Primary omental infarct: conservative vs operative management in the era of ultrasound, computerized tomography, and laparoscopy.
OBJECTIVE
Primary omental infarct is a rare condition in children. The preoperative diagnosis can be accurately accomplished using ultrasound (US) and computerized tomography (CT). This study aimed to elucidate the efficacy of conservative vs operative management.


METHODS
Cases of omental infarction in children diagnosed preoperatively in our institution since laparoscopy became the standard of care were reviewed.


RESULTS
Ten cases of omental infarction in children were treated. There were 6 males and 4 females (age, 5-14 years). The diagnosis was made preoperatively by CT in all cases; in 2 cases, US was also diagnostic. Conservative nonoperative management was successful in 4 cases, and laparoscopic omentectomy and appendectomy done in the other 6. There was no mortality. All children recovered uneventfully. Average hospital stay was 4 days for patients treated nonoperatively. Average postoperative stay was 2 days for children treated with laparoscopy. Three patients initially treated conservatively had surgery because of intractable pain. The preoperative stay was 3 days in these patients.


CONCLUSIONS
Children with omental infarct can be treated conservatively, and a short trial period is warranted. The indications for surgery are uncertain diagnosis, intractable relentless pain, and persistent peritoneal findings. Children treated with laparoscopy have a shorter length of stay and decreased use of narcotics.
Department of Surgery, Division of Pediatric Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Ayodeji
A
Nubi
Whitney
W
McBride
Gustavo
G
Stringel
D000006:Abdomen, Acute / Q000188:drug therapy / Q000209:etiology; D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007238:Infarction / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D010535:Laparoscopy; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D009765:Obesity / Q000150:complications; D009852:Omentum / Q000098:blood supply* / Q000601:surgery; D010538:Peritonitis / Q000209:etiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000209:etiology / Q000601:surgery; D014463:Ultrasonography
D000700:Analgesics