Diagnosis and management of omental infarction in children: Our 10 year experience with ultrasound

Utilization of Imaging to Identify a Benign Condition Mimicking Acute Appendicitis in a Child

“…The relative paucity of intraabdominal fat and omental mass, especially in early childhood, is likely the explanation for lower incidence in children (currently 15% of all reported cases). 2,4 Omental infarction is estimated to be the cause of acute abdominal pain in children 0.1% of the time. 5 …”

“…Alternatively, there may be a relative ischemia of the extra fatty tissue leading to thrombosis. 1,2,4 …”

“…Children may also have leukocytosis, elevated CRP, and anorexia. 1-4,6 Compared with classical appendicitis, children with omental infarction present without fevers, gastrointestinal symptoms like nausea and vomiting, or pain originating periumbically. 4 …”

“…Ultrasonography would show an oval-shaped, noncompressible, hyperechoic mass within the omentum at the point of maximal tenderness. 2,10,13,14 The mass may adhere to the abdominal wall depending on severity of inflammation, and free peritoneal effusion may be present. 10,11 Visualization of a normal appendix on ultrasound can exclude appendicitis immediately.…”

“…Differentiating between the two pathologies is difficult, and the majority of omental infarctions are diagnosed during surgical exploration of the abdomen for possible appendicitis revealing a normal appendix and necrotic omentum. 1,2 Here we report the case of a child whose presentation was concerning, yet not typical, for acute appendicitis and discuss the subtle difference in clinical presentation of an omental infarct and the use of abdominal imaging to identify the disease and prevent unnecessary surgical intervention.…”