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Laasri K, Izi Z, harras YE, Bekkaoui R, El aoufir O, Laamrani FZ, Jroundi L. Primary caecal epiploic appendagitis mimicking acute appendicitis: A diagnostic dilemma of right lower abdominal pain. Radiol Case Rep 2024; 19:4104-4107. [PMID: 39104449 PMCID: PMC11299564 DOI: 10.1016/j.radcr.2024.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 08/07/2024] Open
Abstract
Epiploic appendagitis is a benign and self-limiting condition that has garnered more recognition, particularly in preoperative settings, thanks to advancements in imaging techniques, notably computed tomography (CT). Its distinct radiologic features facilitate accurate diagnosis prior to surgery. Despite its unique characteristics, the clinical presentation of epiploic appendagitis often resembles that of various other intra-abdominal medical and surgical conditions, leading to potential confusion. Here, we present the case of a 37-year-old otherwise healthy woman who was diagnosed with primary epiploic appendagitis based on CT scan findings conducted initially for suspected appendicitis. The patient received successful conservative treatment. This paper seeks to highlight the importance of recognizing this clinical condition and its characteristic imaging features, aiming to prevent unnecessary hospitalizations, antibiotic treatments, and the associated morbidity and mortality linked with surgical interventions.
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Affiliation(s)
- Khadija Laasri
- Department of Emergency Radiology. Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Zineb Izi
- Department of Emergency Radiology. Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Yahya El harras
- Department of Emergency Radiology. Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Rayane Bekkaoui
- Department of Emergency Radiology. Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Omar El aoufir
- Department of Emergency Radiology. Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Fatima Zahra Laamrani
- Department of Emergency Radiology. Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Laila Jroundi
- Department of Emergency Radiology. Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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2
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El-Menyar A, Naqvi SGA, Al-Yahri O, Abusal AM, Al-Shaikhli A, Sajid S, Abdelrahman H, Kloub AG, Ibnas M, Latifi R, Toble YMR, Al-Thani H. Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases. World J Surg 2024; 48:1363-1372. [PMID: 38558004 DOI: 10.1002/wjs.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. METHODS An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. RESULTS There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. CONCLUSION This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Syed G A Naqvi
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Omer Al-Yahri
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Sadia Sajid
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad G Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Muhamed Ibnas
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Latifi
- Kosova College of Surgeons, Prishtina, Kosova, and University of Arizona, Tucson, Arizona, USA
| | - Yasser M R Toble
- Department of Anesthesiology and Pain Management, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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3
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Sahoo J, Bera S, Sarangi PK, Majumdar PK. Secondary Epiploic Appendagitis – Report of Three Cases with CT Findings. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2024; 17:639-643. [DOI: 10.4103/mjdrdypu.mjdrdypu_140_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/09/2023] [Indexed: 09/29/2024] Open
Abstract
ABSTRACT
Epiploic appendages are the fat-containing peritoneal pouches usually seen in the anti-mesenteric border, adjacent to the large bowel loop. The major components are adipose tissue and vessels. The exact functions are not understood. Epiploic appendagitis (EA) is an inflammatory process, primarily may be due to torsion or vascular occlusion or may be secondarily related to other inflammatory processes. Symptoms vary from mild abdominal pain to severe variety, depending on the underlying cause. Primary EA is a benign self-limiting condition and does not require any surgical intervention, whereas secondary cause of inflammation needs management of underlying pathology. Proper diagnosis plays a vital role in appropriate management. Cross-sectional study like computed tomography (CT) is the ideal choice of imaging. On CT, epiploic appendigitis appears as round to oval fat-attenuating lesions with hyperattenuating peripheral rim, usually abutting the adjacent large bowel. Chronic inflammation shows peripheral calcification, may detach, and appears as intra-abdominal loose body. We describe three cases of secondary EA with CT imaging features, which will guide the clinician in proper management, avoiding unwarranted surgery or hospitalization.
