Abdominal pain in a 9-year-old: omental torsion masquerading as appendicitis

A 9-year-old boy was referred to the emergency department by his GP with abdominal symptoms. He complained of periumbilical pain for 3 days which had gradually radiated to his right iliac fossa in the 12 hours before presentation. The pain was colicky, intermittent in nature and exacerbated by moving or eating. There was associated anorexia and nausea but no vomiting. Bowel pattern had remained normal throughout and no urinary symptoms were noted. On presentation he graded the pain as 10/10. A collateral history was taken from his mother who verified the symptoms. There was no history of trauma. On examination he was flushed, dehydrated but apyrexial. Cardiorespiratory examination was normal. Abdominal examination revealed tenderness and guarding in the right iliac fossa. Bowel sounds were normal and he had a positive Rovsing's test. Laboratory investigations revealed a normal full blood count (white cell count of 8.76 × 106), a normal renal profile and a normal serum amylase. Erythrocyte sedimentation ra...