inflammation. Surgical operation disclosed primary omental torsion. The infarcted segment was resected and the girl's clinical recovery was uneventful without any complication. The condition may mimic a variety of other causes of acute abdominal symptoms. In this case report, a presumed diagnosis of acute appendicitis urgently induced the decision of a surgical approach. Physicians involved in the acute pediatric care have to include this rare condition in the differential diagnosis of acute onset right-sided abdominal pain.

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Related in: MedlinePlus

Intraoperative image of the rezected part of the omentus torsioned around a pivotal point (arrow)
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Figure 1: Intraoperative image of the rezected part of the omentus torsioned around a pivotal point (arrow)

Mentions: A 9 year old girl was admitted to the Primary Health Care Centre of Kissamos complaining of acute onset abdominal pain for the last 6 hours located in the right lower quadrant. The girl was referred to the Emergency department of the Saint George General Hospital of Chania, Crete, Greece with the suspicion of acute appendiceal inflammation. Her vital signs on admission were within normal limits except of a slight elevation of her temperature (37.6 degrees Celsius). The girl’s weight was normal for her age. Physical examination revealed a marked right lower abdominal tenderness with guarding while obturator and psoas signs were negative. Intestinal sounds were normal. Initial laboratory work up included complete blood count, renal and liver function tests, urine analysis and chest X ray which were found normal. White blood cell count was 9500 cells/μl with 78% polymorphonuclears, 14% lymphocytes and 7% monocytes. The only pathological finding was a moderate elevation of the C-reactive protein levels [2.1 mg/dl (normal range: 0-0.5 mg/dl)]. Ultrasound (US) examination showed a small amount of free fluid in the pouch of Douglas. Visualization of the appendix was not feasible, while ovaries were found normal. Due to the increasing character of the abdominal pain, the girl was transferred to the operation room. Intraoperatively, during exploration of the peritoneal cavity was detected in the sero-sanguineous fluid. Appendix was found normal. Further exploration for Meckel’s diverticulum was negative. Torsion of the right omental part around its long axis (Fig. 1 and Fig. 2) was discovered with evident signs of vascular congestion and necrosis (Fig. 2). Management consisted of resected of the twisted omentum. The girl recovered normally without any complications and she was discharged home 3 days later.


Primary omental torsion in a 9 year old girl: a case report.

Anyfantakis D, Kastanakis M, Karona V, Symvoulakis EK, Fragiadakis G, Katsougris N, Bobolakis E - J Med Life (2014)

Intraoperative image of the rezected part of the omentus torsioned around a pivotal point (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197507&req=5

Figure 1: Intraoperative image of the rezected part of the omentus torsioned around a pivotal point (arrow)
Mentions: A 9 year old girl was admitted to the Primary Health Care Centre of Kissamos complaining of acute onset abdominal pain for the last 6 hours located in the right lower quadrant. The girl was referred to the Emergency department of the Saint George General Hospital of Chania, Crete, Greece with the suspicion of acute appendiceal inflammation. Her vital signs on admission were within normal limits except of a slight elevation of her temperature (37.6 degrees Celsius). The girl’s weight was normal for her age. Physical examination revealed a marked right lower abdominal tenderness with guarding while obturator and psoas signs were negative. Intestinal sounds were normal. Initial laboratory work up included complete blood count, renal and liver function tests, urine analysis and chest X ray which were found normal. White blood cell count was 9500 cells/μl with 78% polymorphonuclears, 14% lymphocytes and 7% monocytes. The only pathological finding was a moderate elevation of the C-reactive protein levels [2.1 mg/dl (normal range: 0-0.5 mg/dl)]. Ultrasound (US) examination showed a small amount of free fluid in the pouch of Douglas. Visualization of the appendix was not feasible, while ovaries were found normal. Due to the increasing character of the abdominal pain, the girl was transferred to the operation room. Intraoperatively, during exploration of the peritoneal cavity was detected in the sero-sanguineous fluid. Appendix was found normal. Further exploration for Meckel’s diverticulum was negative. Torsion of the right omental part around its long axis (Fig. 1 and Fig. 2) was discovered with evident signs of vascular congestion and necrosis (Fig. 2). Management consisted of resected of the twisted omentum. The girl recovered normally without any complications and she was discharged home 3 days later.

Bottom Line: The infarcted segment was resected and the girl's clinical recovery was uneventful without any complication.In this case report, a presumed diagnosis of acute appendicitis urgently induced the decision of a surgical approach.Physicians involved in the acute pediatric care have to include this rare condition in the differential diagnosis of acute onset right-sided abdominal pain.

View Article: PubMed Central - PubMed

Affiliation: Primary Health Care Centre of Kissamos, Chania, Crete, Greece.

ABSTRACT
Primary torsion of the omentus is an extremely unusual cause of acute abdomen in the pediatric population. This condition occurs from twist of the pedicle of the omental apron around its longer axis, leading to edema, ischaemia and necrosis. Here we present a rare case of a 9 year old girl referred by her general practitioner due to severe right lower quadrant abdominal pain with a presumed diagnosis of acute appendiceal inflammation. Surgical operation disclosed primary omental torsion. The infarcted segment was resected and the girl's clinical recovery was uneventful without any complication. The condition may mimic a variety of other causes of acute abdominal symptoms. In this case report, a presumed diagnosis of acute appendicitis urgently induced the decision of a surgical approach. Physicians involved in the acute pediatric care have to include this rare condition in the differential diagnosis of acute onset right-sided abdominal pain.

Show MeSH
Related in: MedlinePlus