{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T11:25:07Z","timestamp":1768217107949,"version":"3.49.0"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Background<\/jats:title>\n Omental torsion is an uncommon cause of acute abdomen in children and is usually secondary to other intra-abdominal pathology. Congenital midgut malrotation can alter anatomic relationships and lead to atypical presentations. This case report aims to highlight that congenital malrotation should be considered when left-sided appendicitis is suspected, especially when omental abnormalities are present.<\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n We report a 12-year-old child who presented to a tertiary children's hospital in Southwest China with more than 48\u2005h of abdominal pain and 24\u2005h of fever after heavy intake of indigestible meat-based snacks. Initial ultrasound showed diffuse omental thickening in the left abdomen. Repeat ultrasound revealed a hypoechoic avascular area in the perisplanic omentum, raising suspicion of omental torsion. Preoperative computed tomography demonstrated left-sided ileocecal localization consistent with midgut malrotation and features of appendicitis with localized peritonitis. Laparoscopy confirmed purulent peritonitis, a left-sided perforated appendix with abscess, and torsion of the greater omentum near the splenic pole. Appendectomy with peritoneal lavage and drainage was performed, while the omentum was managed conservatively because of gross contamination and the absence of overt necrosis. Postoperative ultrasound showed preserved omental perfusion and confirmed malrotation without volvulus. The patient recovered uneventfully and remained symptom-free during outpatient follow-up.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n When children present with left-sided appendicitis and omental abnormalities, congenital midgut malrotation should be considered early in the diagnostic process to optimize preoperative planning. Ultrasound is invaluable for detecting omental changes, whereas an upper gastrointestinal contrast study remains the reference test for confirming malrotation in stable patients. This case underscores the importance of close collaboration between pediatric radiologists and surgeons in managing atypical acute abdomen.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2025.1728905","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:13:32Z","timestamp":1768205612000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Midgut malrotation presenting as left-sided appendicitis with secondary omental torsion: a diagnostic challenge in a child"],"prefix":"10.3389","volume":"13","author":[{"given":"Han","family":"Yao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puneng","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruiqi","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenghao","family":"Zhanghuang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Yi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"4046","DOI":"10.1016\/j.asjsur.2023.04.047","article-title":"Laparoscopic treatment of primary omental torsion in children: a case report","volume":"46","author":"Liu","year":"2023","journal-title":"Asian J Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.jviscsurg.2013.09.001","article-title":"Omental torsion, a rare cause of acute surgical abdomen","volume":"150","author":"Le Roux","year":"2013","journal-title":"J Visc Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1177\/0036933015581129","article-title":"Unusual cause of acute abdomen in a child\u2013torsion of greater omentum: report of two cases","volume":"60","author":"Pogoreli\u0107","year":"2015","journal-title":"Scott Med J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.1097\/PEC.0000000000001230","article-title":"Primary omental torsion in a pediatric patient: case report and review of the literature","volume":"34","author":"Madha","year":"2018","journal-title":"Pediatr Emerg Care"},{"key":"B5","first-page":"1030","article-title":"Primary omental torsion in children in the laparoscopy era: what have we learned so far?","volume-title":"in Vivo","author":"Alexopoulos","year":"2024"},{"key":"B6","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/1749-7922-6-22","article-title":"Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review","volume":"6","author":"Emanuwa","year":"2011","journal-title":"World J Emerg Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s40644-020-00332-z","article-title":"Greater omentum imaging-reporting and data system: establishing the grade of benign and malignant lesions of the greater omentum using ultrasonography","volume":"20","author":"Chen","year":"2020","journal-title":"Cancer Imaging"},{"key":"B8","first-page":"644","article-title":"Role of upper gastrointestinal contrast studies for suspected malrotation in neonatal population","volume-title":"J Paediatr Child Health","author":"Birajdar","year":"2017"},{"key":"B9","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/1749-7922-8-19","article-title":"Successful treatment of a 14-year-old patient with intestinal malrotation with laparoscopic ladd procedure: case report and literature review","volume":"8","author":"Nakajima","year":"2013","journal-title":"World J Emerg Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.gassur.2024.05.024","article-title":"Intestinal malrotation in the adult population: diagnosis, management, and outcomes after laparoscopic ladd procedure","volume":"28","author":"Gomaa","year":"2024","journal-title":"J Gastrointest Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1177\/000313480707300711","article-title":"Laparoscopic ladd procedure: a minimally invasive approach to malrotation without midgut volvulus","volume":"73","author":"Draus","year":"2007","journal-title":"Am Surg"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1728905\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:13:34Z","timestamp":1768205614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1728905\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":11,"alternative-id":["10.3389\/fped.2025.1728905"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1728905","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1728905"}}