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Alexopoulos V, Sinopidis X, Louta A, Damaskos C, Garmpis N, Tsourouflis G, Kykalos S, Kambouri K, Blevrakis E, Roupakias S, Panagidis A, Dimitroulis D. Primary Omental Torsion in Children in the Laparoscopy Era: What Have we Learned so far? In Vivo 2024; 38:1030-1041. [PMID: 38688642 PMCID: PMC11059881 DOI: 10.21873/invivo.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM Primary omental torsion is uncommon, mimicking appendicitis and other acute abdominal pathologies. It often escapes diagnosis on imaging investigation or conventional open laparotomy. This study aimed to evaluate the effect of laparoscopy on the various parameters of this entity, including incidence, diagnosis, and treatment. MATERIALS AND METHODS A systematic review was performed, including PubMed and Scopus databases, without a time limit, following the PRISMA principles. A total of 16 articles from January 2000 to December 2023, corresponding to 56 children with primary omental torsion, complied with the research criteria. RESULTS Primary omental torsion was associated with obesity. Symptoms were right abdomen oriented, often compared to those of acute appendicitis. Preoperative ultrasound displayed low diagnostic accuracy, whereas computerized tomography diagnosed only two thirds of cases. In all patients, the vermiform appendix was normal. CONCLUSION Laparoscopy affected both diagnosis and treatment of primary omental torsion in children. Easy peritoneal cavity access rendered possible the diagnosis of cases previously discharged as abdominal pain of unknown etiology. Combined with the increased pediatric obesity, it also affected primary omental torsion incidence. The recent pathogenetic theories may be better supported today, as laparoscopy provides a detailed view in situ, and facilitates harvesting of fat tissue from the omentum for molecular investigation. The diagnostic efficiency of laparoscopy is superior to ultrasonography and computerized tomography. Finally, the removal of the ischemic omentum is technically easier compared to the open laparotomy alternative with all the technical difficulties of traction of a vulnerable hemorrhagic tissue through a small incision.
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Affiliation(s)
| | - Xenophon Sinopidis
- Department of Pediatric Surgery, School of Medicine, University of Patras, Patras, Greece;
| | - Aspasia Louta
- Endoscopy Unit, Second Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Damaskos
- Hellenic Minimally Invasive and Robotic Surgery (M.I.R.S.) Study Group, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Renal Transplantation Unit, Laiko General Hospital, Athens, Greece
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Hellenic Minimally Invasive and Robotic Surgery (M.I.R.S.) Study Group, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Propedeutic Surgery, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (M.I.R.S.) Study Group, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Propedeutic Surgery, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Kykalos
- Hellenic Minimally Invasive and Robotic Surgery (M.I.R.S.) Study Group, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Propedeutic Surgery, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Kambouri
- Department of Pediatric Surgery, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelos Blevrakis
- Department of Pediatric Surgery, University General Hospital of Heraklion, Heraklion, Greece
| | - Stylianos Roupakias
- Department of Pediatric Surgery, School of Medicine, University of Patras, Patras, Greece
| | - Antonios Panagidis
- Department of Pediatric Surgery, Patras Children's Hospital, Patras, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (M.I.R.S.) Study Group, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Propedeutic Surgery, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Chen F, Liu J, Fan F, Xu W, Lv Z. Primary omental torsion in children: single-center experience of 17 cases. Abdom Radiol (NY) 2022; 47:1291-1297. [PMID: 35175377 DOI: 10.1007/s00261-022-03445-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Primary omental torsion (POT) is a rare condition in children often misdiagnosed because of a lack of clinical manifestations. Here we present insights gained from the treatment of pediatric POT cases at a single center over 8 years and summarize some influencing factors found in diagnosis and treatment, in order to reduce the misdiagnosis of POT in children in the future. METHODS Demographic and clinical data of 17 children with POT treated in Shanghai Children's Hospital, Shanghai Jiaotong University from June 2012 to December 2020 were reviewed. RESULTS The mean age of the 17 pediatric patients was 7.65 ± 2.12 years (range: 4-12 years), sixteen were male. The average time from the pain onset to operation was 73.82 ± 47.21 h (range: 21-144 h). In 5 cases, the ultrasound scan revealed a low-intensity inflammatory mass in the abdominal cavity. Only 1 of the 17 patients had normal body mass index, while others were overweight or obese. The mean computed tomography (CT) value of the mass in the lower right abdomen was - 58.74 ± 10.32 HU (range: - 70 to - 46 HU), which is close to that of its own abdominal wall fat [- 46.29 ± 9.45 HU (range: - 62 to - 32 HU)]. The location of the mass was located in front of the right colon in ten cases, except for two cases near the ligamentum teres. Five patients had whirl sign on CT images and 8 patients had pelvic fluid. Five cases were diagnosed as acute appendicitis and 12 were diagnosed as POT, the preoperative diagnosis was correct in 70.59% of cases. All 17 patients were treated with laparoscopic omentectomy. The average duration of hospitalization was 5.53 ± 1.12 days (range: 4-8 days). All cases were followed up. 1 case relapsed 8 months post operation, while the remaining cases had no complications. CONCLUSION POT is rare in children with acute abdominal pain, which is more common in obese boys. The fatty mass in front of colon and between rectus abdominis sheath in CT image is specific, which is helpful for diagnosis of POT. Laparoscopy is an effective method for the treatment of POT in children.