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Affiliation(s)
- Jyotibash Sahoo
- Department of Radiology, Central Hospital, South-Eastern Railway, Garden Reach, Kolkata, West Bengal, India
| | - Sourav Bera
- Department of Radiology, Central Hospital, South-Eastern Railway, Garden Reach, Kolkata, West Bengal, India
| | - Pradosh Kumar Sarangi
- Department of Radiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Prasanta K. Majumdar
- Department of Radiology, Central Hospital, South-Eastern Railway, Garden Reach, Kolkata, West Bengal, India
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Wong J, Lau KK. Prevalence of SIRS with primary epiploic appendagitis. Emerg Radiol 2024; 31:17-23. [PMID: 38049601 DOI: 10.1007/s10140-023-02191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE Primary epiploic appendagitis (PEA) is not an uncommon cause of abdominal pain. The systemic inflammatory response syndrome (SIRS) criteria have high sensitivity for early detection of inflammation and infection. To date, there is limited data about the association between SIRS and PEA. The aims of this retrospective study were to evaluate the prevalence of SIRS response and its clinical relevance in patients diagnosed with PEA within a large tertiary hospital network. METHODS A retrospective study was performed on all consecutive adult patients who presented to four major emergency departments with CT-confirmed PEA from 01 January 2022 to 27 March 2023. The fulfilment of SIRS criteria, hospital admission rate and treatments provided were analysed for these patients. RESULTS Seventy-three patients had CT-confirmed PEA. Seventeen patients (23.2%) with PEA were SIRS positive. The hospital admission rate in the SIRS group trended higher than the non-SIRS group (odds ratio of 2.51, 95% CI (0.75, 8.39)). The odds of having an associated radiological comorbidity unrelated to PEA were 18.7 times higher in the SIRS positive group. Fifty-seven (78%) patients were discharged home, and 16 (22%) patients were admitted into hospital. Nearly all patients were treated conservatively (98.6%). CONCLUSION PEA patients with SIRS response trend towards a higher hospital admission rate and are significantly more likely to have other radiological comorbidities than non-SIRS patients. It is important to look for other pathological conditions in a SIRS positive patient with a CT-diagnosis of PEA.
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Affiliation(s)
- Julian Wong
- Diagnostic Imaging, Monash Health, Melbourne, VIC, Australia.
| | - Kenneth K Lau
- Diagnostic Imaging, Monash Health, Melbourne, VIC, Australia
- Faculty of Medicine, Monash University, Clayton, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
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Lee HJ, Kim J, Suh SO. [A Case of Epiploic Appendagitis after COVID-19]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 81:125-128. [PMID: 36960695 DOI: 10.4166/kjg.2022.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 06/18/2023]
Abstract
Acute epiploic appendagitis is an uncommon cause of abdominal pain resulting from appendageal ischemia caused by torsion or thrombosis of the draining vein. It is frequently misdiagnosed as acute appendicitis or diverticulitis. The coronavirus disease 2019 (COVID-19) pandemic has changed how this rare disease is diagnosed. There was a report of a young men diagnosed with COVID-19 and epiploic appendagitis as a rare cause of abdominal pain. In addition, a 50-year-old men was diagnosed with epiploic appendagitis during the treatment of COVID-19. This paper reports the case of a 53-year-old men who presented with right lower quadrant abdominal pain after COVID-19 and was diagnosed with acute epiploic appendagitis by computed tomography image findings. The thrombotic condition of COVID-19 may contribute to acute appendagitis, but more studies are needed to confirm this hypothesis.
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Affiliation(s)
- Hun Joo Lee
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jaeyeon Kim
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Seong O Suh
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
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Kahveci S, Zitouni S, Abubakar AR, İkizceli T, Ozturk M, Aktürk A, Aksu Y. Primary Epiploic Appendagitis: Not Rare But Rarely Diagnosed Pathology. Curr Med Imaging 2023; 19:1279-1285. [PMID: 36642882 DOI: 10.2174/1573405619666230113122949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/06/2022] [Accepted: 11/23/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study is to determine the clinical and laboratory parameters which may be suggestive of or even pathognomonic for primary epiploic appendagitis (PEA) and to discuss the diagnostic efficacy of ultrasound (US) compared to computed tomography (CT) in patients with PEA. MATERIALS AND METHODS For this retrospective study, 92 patients diagnosed with PEA using US, CT or both modalities were included. All patient symptoms, clinical findings and laboratory parameters were reviewed. The CT and US images of the PEA were evaluated for lesion size and location, the relationship of the lesion to the colon and the distance of the lesion to the skin. RESULTS There were 16 female and 76 male patients in the study group. The mean age was 35 years (range: 38-79 years). Well-localized abdominal pain was the primary symptom in all patients. The mean leukocyte count was 7857±1326 mm-3. The most frequent localization of PEA was sigmoiddescending colon junction (79/92). In patients who were examined by both US and CT, the size of the fatty central core was between 15-48 mm (mean:28.10 mm) and 9-22 mm (mean:15.07 mm) in its long-axis and short-axis diameter, respectively on US, whilst that by CT was between 15-46 mm (mean:26.88 mm) and 9-21 mm (mean:14.40 mm) in its long-axis and short-axis diameter, respectively. In patients who were examined by both US and CT, the mean distance of the lesions to the skin was 20.80 mm and 33.97 mm, respectively. All patients were treated conservatively with complete resolution of symptoms within a week of presentation. CONCLUSION PEA is an unrare self-limiting condition that should be considered in the differential diagnosis of acute abdomen. To support clinicians and radiologists regarding PEA and its clinical, laboratory and radiological findings, targeted sonographic examination - which is radiation and contrast agent-free - could be highly sufficient for the diagnosis of PEA and may prevent unnecessary further imaging and mistreatment.
