Primary omental infarct: conservative vs operative management in the era of ultrasound, computerized tomography, and laparoscopy

Nubi, Ayodeji; McBride, Whitney; Stringel, Gustavo

doi:10.1016/j.jpedsurg.2009.01.032

Cited by 71 publications

(100 citation statements)

References 12 publications

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“…approximately 0.1%. 10 The higher ratio (1:224) found in our series is in accordance with more recent reviews; 11,12 this may reflect the increasing disease's recognition and/or incidence, the latter being related to the growing prevalence of childhood obesity, a predisposing risk factor in OI. 7,8,13 OI is no longer a surprisingly intra-operative finding.…”

Section: Discussionsupporting

confidence: 92%

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Omental Infarction: a Reappraisal of Conservative Management in Children

et al. 2014

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RESUMOIntrodução: A melhoria da acuidade diagnóstica do enfarte do omento resultou num incremento da atitude conservadora no seu tratamento. Com o objectivo de avaliar a eficácia e segurança da abordagem não-operatória, analisámos os casos de enfarte do omento tratados num hospital terciário. Material e Métodos: Incluímos os casos de enfarte do omento primários tratados entre 2004 e 2011. Os enfartes do omento diagnosticados por imagiologia foram submetidos a tratamento conservador que constou de analgésicos e antibioterapia intravenosa. Avaliámos os dados demográficos, apresentação clínica, dados laboratoriais, imagiologia e resultado. Resultados: Ocorreram nove casos de enfarte do omento. Oito pacientes (4 rapazes), com uma idade mediana de 8,5 anos, apresentaram-se na fase inicial da doença por dor abdominal à direita; a contagem leucocitária era normal ou ligeiramente elevada. Seis casos, diagnosticados por TC após ecografia suspeita de enfarte do omento em quatro, foram trados conservadoramente sem complicações, tendo alta ao terceiro dia (mediana). Dois doentes foram apenas diagnosticados durante a intervenção cirúrgica por suposta apendicite. O nono caso apresentou-se com uma obstrução intestinal devida a hérnia interna que foi resolvida por laparoscopia. Discussão: A imagiologia foi diagnóstica na maioria dos casos de enfarte do omento, permitindo a adoção de uma abordagem conservadora. O tratamento não-operatório foi eficaz e sem complicações em todos os doentes que se apresentaram na fase inicial da doença. Um doente apresentou-se com uma complicação grave que requereu intervenção cirúrgica. Conclusão: Na ausência de um tratamento consensual para o enfarte do omento, a abordagem não-operatória é uma alternativa não invasiva e eficaz, mas requer uma vigilância clínica ativa. Palavras-chave: Enfarte; Omento.ABSTRACT Introduction: Accurate recognition of omental infarction has resulted in increasing supporters of non-operative approach. In order to assess the efficacy and safety of conservative management, we surveyed the cases of omental infarction treated at a single institution. Material and Methods: Primary omental infarction treated between 2004 and 2011 were reviewed. Cases recognized by imaging studies were submitted to conservative treatment that consisted of intravenous analgesics and antibiotics. Demographics, clinical presentation, laboratory findings, imaging diagnosis and outcome were analyzed.Results: There were 9 cases of omental infarction. Eight patients (4 males; median age, 8.5 years) presented at initial course of disease; all had right-sided abdominal pain and a normal or lightly increased leukocyte count. Six cases, diagnosed by CT scan after US suspicion in four, were managed conservatively, recovered uneventfully, and were discharged after a median hospital stay of 3 days. Two patients were only recognized at surgery. An additional case presented with intestinal obstruction due to an internal hernia and was successfully resolved by laparoscopy. Discussion: Imaging techniques were d...

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Section: Discussionsupporting

confidence: 92%

“…Eight patients (4 males) with an age of 8.5 [6][7][8][9][10][11][12][13] years were treated at initial course of the disease (Table 1). All presented with right-sided abdominal pain accompanied by hyperthermia in two cases; their weight was positioned in percentile 90 .…”

Section: Resultsmentioning

confidence: 99%

Omental Infarction: a Reappraisal of Conservative Management in Children

et al. 2014

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“…Although many authors, such as Goti et al, maintain that exploratory laparoscopy and resection of the affected omentum with appendectomy is the treatment of choice (9). Conservative treatment had been described of this entity in selected cases (10). However, surgery is currently the treatment of choice for complications such as intra-abdominal abscesses, sepsis or adhesion formation.…”

Section: Discussionmentioning

confidence: 99%

Primary omental torsion as presentation of acute abdomen. Case report

et al. 2015

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“…Laboratory parameters, such as white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or other inflammatory findings, are also not diagnostic (7). Therefore, it is important to differentiate it from other conditions to avoid unnecessary surgery by using imaging modalities (10).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Helm- (4)(5)(6). Thrombosis of an omental vessel due to a heavy meal or obesity can also induce omental infarction (7,8). Rarely, omental infarction occurs after blunt abdominal trauma such as a bicycle handlebar injury (9).…”

Section: Introductionmentioning

confidence: 99%