Omental Infarction

Abstract

Objective: To evaluate the prevalence of omental infarction (OI) in children with suspected appendicitis, the role of ultrasonography (US) in its diagnosis and management and the efficacy of conservative management.Methods: Consecutive children with suspected acute appendicitis were prospectively enrolled. Ultrasonography was performed at baseline, during follow-up, before the discharge, and at 15-day intervals until US findings of OI disappeared. All children with a diagnosis of OI were treated conservatively.Results: One hundred ninety-nine children (91 male; age range, 3-15 years) were evaluated. Eighty-four patients had acute appendicitis. Omental infarctions were found in 14 children (8 male; mean age, 9.8 ± 2.6 years), with an incidence of 7%. Ultrasonography depicted an echogenic mass consistent with OI in all children. Ultrasonography detected in 8 patients a normal-looking appendix, whereas in other 6 patients, it identified neither appendix nor indirect signs of acute appendicitis. A normal appendix has been detected by US during follow-up in 2 of these 6 patients. During follow-up, US finding of OI disappeared in all cases and no signs of acute appendicitis or other disease occurred. All 14 OIs were treated conservatively, with no reported complications.Conclusions: Omental infarction is an underestimated cause of abdominal pain in children accounting for 7% of patients with suspected appendicitis. Ultrasonography is a useful method for the diagnoses and to guide clinical management of OI. Conservative therapy is a safe option for the management of OI.

Omental Infarction in a Child—Conservative Management as an Effective and Safe Strategy in Diagnosis and Treatment

“…Omental infarction (OI) occurs in approximately 0.1% to 0.5% of children undergoing surgery for suspected appendicitis [1,8,9], which makes OI a rare cause of acute abdominal pain in children [10]. For the first time, an idiopathic omental infarct was described by Bush in 1896 [1].…”

“…Fifteen percent of all reported cases of omental infarction are children [10]. Those under 4 years of age are particularly rarely affected, which may be the effect of a relatively low amount of intra-abdominal fat and omentum at this age [4,8]. The most important risk factor for OI is obesity [3], therefore the increasing tendency in childhood obesity may impact the increase in the incidence of OI in more recent publications [4].…”

“…As shown in our case, but also in the literature, conservative treatment in the form of oral anti-inflammatory drugs and/or antibiotic therapy leads to a decrease in the severity and subsequent subsidence of clinical symptoms. Thus, conservative treatment is safe and no complications are observed in long-term follow-up [8,12,17]. On the other hand, surgical treatment is also used in clinical practice.…”