title: Clinical presentation and treatment considerations in children with acute omental torsion: a retrospective review.
abstract: Omental torsion is an underdiagnosed cause of abdominal pain in children. It resembles appendicitis, and the diagnosis is often made surgically. We review the presentation, treatment, and outcomes in the largest reported series to date. We recorded demographics, diagnostics, treatment, and histopathology in 18 children with omental torsion between May 2000 and 2007. We found a 4:1 male to female ratio and 85 per cent met criteria for obesity based on Centers for Disease Control and Prevention body mass index-for-age growth chart calculations. Fourteen of 18 (78%) presented with right lower quadrant pain concerning for appendicitis and seven of 18 (39%) with fever, nausea, or vomiting. Mild leukocytosis was found in 78 per cent of patients. All but one was taken to surgery with a diagnosis of appendicitis. Partial omentectomy, either open (50%) or laparoscopic (50%), was performed in all cases. The appendix, resected in 17 patients, was grossly normal. However, 30 per cent of specimens had histopathologic findings of appendicitis. Hospital discharge, after symptom resolution, averaged 33 hours. Surgeons should have a high index of suspicion for omental torsion when evaluating obese children for right lower quadrant pain. Both surgical approaches provide the diagnosis and treatment with minimal morbidity and rapid recovery. We advocate simultaneous appendectomy because appendicitis is often encountered with the torsion.
authors.affiliation: Department of Surgery/Pediatric Surgery Division, University of Texas Health Science Center, San Rosa Children's Hospital, San Antonio, Texas, USA. lanisita@hotmail.com
authors.forename: Bianca J
authors.initials: BJ
authors.lastname: Vázquez
authors.forename: Robert
authors.initials: R
authors.lastname: Thomas
authors.forename: Jason
authors.initials: J
authors.lastname: Pfluke
authors.forename: John
authors.initials: J
authors.lastname: Doski
authors.forename: Barry
authors.initials: B
authors.lastname: Cofer
authors.forename: Frank
authors.initials: F
authors.lastname: Robertson
authors.forename: Joseph
authors.initials: J
authors.lastname: Kidd
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009765:Obesity / Q000150:complications; D009852:Omentum / Q000601:surgery*; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome