Laparoscopic surgery for pediatric idiopathic omental torsion Nobuhiro TADA 1 , Hajime IMAMURA 1 , Daisuke KAWAHARA 1 , Hirotaka TOKAI 1 , Kazumasa NODA 1 , Keiji INOUE 1 1Department of Surgery, Nagasaki Harbor Medical Center City Hospital Keyword: 特発性大網捻転 , 小児 , 腹腔鏡 pp.121-126
Published Date 2020/3/15
DOI https://doi.org/10.11477/mf.4426200786
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 A 5-year-old girl presented to our emergency department for evaluation of right lower abdominal pain concomitant with low-grade fever that lasted for two days. The physical examination showed clear tenderness and muscle guarding in the right lower quadrant of the abdomen. Laboratory tests demonstrated leukocytosis(20.7×1000/μl) and elevation of C-reactive protein(17.4mg/dl). A computed tomography scan revealed a slightly swollen appendix and a large fatty density mass with lineal strands inside the ascending colon. The initial diagnosis was acute appendicitis and she underwent an emergent laparoscopic exploration via the umblilicus. The laparoscopy revealed mild hemorrhagic ascites in the pelvis and a thick uneven mass in the right lower abdominal cavity. The mass was found to be a necrotic omentum that was twisted around its vascular axis several times. The appendix was normal in appearance. We performed partial omentectomy including all the necrotic areas of the omentum without appendectomy. The clinical course was uneventful and the patient was discharged at postoperative day 4. Laparoscopic approach was effective in the diagnosis and treatment for pediatric patient with omental torsion.

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