Omental infarction: preoperative diagnosis and laparoscopic management in children.
BACKGROUND
Omental infarction (OI) is an unusual, poorly characterized cause of abdominal pain in children and is often mistaken for appendicitis preoperatively. We present our experience with this disease process over a 5-year period to identify preoperative factors to aid in timely diagnosis and treatment.


METHODS
We retrospectively reviewed the medical records of all children that had OI and underwent laparoscopic omentectomy from November 2004 to June 2009.


RESULTS
Ten patients with the diagnosis of OI were identified. OI occurred in 9 boys and 1 girl, with a median age at presentation of 8.5 years (range, 7-11). Median body mass index at presentation was 23.7 (range, 17-29), with 1 child categorized as healthy weight for age, 1 child as overweight for age, and 5 children as obese for age, based on Centers for Disease Control and Prevention criteria. All patients complained of right-sided abdominal pain; 4 patients complained of predominantly right-upper quadrant (RUQ) pain, 3 patients of right-lower quadrant (RLQ) pain, and 3 of combined RUQ/RLQ pain. On examination, 6 patients had RUQ tenderness and 4 patients had RLQ tenderness. The median duration of symptoms prior to seeking medical attention was 3 days (range, 2-7). All patients underwent computed tomography and the preoperative diagnosis of OI was established in 9 of 10 cases. Operative time was 48 ± 14 minutes. All patients underwent resection of the infarcted omentum; 2 patients underwent concurrent appendectomy. Median length of stay was 2 days (range, 2-4).


CONCLUSIONS
OI occurs predominantly, but not exclusively, in obese preadolescent males. OI can be reliably distinguished from appendicitis on preoperative history, physical examination, laboratory analysis, and imaging. Laparoscopic omentectomy results in prompt resolution of symptoms and discharge.
Gosain
Ankush
A
Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center , Le Bonheur Children's Medical Center, Memphis, Tennessee 38105, USA.
Blakely
Martin
M
Boulden
Thomas
T
Uffman
John K
JK
Seetharamaiah
Rupa
R
Huang
Eunice
E
Langham
Max
M
Eubanks
James W
JW
D015746:Abdominal Pain / Q000209:etiology; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007238:Infarction / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009852:Omentum / Q000098:blood supply*; D012189:Retrospective Studies; D016896:Treatment Outcome