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Affiliation(s)
- Servet Kahveci
- Department of Radiology, Qatar University Health Center, Doha, Qatar
| | - Soubhi Zitouni
- Department of Radiology, Abu Baker Al Siddiq Health Center, Doha, Qatar
| | | | - Turkan İkizceli
- University of Health Sciences, Haseki Training and Research Hospital, Radiology, Istanbul, Turkey
| | - Mehmet Ozturk
- Department of Radiology, Selcuk University Faculty of Medicine, Division of Pediatric Radiology, Alaeddin Keykubat Yerleşkesi, Akademi Mah. Yeni Istanbul Street. No: 369, Konya, Turkey
| | - Adem Aktürk
- Surp Pırgiç Armenian Hospital Radiology Department, Istanbul, Turkey
| | - Yusuf Aksu
- Nevşehir State Hospital Radiology Department, Nevşehir, Turkey
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Kefala MA, Tepelenis K, Stefanou CK, Stefanou SK, Papathanakos G, Kitsouli A, Tepelenis N, Kitsoulis P. Primary Epiploic Appendagitis Mimicking Acute Appendicitis: A Case Report and Narrative Review of the Literature. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 76:88-93. [PMID: 32839372 DOI: 10.4166/kjg.2020.76.2.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 11/03/2022]
Abstract
Primary epiploic appendagitis is uncommon and is estimated to induce 1.1-1.3% of all abdominal pain. We report a 42-year-old male who appeared in the morning in the emergency department with abdominal pain localized in the right lower abdomen and associated with anorexia and nausea. Clinical examination, laboratory tests, and abdominal ultrasound revealed deep tenderness at Mc Burney point and a mild elevation of CRP (0.7 mg/dL). In the evening, the symptoms were exacerbated, and a diagnostic laparoscopy was performed. Intra-operatively, the appendix was normal and a twisted, necrotic epiploic appendage originating from the antimesenteric border of the mid ascending colon was found. Laparoscopic resection of the necrotic epiploic appendage and prophylactic appendectomy was carried out. Histology indicated the diagnosis of the necrotic epiploic appendage. Postoperatively, the patient recovered without complications. Although the preoperative diagnosis of primary epiploic appendagitis has improved due to abdominal ultrasound and mainly CT, there are still cases which are diagnosed during laparoscopy. The treatment of choice is conservative management, while the use of antibiotics remains controversial. The relapse and complication rates are rare. Surgical excision, particularly laparoscopic, should be considered in cases of uncertain diagnosis, persistent symptoms, or recurrence.
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Affiliation(s)
- Maria Alexandra Kefala
- Department of Pediatrics, General Hospital of Ioannina "G. Xatzikosta", Ioannina, Greece
| | - Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | | | | | | | | | - Panagiotis Kitsoulis
- Anatomy-Histology-Embryology, University of Ioannina, Ioannina, Greece.,Department of Orthopaedics, University Hospital of Ioannina, Ioannina, Greece
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Abstract
Acute epiploic appendagitis is a benign condition caused by inflammation of the epiploic appendages that are serosal lined outpouchings of the colon lying adjacent to the tenia coli. This rare condition has non-specific clinical findings and is frequently misdiagnosed as either acute diverticulitis or acute appendicitis. However, unlike other surgical causes of acute abdomen, epiploic appendagitis is a self-limited condition and resolves with conservative management. CT of the abdomen plays a vital role in diagnosing this condition and excluding other causes of acute abdomen. This case report highlights the importance of being aware of this rare condition and its consideration in the differential diagnosis of acute lower abdominal pain to avoid unnecessary hospitalization and surgery.
