Laparoscopic Management of Pediatric Omental Infarction

Objective: Primary segmental infarction of the omentum is an infrequent cause of acute abdominal pain in children. We describe our experience with seven children. Methods: A retrospective chart review was performed at a tertiary referral center for 2001. Results: Seven patients, five boys and two girls, presented at the age of 4 to 13 years (average age, 8.7 years). Four patients were above the 95th percentile, with all above the 70th percentile, for weight. All experienced right lower quadrant pain of 18 to 96 hours’ duration. White blood cell counts were 7800 to 16,200/mm3, and one child had fever. Two ultrasonograms were performed for appendicitis, with one false positive and one nonvisualized appendix. In one case, computed tomography revealed nonmesenteric intra-abdominal fat streaking, suggesting omental infarction. Six of seven patients’ preoperative diagnoses were acute appendicitis. All underwent partial omentectomy and incidental appendectomy. Four cases were laparoscopic and two open, and one was converted to open because of concern for bowel injury. Pathology revealed normal appendices and acute hemorrhagic omental infarction. Two cases of umbilical port site cellulitis resolved with antibiotics. Patients were discharged home on the first or second postoperative day and were doing well at final follow-up. Conclusions: Primary omental infarction is a rare cause of acute abdominal pain in children that is often misdiagnosed as acute appendicitis. Laparoscopy is an excellent diagnostic and therapeutic approach for these often overweight patients.