Department of General Surgery, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, 200062, China.
Abdom Radiol (NY). 2022 Apr;47(4):1291-1297. doi: 10.1007/s00261-022-03445-0. Epub 2022 Feb 17.
Primary omental torsion (POT) is a rare condition in children often misdiagnosed because of a lack of clinical manifestations. Here we present insights gained from the treatment of pediatric POT cases at a single center over 8 years and summarize some influencing factors found in diagnosis and treatment, in order to reduce the misdiagnosis of POT in children in the future.
Demographic and clinical data of 17 children with POT treated in Shanghai Children's Hospital, Shanghai Jiaotong University from June 2012 to December 2020 were reviewed.
The mean age of the 17 pediatric patients was 7.65 ± 2.12 years (range: 4-12 years), sixteen were male. The average time from the pain onset to operation was 73.82 ± 47.21 h (range: 21-144 h). In 5 cases, the ultrasound scan revealed a low-intensity inflammatory mass in the abdominal cavity. Only 1 of the 17 patients had normal body mass index, while others were overweight or obese. The mean computed tomography (CT) value of the mass in the lower right abdomen was - 58.74 ± 10.32 HU (range: - 70 to - 46 HU), which is close to that of its own abdominal wall fat [- 46.29 ± 9.45 HU (range: - 62 to - 32 HU)]. The location of the mass was located in front of the right colon in ten cases, except for two cases near the ligamentum teres. Five patients had whirl sign on CT images and 8 patients had pelvic fluid. Five cases were diagnosed as acute appendicitis and 12 were diagnosed as POT, the preoperative diagnosis was correct in 70.59% of cases. All 17 patients were treated with laparoscopic omentectomy. The average duration of hospitalization was 5.53 ± 1.12 days (range: 4-8 days). All cases were followed up. 1 case relapsed 8 months post operation, while the remaining cases had no complications.
POT is rare in children with acute abdominal pain, which is more common in obese boys. The fatty mass in front of colon and between rectus abdominis sheath in CT image is specific, which is helpful for diagnosis of POT. Laparoscopy is an effective method for the treatment of POT in children.
原发性网膜扭转（POT）在儿童中较为罕见，由于临床表现缺乏，常被误诊。本研究总结了单中心 8 年来治疗小儿 POT 病例的经验，分析了影响诊断和治疗的因素，旨在减少儿童 POT 的误诊。
回顾分析 2012 年 6 月至 2020 年 12 月上海交通大学附属儿童医院收治的 17 例 POT 患儿的临床资料。
17 例患儿中男 16 例，女 1 例，年龄 4～12 岁，平均 7.65±2.12 岁。腹痛至手术时间为 21～144 h，平均 73.82±47.21 h。5 例超声检查提示腹腔内低回声炎性包块，17 例患儿中仅 1 例患儿 BMI 正常，余均超重或肥胖。17 例患儿均行 CT 检查，右下腹部包块 CT 值为-58.74±10.32 HU（-70～-46 HU），与自身腹壁脂肪 CT 值接近[-46.29±9.45 HU（-62～-32 HU）]。包块位于右半结肠前方 10 例，除 2 例靠近圆韧带外，均远离右半结肠系膜根部。5 例 CT 提示漩涡征，8 例盆腔积液。术前误诊为急性阑尾炎 5 例，POT 12 例，术前诊断正确率为 70.59%。17 例患儿均行腹腔镜网膜切除术，平均住院时间 5.53±1.12 d（4～8 d）。术后随访 1 例 8 个月后复发，余患儿均无并发症。
儿童以急性腹痛为表现的 POT 少见，肥胖男性多见。CT 检查提示位于结肠前、腹直肌鞘间的脂肪密度包块具有特征性，有助于 POT 的诊断。腹腔镜手术是治疗小儿 POT 的有效方法。
