PRIMARY OMENTAL TORSION IN CHILDREN

Objective: A retrospective review was conducted to establish the preva lence and clinical features of omental torsion or infarction as a caus e of acute abdominal pain in childhood. Methodology: the case records were analysed for all patients admitted with primary omental pathology to the Department of General Surgery, Royal Children's Hospital, Melb ourne, between January 1975 and July 1994. Results: From 1975 to 1994 (20 years) 13 children were admitted to our General Surgical Departmen t with primary omental disease. There were nine males and four females under 16 years of age. The presenting complaint was abdominal pain wi th vomiting or diarrhoea. Four children had major medical conditions. Pre-operative diagnosis in all cases was acute appendicitis. Appendice ctomy and omentectomy were performed without complication in all cases . Histology of the omentum demonstrated torsion, infarction or haemorr hage. Conclusions: All children presented with features of acute appen dicitis, a majority were male, and two out of the 13 patients were obe se. The absence of any children under 4 years was consistent with the relative paucity of omental fat in younger children. We found no clear mechanism for primary omental torsion, although rotation around the r ight epiploic artery was observed.