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Affiliation(s)
- Faling Chen
- Department of General Surgery, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, 200062, China
| | - Jiangbin Liu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, 200062, China.
| | - Feilong Fan
- Department of General Surgery, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, 200062, China
| | - Weijue Xu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, 200062, China
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, 200062, China
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Kumar A, Shah J, Vaidya P. Primary omental gangrene mimicking appendicular perforation peritonitis-A case report. Int J Surg Case Rep 2016; 21:67-9. [PMID: 26945486 PMCID: PMC4802291 DOI: 10.1016/j.ijscr.2016.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/17/2016] [Accepted: 02/20/2016] [Indexed: 11/22/2022] Open
Abstract
Patient presented as a case of appendicular perofration with pyoperitoneum leading to localized peritonitis which is a common surgical emergency. Primary omental torsion is a rare diagnosis and very difficult to diagnose at the emergency room. We report a patient with omental torsion and further gangrene of the omentum leading to pyoperitoneum mimicking appendicuar perforation peritonitis. A review of literature is also included.
Introduction Primary omental torsion is a rare cause of acute abdomen in adults and presents with variable signs and symptoms. Establishing a preoperative diagnosis may be difficult in the emergency setting. It is rarely diagnosed preoperatively as it mimics common surgical emergencies such as acute appendicitis, appendicular perforation, acute cholecystitis and perforated peptic ulcers and can lead to the clinical deterioration of patient if missed Presentation of case A 47 years old male was taken to the operating room with a diagnosis of appendicular perforation peritonitis and during surgery was found to have a primary omental gangrene with pyoperitoneum, for which omentectomy and peritoneal lavage was performed. Discussion Torsion of the omentum is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Omental torsion can be primary (idiopathic) or secondary, depending on an underlying cause. Primary omental torsion was first described by Eitel in 1899. However, very few cases have been reported. Our case was a rare case presenting with omental gangrene with pyoperitoneum mimicking appendicular perforation peritonitis. Conclusion Primary omental torsion is a rare diagnosis. A high index of clinical suspicion is required for a preoperative diagnosis. In doubtful cases a CT scan may be helpful. Surgical excision of the omentum remains the treatment of choice; however, conservative management may be attempted in an uncomplicated omental torsion.
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Affiliation(s)
- A Kumar
- Department of Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal.
| | - J Shah
- Department of Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - P Vaidya
- Department of Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
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Borgaonkar V, Deshpande S, Rathod M, Khan I. Primary Omental Torsion Is a Diagnostic Challenge in Acute Abdomen-a Case Report and Literature Review. Indian J Surg 2014; 75:255-7. [PMID: 24426445 DOI: 10.1007/s12262-013-0807-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 01/02/2013] [Indexed: 11/30/2022] Open
Abstract
Torsion of greater omentum is a rare cause of acute abdominal pain. It can be primary or secondary. Secondary omental torsions are associated with a number of preexisting conditions like inguinal hernia (most common), tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting along its long axis resulting in impaired blood supply. This condition is rare and predominant in males. Most patients are middle-aged adults. It clinically mimics acute appendicitis. If evaluated properly and diagnosed in time, good results can be achieved. We are presenting herewith a case of primary greater omental torsion and review of available literature.
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Affiliation(s)
- Vijay Borgaonkar
- Department of Surgery, Seth Nandalal Dhoot Hospital, A-1, MIDC, Chikalthana, Aurangabad, 431005 Maharashtra India
| | - Sushil Deshpande
- Department of Surgery, Seth Nandalal Dhoot Hospital, A-1, MIDC, Chikalthana, Aurangabad, 431005 Maharashtra India
| | - Mukesh Rathod
- Department of Surgery, Seth Nandalal Dhoot Hospital, A-1, MIDC, Chikalthana, Aurangabad, 431005 Maharashtra India
| | - Imran Khan
- Department of Surgery, Seth Nandalal Dhoot Hospital, A-1, MIDC, Chikalthana, Aurangabad, 431005 Maharashtra India
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