Omental Infarction

Sudden Pain

Step 1: View clinicals

A 6 year old girl presents with lower abdominal pain for 6 hours, which was sudden in onset. She is also mildly febrile. There was no history of nausea or vomiting. No urinary or bowel symptoms were present. Her medical, surgical and drug histories are uneventful.


Step 2: Order all relevant investigations

FBC & CRP

WBC: 14,350/mm3 (4,000-11,000) 80% Neutrophils; left-shift noted. Hb: 13.4 g/dl (11.5-18.5) Plt : 285,000/mm3 (150,000-350,000) C-Reactive Protein: 1.7 mg/dL (< 6)

Ultrasound Abdomen

The abdominal cavity is difficult to visualize due to the child's obesity. However, a hyperechoic mass is seen just beneath the abdominal wall in the right iliac fossa. The appendix cannot be visualized clearly.

CT Abdomen and Pelvis

There is a triangular, heterogenous fatty mass located between the anterior abdominal wall and the ascending colon, with surrounding inflammatory changes. The appendix appears normal.

Urinalysis

The urinalysis is unremarkable.


Step 3: Select appropriate management

Emergency Laparotomy
Analgesics
IV Antibiotics
Laxatives


Score: ★★☆