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Affiliation(s)
| | - David Lerner
- Department of Radiology: Abdominal Imaging, University of Washington, Seattle, USA
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Giannis D, Matenoglou E, Sidiropoulou MS, Papalampros A, Schmitz R, Felekouras E, Moris D. Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:814. [PMID: 32042830 PMCID: PMC6989878 DOI: 10.21037/atm.2019.12.74] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/15/2019] [Indexed: 12/20/2022]
Abstract
Primary epiploic appendagitis (PEA) is a rare and frequently underdiagnosed cause of acute abdominal pain. PEA most commonly affects obese, male patients in the 4th and 5th decade of life. Clinical presentation includes acute, localized, non-migrating pain without fever, nausea, vomiting or diarrhea and the laboratory workup is usually within normal limits. PEA is commonly mistaken as other more severe causes of acute abdominal pain, such as diverticulitis, acute appendicitis or cholecystitis and thus patients undergo unnecessary diagnostic and therapeutic procedures. The emergence of computerized tomography (CT) as the gold standard imaging test in diagnostic dilemmas of acute abdominal pain has resulted in increased recognition and diagnosis of PEA. Upon confirmation, PEA is considered a self-limiting disease and is managed conservatively with analgesics, occasionally combined with nonsteroidal anti-inflammatory drugs (NSAIDS). Persistence of symptoms or recurrence mandate the consideration of surgical management with laparoscopic appendage excision as the definitive treatment. We review the current literature of PEA, with a focus on clinical and imaging findings, in order to raise awareness about this frequently misdiagnosed entity.
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Affiliation(s)
- Dimitrios Giannis
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Evangelia Matenoglou
- Department of Medical Imaging, Hippokratio General Hospital, Thessaloniki, Greece
| | | | | | - Robin Schmitz
- Duke Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Dimitrios Moris
- Duke Surgery, Duke University Medical Center, Durham, NC, USA
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Choi YI, Woo HS, Chung JW, Shim YS, Kwon KA, Kim KO, Kim YJ, Park DK. Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence. Intest Res 2019; 17:554-560. [PMID: 31602962 PMCID: PMC6821941 DOI: 10.5217/ir.2018.00148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/13/2019] [Indexed: 11/05/2022] Open
Abstract
Background/Aims There is limited data to compare the clinical characteristics and recurrence rates between left-sided primary epiploic appendagitis (PEA) versus left-sided acute colonic diverticulitis (ACD), and right-sided PEA versus right-sided ACD, respectively. Methods We retrospectively reviewed the medical records and radiologic images of the patients who presented with left-sided or right-sided acute abdominal pain and had computer tomography performed at the time of presentation showing radiological signs of PEA or ACD between January 2004 and December 2014. We compared the clinical characteristics of left PEA versus left ACD and right PEA versus right ACD, respectively. Results Fifty-six patients (left:right = 27:29) and 308 patients (left:right = 24:284) were diagnosed with symptomatic PEA and ACD, respectively. Left-sided PEA were statistically significantly younger (50.2 ± 15.4 years vs. 62.1 ± 15.8 years, P= 0.009), more obese (body mass index [BMI]: 26.3 ± 2.9 kg/m2 vs. 22.3 ± 3.1 kg/m2 , P< 0.001), and had more tendencies with normal or mildly elevated high-sensitivity C-reactive protein (hsCRP) (1.2 ± 1.3 mg/dL vs. 8.4 ± 7.9 mg/dL, P< 0.001) than patients with left-sided ACD. The discriminative function of age, BMI and CRP between left-sided PEA versus left-sided ACD was 0.71 (cutoff: age ≤ 59 years, sensitivity of 66.7%, specificity of 77.8%), 0.84 (cutoff: BMI > 24.5 kg/m2 , sensitivity of 80.0%, specificity of 80.0%) and 0.80 (cutoff: CRP < 1.8 mg/dL, sensitivity of 72.2%, specificity of 85.7%). Conclusions If patients with left lower quadrant abdominal pain are less than 60 years, obese (BMI > 24.5 kg/m2 ) with or without normal to mild elevated CRP levels (CRP < 1.8 mg/dL), it might be necessary for clinicians to suspect the diagnosis of PEA rather than ACD.
