Primary omental torsion in children: ten-year experience.

Primary omental torsion (POT), is a rare cause of acute abdomen commonly affecting obese male adults, whereas it is extremely rare in children. In this retrospective study, we present our experience regarding the management of five children with POT and discuss the diagnostic and therapeutic implications of this entity. We retrospectively reviewed the medical records of children diagnosed for POT, from January 1996 to July 2006 at our department. Among 2,734 children operated for acute appendicitis, five patients were diagnosed with POT (ratio 1:587 or 0.18%). Clinical presentation, laboratory findings, diagnostic imaging results as well as surgical and histological findings were reviewed. There were four boys and one girl, M/F ratio 4:1, with a mean age of 9.5 years (range 7.2-10.3). All subjects were obese and their weight percentages were over 85% for their age group. On admission the clinical symptoms and laboratory findings were similar to those of acute appendicitis. They were submitted to laparotomy and the surgical findings were; free serosanguineous fluid in the peritoneal cavity, normal appendix and an ischemic twisted mass of the omentum at the right side of the abdomen. The mass and the appendix were excised and the postoperative course was uneventful. The histological examination of the specimens revealed hemorrhagic ischemic necrosis of the omentum and normal appendix. POT is very rare in children. In the pediatric age group the clinical presentation and the laboratory findings are similar to those of acute appendicitis and it is extremely difficult to be diagnosed preoperatively. Obesity seems to be an important predisposing high-risk factor. Excision of the twisted omentum is the treatment of choice.

Paraesophageal hernia in childhood.

AIM OF THE STUDY: Paraesophageal hernia is a particularly rare condition in childhood. Sometimes it is possible to have an asymptomatic course and to be discovered incidentally. Anyway there are no more than 20 reported cases of which only two are well studied and documented to be real paraesophageal hernias. CASE REPORT: Patients were all over 4 years old except for our little patient which was 18 months old, the only infant reported with this condition. On the contrary it is the most common postoperative complication of Nissen fundoplication, which is the most commonly performed, surgical technique for the correction of gastroesophageal reflux in children. CONCLUSIONS: The Authors believe that the presentation of this case with all its special characteristics will improve knowledge about this rare entity and add information about its treatment and surgical correction that are use full for all doctors that care children.