Presentation
Presented with acute right iliac fossa (RIF) pain extending to right upper quadrant and fever. Physical examination revealed abdominal tenderness in the RIF with positive rebound tenderness. C-reactive protein is elevated.
Patient Data
Color Doppler ultrasound image of the right lower quadrant shows an ovoid area of echogenic fat that corresponds to the area of pain. No increased flow on color Doppler imaging.
The appendix is not visualized.
Selected images of a contrast enhanced abdomen CT scan in the portal venous phase.
Large (>5 cm) non-enhancing, elongated, fat attenuation mass lesion with hyperdense peripheral halo, located in the right upper quadrant, deep to the rectus abdominis muscle and adjacent to, but separate from, the ascending colon.
No bowel wall thickening or lymphadenopathy.
The appendix is normal - no signs of appendicitis.
The size and right-sided location make it much more likely to be a mesenteric infarction rather than epiploic appendagitis, although both are possible.
Case Discussion
Omental infarction is an uncommon cause of acute abdomen in children and is usually seen in obese children with appendicitis-like abdominal pain.
This diagnosis is important to make as it will be treated by conservatively rather than surgically.
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