Primary omental torsion in children: single-center experience of 17 cases

Primary Omental Torsion in Children in the Laparoscopy Era: What Have we Learned so far?

“…POT symptoms are nonspecific. They mainly mimic appendicitis while older children and adults may also present with symptoms indicative of cholecystitis, perforation or peptic ulcer, and ovarian torsion (29,30). During the early phases of torsion, traction of the omental root occurs, causing initially periumbilical pain, or pain at the xiphoid process (30).…”

“…They mainly mimic appendicitis while older children and adults may also present with symptoms indicative of cholecystitis, perforation or peptic ulcer, and ovarian torsion (29,30). During the early phases of torsion, traction of the omental root occurs, causing initially periumbilical pain, or pain at the xiphoid process (30). As congestion, ischemia and necrosis of the rotated segment develop, the pain adopts the characteristics of appendicitis, in many instances without the typical symptoms of appendiceal bacterial infection, such as nausea, vomiting, fever, tension, emergency, or diarrhea (31).…”

“…The sonographic criterion for the diagnosis of omental infarct is the identification of an oval hyperechoic mass, adherent to the abdominal wall with a hypoechoic rim, located mainly at the right side of the abdomen, with the presence of a normal appendix (40,41). In the CT, the density of the omental mass is not different from that of the abdominal wall fat (30). The location of a fatty soft tissue structure between the colon and the rectus abdominis sheath has been considered specific for the diagnosis with CT (30,40).…”

“…In the CT, the density of the omental mass is not different from that of the abdominal wall fat (30). The location of a fatty soft tissue structure between the colon and the rectus abdominis sheath has been considered specific for the diagnosis with CT (30,40). The infracted omentum is delineated as a fatty mass immediately deep to the parietal peritoneum, with secondary thickening and inflammation of the overlying anterior abdominal wall (24,37,42,43).…”

“…The infracted omentum is delineated as a fatty mass immediately deep to the parietal peritoneum, with secondary thickening and inflammation of the overlying anterior abdominal wall (24,37,42,43). The presence of a vascular pedicle, and the whirl of the omentum are characteristic signs (30). A variety of diseases are included in the imaging differential diagnoses of omental torsion, such as mesenteric panniculitis, lipoma, liposarcoma, teratoma, angiomyolipoma, epiploic appendagitis, gossypiboma and tumours containing fat (44).…”