A case report of idiopathic omental infarction in an obese child

Are all primary omental infarcts truly idiopathic? Five case reports

BACKGROUND

Idiopathic omental infarction (IOI) is challenging to diagnose due to its low incidence and vague symptoms. Its differential diagnosis also poses difficulties because it can mimic many intra-abdominal organ pathologies. Although hypercoagulability and thrombosis are among the causes of omental infarction, venous thromboembolism scanning is rarely performed as an etiological investigation.

CASE SUMMARY

The medical records of the 5 cases, who had the diagnosis of IOI by computed tomography, were examined. The majority of the patients were male (n = 4, 80%) and the mean age was 31 years (range: 21-38). The patients had no previous abdominal surgery or a history of any chronic disease. The main complaint of all patients was persistent abdominal pain. Omental infarction was detected in all patients with contrast-enhanced computed tomography. Conservative treatment was initially preferred in all patients, but it failed in 1 patient (20%). After discharge, all patients were referred to the hematology department for thrombophilia screening. Only 1 patient applied for thrombophilia screening and was homozygous for methylenetetrahydrofolate reductase (A1298C mutation) and heterozygous for a factor V Leiden mutation.

CONCLUSION

IOI should be considered in the differential diagnosis in patients presenting with progressive and/or persistent right side abdominal pain. Investigating risk factors such as hypercoagulability in patients with IOI is also important in preventing future conditions related to venous thromboembolism.

Spontaneous omental infarction in an obese young female patient treated with laparoscopy: a case report

Partial infarction of the great omentum is a rare cause of abdominal pain and may present as a surgical emergency. Omental infarction might occur due to its torsion, but cases without obvious cause are reported. Risk factors related to this condition are overweight, obesity, abdominal trauma, recent abdominal surgery, hypercoagulability, postprandial vascular congestion and an increase in intra-abdominal pressure. Because of the condition's rarity, most patients are treated with surgery and the diagnosis is established intraoperatively. Preoperative diagnosis allows successful conservative treatment with analgesics and anti-inflammatory drugs. This case reports a young female patient with class III obesity presented with spontaneous partial infarction of the great omentum treated with laparoscopy.

Epiploic Appendagitis and Omental Infarction as Rare Causes of Acute Abdominal Pain in Children

Omental infarction and epiploic appendagitis are rare causes of acute abdominal pain in the pediatric population. Radiological evaluation is necessary to establish a specific diagnosis and to differentiate appendicitis from these conditions as they can be often managed conservatively without surgical intervention.

"Tethered Fat Sign": The Sonographic Sign of Omental Infarction

Our purpose is to describe the ultrasound sign for a correct non-invasive diagnosis of omental infarction in children. From January 2014 to December 2018, a total of 234 children (109 boys and 125 girls, age range 3-15 y) with acute right-sided abdominal pain, admitted to our hospital with a presumptive diagnosis of acute appendicitis, were prospectively evaluated. In all patients, abdominal ultrasound was performed, and the omental fat was always evaluated. In 228 patients, the omental fat resulted to be normal or hyperechogenic, never tethered, and they results affected by other causes of abdominal pain different from omental infarction (such as appendicitis, pancreatitis, urolithiasis and others). In the remaining 6 children, we found a hyperechoic mass between the anterior abdominal wall and the ascending or transverse colon in the right abdomen quadrant, suggesting the diagnosis of omental infarction. This subhepatic mass was always tethered to the abdominal wall, motionless during respiratory excursions. We named this finding the "tethered fat sign." The diagnosis was confirmed with laparoscopy in 4 children. The other 2 children were treated with conservative therapy. In these 2 patients, a sonographic follow-up was performed, showing a progressive reduction in size of the right-sided hyperechoic mass. In conclusion, our study suggests that the presence of the "tethered fat sign" may be an accurate sonographic sign for non-invasive diagnosis of omental infarction in children.

Omental Infarction: An Unusual Cause of Left-Sided Abdominal Pain

Left-sided omental infarction (OI) is rare in both the adult and pediatric patients. To our knowledge, only 2 pediatric cases of a left-sided OI have been reported in the literature. We report a case of an obese 13-year-old male who presented with a 6-day history of intermittent, colicky, left upper quadrant abdominal pain.

Ultrasound in newborns and children suffering from non-traumatic acute abdominal pain: imaging with clinical and surgical correlation

The purpose of this article is to review ultrasonographic appearance of the most common causes of non-traumatic acute abdominal pain in pediatric patients and to understand the applications and limitations of this technique giving a practical approach showing different clinical cases. A pictorial review of cases was made presenting the most common causes of neonatal and pediatric non-traumatic acute abdominal pain; sonographic features are discussed. Ultrasound in conjunction with Color Doppler imaging is a valuable tool in the evaluation of neonatal and pediatric non-traumatic acute abdominal pain; causes of acute abdomen in children could vary depending on the ages of the children.