Primary Omental Torsion Mimics Acute Appendicitis in Children - A Case Series & Review of Literature

Author(s): Manas Ranjan Dash1 , Saroj Kumar Barma2 , Pranay Panigrahi3 , Pramod Kumar Mohanty4 , Pradeep Kumar Jena5

BACKGROUND Paediatric acute abdomen is challenging to tackle due to subtle variations in signs and symptoms. Acute appendicitis is one of the common acute surgical conditions encountered by paediatric surgeons. Primary omental torsion is rare & can mimic clinical features of acute appendicitis. We wanted to study primary omental torsion in children. METHODS Laparoscopy used as surgical tool to diagnose and treat this condition. Available data mentioning seven diagnosed cases out of 748 cases of acute appendicitis were retrospectively collected from operative notes from the period 2013 - 2019, from a single tertiary care hospital. RESULTS Majority of cases were referred to surgical emergency wing, with a mean age of 9.3 years. Most of them were male, and pre-obese. All cases could not be diagnosed preoperatively by ultrasonography except one reported as greater omentum thickened & adherent to right iliac parietes. On performing diagnostic laparoscopy, haemoperitoneum was the key finding in six cases with infarcted omentum in all cases. Laparoscopic omentectomy with appendectomy and peritoneal toileting was done in all cases. Recovery and post-operative period were uneventful. CONCLUSIONS Primary omental torsion might get missed as a differential to acute appendicitis & haemoperitoneum should be considered as a tell-tale sign of this condition.