Pre-Operatively Diagnosed Omental Torsion and Infarction in a Child: A Rare Case Report

Case Report

Austin J Surg. 2016; 3(1): 1080.

Pre-Operatively Diagnosed Omental Torsion and Infarction in a Child: A Rare Case Report

Tiwari C, Shah H*, Desale J, Makhija D and Jayaswal S

Department of Paediatric Surgery, TNMC & BYL Nair Hospital, India

*Corresponding author: Shah H, Department of Paediatric Surgery, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India

Received: January 18, 2016; Accepted: March 10, 2016; Published: March 14, 2016


Omental torsion leading to infarction is a rare cause of acute abdomen and is rarely diagnosed pre-operatively. It mimics acute abdominal conditions like appendicitis, acute diverticulitis and Meckel’s diverticulum. The patient presents with right-sided abdominal pain, especially in the paediatric age group. About 0.1% of paediatric patients who undergo laparotomy for suspected appendicitis, will have omental infarction. We describe a case of an 11 year-old boy diagnosed pre-operatively as omental torsion by contrast-enhanced Computed Tomography Scan which was confirmed at laparoscopy.

Keywords: Omental torsion; Omental infarction; Whirl sign; Laparoscopy

Case Presentation

An eleven year-old boy was admitted with complaints of rightsided lower abdominal pain of one day duration. There was history of mild fever; but no history of prodromal syndromes like nausea, vomiting, anorexia, diarrhea or constipation. At admission, his vitals were stable except for tachycardia. There was severe tenderness and involuntary guarding present in right lumbar, right iliac fossa and umbilical region. Leucocytosis was present (Total Leucocyte Count: 17,600 per Abdominal ultrasound revealed an ill-defined area of size 5.2x1.9x4.7cm in the right para-umbilical region with hyperechoic linear strands suggesting inflamed fat abutting the anterior abdominal wall suggestive of omental torsion. Contrast Enhanced Computed Tomography (CECT) scan (Figure 1) showed a 3.7x4.8x3.4cm focal area of fat stranding in the right sub-hepatic region abutting the anterior abdominal wall inferior to the transverse colon. It contained a vascular pedicle at its centre which did not show enhancement on post contrast arterial and venous phase. Linear folds of omental tissue in concentric pattern (Whirl Sign) could be seen (Figure 2). This suggested possibility of omental torsion with thrombosed vascular pedicle resulting in secondary omental infarct. Patient was started on intravenous antibiotics and analgesics. But the pain persisted. At diagnostic laparoscopy, infarcted and necroses omentum was seen adherent to the right anterior abdominal wall near the umbilicus (Figure 2). There was minimal sero-sanguinous fluid in the peritoneal cavity. Rest of the abdomen was normal. The omentum was mobilized and delivered through the umbilical site (Figure 3). Three turns of torsion were seen and the omentum distal to it was necrosed. The omentum was excised. Patient had an uneventful recovery. Histopathology revealed necrosed omentum.