Omental torsion should not be overlooked during negative appendectomy for acute right lower quadrant abdominal pain in children: A case report

Acute appendicitis is the most common indication for surgery in children presenting with abdominal pain. Its diagnosis is based on a combination of clinical, laboratory, and radiologic findings. In this case report, we present a patient who was considered to have acute appendicitis on clinical, laboratory, and radiologic grounds, but was found intraoperatively to have omental torsion. A 9-year-old boy presented to the emergency department with right lower quadrant (RLQ) abdominal pain, vomiting, and loss of appetite. Following evaluation—particularly abdominal ultrasonography (USG) demonstrating a hyperechoic solid lesion within the mesenteric tissue along with mild mesenteric haziness—he underwent surgery with a preliminary diagnosis of perforated plastron appendicitis. Intraoperatively, the appendix was normal. Further exploration revealed a torsioned segment of omentum in the umbilical region, which was resected. The patient had an uneventful postoperative recovery and was discharged in good condition. Although omental torsion is rare in childhood, it can present with acute RLQ pain and closely mimic appendicitis; therefore, it should be considered in the differential diagnosis.