Abstract: Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few cases are known. Objec tive: To analyze through a clinical case the characteristics and management of this pathology, to consider this entity in the differential diagnosis of acute abdominal pain. Clinical Case: An 11-year- old child consulted the emergency department due to a 48-hour history of continuous abdominal pain, which had progressively increased. On the physical examination, the patient presented pain in the right side of the abdomen and the epigastric area, with no signs of peritoneal irritation, and was overweight (BMI 91st percentile). Biochemical analysis showed a slight increase in c-reactive protein (CRP) 41.31 mg/L (reference value < 3.0 mg/L) without leukocytosis and normal ultrasound study, without visualization of the appendix. Due to persistent pain, increased CRP, and absence of appen dix visualization in the ultrasound, the study was completed with an abdomen and pelvis CT scan which showed trabeculation of the fat of the anterior right subhepatic space, thus diagnosing omental infarction. The patient was hospitalized for conservative management with analgesia, anti-inflamma tory drugs, and fluid therapy, presenting good evolution in the first 48 hours. Conclusion: Omental infarction is an infrequent cause of acute abdominal pain in childhood. Imaging studies play a funda mental role in the differential diagnosis of this entity with other clinical conditions of similar course, thus avoiding unnecessary surgical interventions.

Resumen: Introducción: El infarto omental describe la torsión isquémica de la porción distal del omento y constituye una causa infrecuente de dolor abdominal agudo en la infancia, de la que se conocen pocos casos. Objeti vo: Analizar a través de un caso clínico sus características y manejo, dando así a conocer esta entidad en el diagnóstico diferencial del dolor abdominal agudo. Caso Clínico: Varón de 11 años que con sultó en el servicio de urgencias por dolor abdominal continuo de 48 horas de evolución, que había aumentado progresivamente. A la exploración destacaba dolor en epigastrio y hemiabdomen derecho sin signos de irritación peritoneal y sobrepeso con un índice de masa corporal (IMC) en percentil 91. En el análisis bioquímico destacaba aumento de Proteína C Reactiva (PCR) 41,31 mg/L (valor de referencia < 3,0 mg/L) sin leucocitosis y estudio ecográfico normal, sin lograr visualizar apéndice. Ante persistencia del dolor, aumento de PCR y ausencia de visualización de apéndice en la ecografía, se completó estudio con una tomografía computarizada (TC) abdomino-pélvica en la que se objetivó trabeculación de la grasa del espacio subhepático anterior derecho, siendo diagnóstico de infarto omental. Se hospitalizó para manejo conservador con analgesia, antiinflamatorios y fluidoterapia presentando buena evolución en las primeras 48 horas. Conclusión: El infarto omental es causa poco frecuente de dolor abdominal agudo en la infancia. Los estudios de imagen desempeñan un papel fundamental en el diagnóstico diferencial de esta entidad con otros cuadros clínicos de curso similar, evitando así intervenciones quirúrgicas innecesarias.

The majority of children with Down syndrome (DS) tend to have frequent bacterial infections including recurrent respiratory infections. Our objective was to evaluate the production of antibodies to pneumococcal polysaccharide antigens after active immunization in DS subjects. IgG antibodies to pneumococcal serotypes (1, 3, 6B, 9V, and 14) were measured before and 6 weeks after immunization with a 23-valent pneumococcal vaccine (Pneumo23®, Pasteur-Merrieux) in 6- to 13-year-old DS children (N = 17) and in aged-matched normal controls (N = 30). An adequate response was defined as a 4-fold increase over baseline or a post-immunization level of specific pneumococcal serotype antibody > or = 1.3 µg/mL. After immunization, all DS children had an increase in post-immunization levels against all serotypes analyzed. A 4-fold or more increase was observed in all DS children concerning serotypes 1 and 14, in 90% of subjects for serotypes 3 and 9V, and in 65% for serotype 6B. Regarding this increase, 8 of the 17 DS children had an adequate response to all serotypes analyzed, 8/17 patients to 4 serotypes and 1/17 to 3 serotypes. However, when we compared post-immunization levels between DS children and controls, we observed lower levels in the former group (P < 0.05) for all serotypes except serotype 3. We conclude that pneumococcal polysaccharide immunization could be beneficial for these DS children.