Laparoscopic-assisted omentectomy for omental torsion: A case report

Abstract

Introduction: Omental torsion is an uncommon cause of acute abdominal pain in children and conservative treatment has been successful in some cases. We report a case in which the patient's symptoms did not improve despite conservative treatment and required a surgical intervention. Case presentation: A 5-year-old girl was referred to our hospital because of right-sided abdominal pain and fever for 2 days. The vital signs on admission were within normal limits except for low-grade fever (37.6 °C). Laboratory examinations revealed an inflammatory reaction. White blood cell count was 10,500 cells/μl with 67.1 % neutrophils, and serum C-reactive protein concentration was 6.01 mg/dl. Ultrasonography revealed a hypoechoic mass in the right lower abdomen, and contrast-enhanced computed tomography showed a fatty mass with a whirl sign located between the anterior abdominal wall and the ascending colon. Conservative therapy with fasting, analgesics and antibiotics was initially chosen. However, because the symptoms were not relieved after 24 h, we decided to proceed with a surgical management. A single-incision laparoscopic surgery was done the following day. The operation included an adhesiolysis and omentectomy. The patient was discharged home after 5 days after re-gaining proper oral intake, without postoperative complications. Conclusion: Omental torsion is a rare acute abdominal condition in children that may respond to conservative treatment. If conservative treatment is ineffective for more than 24–48 hours, surgical intervention is recommended.

Keywords

• Omental torsion
• Conservative treatment
• Case report
• Laparoscopy