Year : 2004 | Volume
: 10 | Issue : 3 | Page : 157--159
Omental infection secondary to blunt trauma in a child
Asal Izzidien Al-Samarrai1, Jenny Almond2, Ayodele Kolawole Adebanjo1,
1 Department of Surgery, Prince Charles Hospital, Wales, United Kingdom
2 Department of Pediatric Radiology, Prince Charles Hospital, Wales, United Kingdom
Asal Izzidien Al-Samarrai
Department of Surgery, Prince Charles Hospital Merthyr Tydfil CF47 9DT, Wales
|How to cite this article:|
Al-Samarrai AI, Almond J, Adebanjo AK. Omental infection secondary to blunt trauma in a child.Saudi J Gastroenterol 2004;10:157-159
|How to cite this URL:|
Al-Samarrai AI, Almond J, Adebanjo AK. Omental infection secondary to blunt trauma in a child. Saudi J Gastroenterol [serial online] 2004 [cited 2022 Jan 22 ];10:157-159
Available from: https://www.saudijgastro.com/text.asp?2004/10/3/157/33331
Minor blunt abdominal tumor is usually selflimited and therefore treated conservatively. However certain cases present with subtle findings which may require surgical intervention. This paper describes unusual findings following a history of minor trauma to a child.
An 8-year old child presented with a history of abdominal pain. His father had noticed that his child was walking awkwardly and on questioning he said he had fallen while playing tag at school. Next day a different story emerged; his brother with whom he had been playing rough and tumble, had hit him twice in the abdomen. He came initially to the Casualty Department and was sent home as a physical examination was unremarkable apart from minimal tenderness around the umbilicus. He returned the following day, by which time he was unable to lie on the bed and the Casualty Officer felt that he needed admission for assessment. Although the child looked very well at the time of examination he was tearful and very reluctant to be examined, refusing to sit forward as he said it hurts. His blood pressure, pulse, respiratory rate and temperature were normal. There were no bruises over the abdominal wall but he had localized tenderness and rigidity over the right side of his abdomen. Bowel sound was normal. Investigations showed leucocylosis of 14.0x10^9/L and CRP of 64.9mg/l, otherwise his blood picture urea and electrolytes and serum amylase were normal. An urgent computed tomography (CT) scan revealed no evidence of focal injury in the liver, spleen, pancreas and kidneys. There is a segment of abnormal bowel with narrowing of the lumen and thickening of its wall in the right iliac fossa. Its exact nature is uncertain but raises suspecion of appendicitis or localized inflammatory bowel change. Proximal gas distended bowel loops are noted.
No evidence of fluid collection in the upper abdomen, flanks and pelvis. He was kept under observation overnight. When the child was examined next morning the tenderness on the right side of his abdomen was more exaggerated and he was taken for laparotomy. A 300 mls of free blood was found in the peritoneal cavity and there was a 10 x 7cm piece of necrotic hemorrhaged omentum, which was excised [Figure 1]. Histology showed hemorrhage and acute inflammation.
Although most traumatic abdominal injuries in children are treated conservatively, traumatic perforation or infarction of the gastrointestinal tract still necessitates surgical management. It is imperative to recognize the often subtle CT findings of bowel or mesenteric trauma in children. Pediatric patients with bowel perforation or infarction due to trauma usually demonstrate multiple abnormalities at CT. computed tomographic findings in children with bowel or mesenteric trauma include free intraperitoneal air, free retroperitoneal air, extra luminal oral contrast material, free intraperitoneal fluid, bowel wall defect, bowel wall thickening, mesenteric stranding, fluid at the mesenteric root, focal haematoma, active hemorrhage and mesenteric pseudoaneurysm. Some findings, such as free intraperitoneal air and focal bowel wall thickening are associated with a strong likehood of bowel injury that require surgical repair. Other findings such as free intraperitoneal fluid, mesenteric stranding, fluid at the mesenteric root, and focal haematoma are less specific for an injury that require surgical repair  . A mesenteric haematoma resulting from a handlebar injury in a 4-year-old boy was reported in 1999  . Abdominal sonography showed a heterogenous hypoechoic mass with an echogenic wall in the central portion of the abdomen. Colour doppler's study revealed vascularity at the periphery of the lesion, suggesting mesenteric haematoma. Large haematomas were seen in the mesentery as well as unsuspected splenic laceration in a 4-year-old boy who was a back-seat passenger in a head-on collision. At laparoscopy a jejunal perforation were found and successfully repaired laparoscopically  . Blunt abdominal trauma is common in children. Handlebar injuries may produce duodenal haematoma and pancreatic injuries but mesenteric haematoma is relatively uncommon. Spontaneous omental infarction has also been reported in the literature and commonly mimics acute appendicitis ,, , however this does not seem to be the case in our patient. He had history of blunt trauma confined to the abdomen, corresponding to hemmorrhage and acute inflammation of the omentum. In conclusion, the lesson from this case is to take seriously blunt trauma in children presented with clinical features related to abdominal pain. These children require admission, evaluation and regular monitoring and investigation such as ultrasound and/or CT scan if the child does not respond to conservative treatment.
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