Mallick Mohammad S, Al-Bassam Abdulrahman A
Department of Surgery, Division of Pediatric Surgery, King Khalid University Hospital, College of Medicine, Riyadh, Kingdom of Saudi Arabia.
Saudi Med J. 2006 Feb;27(2):194-7.
To determine the predisposing factors and to evaluate the role of laparoscopy in the diagnosis and management of primary omental torsion in children.
We retrospectively reviewed the clinical records of all children treated for primary omental torsion from August 1999 to December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. Demographic data, clinical presentation, diagnostic and therapeutic modalities were evaluated. Follow-up was also obtained.
Six children were included in the study. Their age ranging between 9-12 years (average 10.4 years). All of them presented with right lower quadrant (RLQ) pain mimicking appendicitis. The duration of symptoms varied from 3-5 days prior to presentation. Localized RLQ tenderness with guarding was demonstrated in all patients. All children were noted to be obese. Only one patient had low grade fever and nausea. None of the patients had an elevated white blood cell count. Laparoscopic exploration was carried out in all cases for possible appendicitis. Appendix was found to be normal and torted omentum was clearly seen in all cases. The infarcted omentum was removed laparoscopically; all patients had uneventful recovery and were discharged on second postoperative day. Pathological examination showed necrotic infarcted omentum with no other abnormalities. Follow-up documented complete resolution of the patient's symptoms.
Clinical presentation of primary omental torsion mimics that of acute appendicitis. Its diagnosis is usually difficult and almost impossible pre-operatively. Obesity, paucity of gastrointestinal symptoms and relatively long duration of symptoms should increase the index of suspicion. We believe that the laparoscopic approach is an excellent tool for the diagnosis and treatment for the primary omental torsion.
确定原发性大网膜扭转的诱发因素，并评估腹腔镜检查在儿童原发性大网膜扭转诊断和治疗中的作用。
我们回顾性分析了1999年8月至2004年12月在沙特阿拉伯利雅得哈立德国王大学医院接受原发性大网膜扭转治疗的所有儿童的临床记录。评估了人口统计学数据、临床表现、诊断和治疗方式。同时也进行了随访。
6名儿童纳入研究。他们的年龄在9至12岁之间（平均10.4岁）。所有患儿均表现为右下象限（RLQ）疼痛，类似阑尾炎。症状持续时间为就诊前3至5天。所有患者均有局限性右下腹压痛伴肌紧张。所有儿童均被发现肥胖。只有1例患者有低热和恶心。所有患者白细胞计数均未升高。所有病例均因可能的阑尾炎而进行了腹腔镜探查。所有病例中阑尾均正常，可见扭转的大网膜。梗死的大网膜通过腹腔镜切除；所有患者恢复顺利，术后第二天出院。病理检查显示坏死梗死的大网膜，无其他异常。随访记录显示患者症状完全缓解。
原发性大网膜扭转的临床表现与急性阑尾炎相似。其诊断通常困难，术前几乎不可能确诊。肥胖、胃肠道症状少和症状持续时间相对较长应提高怀疑指数。我们认为腹腔镜方法是诊断和治疗原发性大网膜扭转的极佳工具。
