Pediatric case of acute right-sided abdominal pain: diagnosis is not always appendicitis

Abstract

Omental infarction (OI) is a rare cause of acute abdominal pain occurring in 0.1% of children, which is typically diagnosed during surgery for suspected appendicitis. We present the case of a 7-year-old Pakistani girl. She presented with acute, severe, progressive, right-sided abdominal pain, which was present for 12 hours before presentation. No constitutional symptoms such as fever, anorexia, nausea or vomiting were present. Clinical examination revealed an adequately growing child following the 50th centile. She had severe generalized abdominal tenderness with rebound tenderness and guarding, mainly on the right lower abdominal quadrant, with all other system examinations normal. She had mildly increased inflammatory markers, and her initial abdominal ultrasound scan result was within normal limits. She had laparoscopic surgery following a diagnosis of suspected acute appendicitis; however, an intraoperative diagnosis of OI was made. This was later confirmed by histopathology. This case report highlights the importance of including OI in the differential diagnosis list of acute abdominal pain in children, in addition to the importance of computed tomography (CT) as the gold standard tool to aid diagnosis. In the presence of typical symptoms and signs of OI, a CT scan can assist and guide the management of similar cases. This course of action is suggested for the reason that OI typically runs a self-limited course and conservative care may be the most appropriate recommended course of action. Consequently, unnecessary operations could be avoided due to the diagnosis confirmation of studying images.

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

“…There are clinical situations where the diagnosis of IO is made intraoperatively. Patients are initially diagnosed with acute appendicitis, but despite a lack of clear evidence of appendicitis on imaging, surgical treatment is implemented [16]. Surgeons then find a normal appendix.…”

“…It is important to monitor the patient's condition, as during hospitalization, symptoms may worsen and previous treatments may be insufficient. This may lead to a change in the management strategy from conservative to operative [16]. When choosing a therapeutic procedure, the advantages and disadvantages of each should be taken into account.…”

“…When choosing a therapeutic procedure, the advantages and disadvantages of each should be taken into account. Attention should also be paid to the possibility of postoperative complications, such as a wound infection [16].…”

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

“… 2 , 4 Omental infarction is estimated to be the cause of acute abdominal pain in children 0.1% of the time. 5 …”

“…Since obesity seems to be the most important risk factor for the development of omental infarction, the increasing rates of childhood obesity may explain the increasing prevalence of omental infarction in the recent literature. 2 , 5 , 7 This is related to the hypothesis that an increase in fat of the redundant omentum may predispose it to twisting. Alternatively, there may be a relative ischemia of the extra fatty tissue leading to thrombosis.…”