Diagnosis and management of omental infarction in children: Our 10 year experience with ultrasound.

ABSTRACT

AIM: To review children with Omental Infarction (OI) and the role of Ultrasound Scan (US) in its diagnosis and management. METHODS: Cases of OI were identified retrospectively from 2004 to 2014 through screening of admission coding, pathology databases and radiology records. Demographic, clinical and pathological data were extracted from case records. MAIN RESULTS: 30 cases were identified (17 male, 13 female). Mean age was 10.7years (range 3.5-17.2). The majority of the patients were grossly overweight, with 83.3% of patients weighing greater than the mean for their age. All patients underwent at least one US, 4 had a repeat US and 1 patient also had a CT to rule out appendicitis after a US demonstrating OI. OI was demonstrated in 26 initial USs; in 4 cases initial USs were negative but repeat USs correctly detected OI. In 34 USs the appendix was identified on 20 occasions (15 normal, equivocal in 5). 13 patients underwent surgery, while 17 were managed nonoperatively; 7 underwent omentectomy only, 5 had omentectomy plus appendicectomy and 1 underwent appendicectomy only. All 12 omentectomy specimens were confirmed as OI histologically while none of the 6 appendices showed inflammation histologically. There were no postoperative complications. CONCLUSION: In a large series we have demonstrated the efficacy of US in the diagnosis and management of OI in children. To our knowledge this is the largest series of its kind to date. No patient with OI was incorrectly diagnosed with acute appendicitis or vice versa. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Retrospective Case Series.