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Yang L, Jia M, Han P. Primary epiploic appendagitis as an unusual cause of acute abdominal pain in a middle-aged male: A case report. Medicine (Baltimore) 2019; 98:e16846. [PMID: 31415410 PMCID: PMC6831169 DOI: 10.1097/md.0000000000016846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary epiploic appendagitis (PEA) is a rare cause of acute abdomen caused by spontaneous torsion or venous thrombosis of epiploic appendices, it commonly manifests with acute lower quadrant pain, thus may mimic acute diverticulitis, appendicitis, or mesenteric infarction. PATIENT CONCERNS In this case report, we report a 44 years old man who presented with persistent sharp pain in the left lower quadrant abdomen, Laboratory tests were mostly normal, contrast enhanced computed tomography (CECT) revealed a slightly high density shadow with fat foci in the middle was presented around the local descending colon, accompanied by the adjacent peritoneal thickening. DIAGNOSES He was diagnosed with PEA as confirmed by an abdominal contrast enhanced computed tomography (CECT) scan. INTERVENTIONS He was followed up in the clinic without any dietary restrictions, antibiotic or analgesic drugs use. OUTCOMES The abdominal pain gradually subsided a week later, and there were no recurrence of the symptoms during follow-up. LESSONS In our case, the diagnosis of PEA using CECT allows the patient to avoid surgery and other invasive treatment.
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Affiliation(s)
- Lan Yang
- Department of Ultrasound, the Fifth People's Hospital of Nanchong
| | - Min Jia
- Department of radiology, Nanchong Central Hospital, Nanchong
| | - Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Impact of Radiology Report Wording on Care of Patients With Acute Epiploic Appendagitis. AJR Am J Roentgenol 2019; 212:1265-1270. [PMID: 30860892 DOI: 10.2214/ajr.18.20747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the association between the diagnostic certainty expressed by the wording of CT report impressions and subsequent use of standard treatment with analgesics versus nonstandard antibiotic administration in patients with acute epiploic appendagitis (EA). MATERIALS AND METHODS. Demographic, clinical, and radiologic data from a 10-year cohort of patients with acute EA were retrospectively analyzed and correlated with standard treatment with analgesics versus nonstandard treatment with antibiotics. A level of certainty was assigned to the CT report language based on the wording of the impression statements by two radiologists; their interreader agreement was assessed with kappa statistics. Bivariate analyses were performed to correlate all variables with antibiotic administration and to assess for collinearity. Multivariate logistic regression was performed to identify independent predictors of antibiotic use in patients with acute EA. RESULTS. Of 124 patients with CT-diagnosed acute EA, 22% (27/124) received antibiotic treatment. After the CT report impressions were evaluated, 27% (34/124) were categorized as low certainty and 73% (90/124) as high certainty (κ = 0.958, p < 0.001). Multivariate regression was significant (p < 0.001, Nagelkerke R2 = 0.249) and found CT report impressions' level of certainty (odds ratio [OR] = 6.1, p < 0.001) and evaluation in an outpatient clinic rather than an emergency department (ED) (OR = 4.4, p = 0.003) to be independent predictors of antibiotic administration for patients with acute EA. Outpatient presentation was also correlated with age, abdominal pain duration, and left-colonic involvement in the bivariate analysis (all p ≤ 0.01). CONCLUSION. The diagnostic certainty conveyed by the wording of CT report impressions correlated with antibiotic treatment decisions for patients with acute EA. Patients whose report impressions expressed low rather than high certainty were six times more likely to receive antibiotic therapy; patients evaluated at outpatient clinics rather than EDs were four times more likely.
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13
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Giambelluca D, Cannella R, Caruana G, Salvaggio L, Grassedonio E, Galia M, Midiri M, Salvaggio G. CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain. Insights Imaging 2019; 10:26. [PMID: 30796645 PMCID: PMC6386757 DOI: 10.1186/s13244-019-0715-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/04/2019] [Indexed: 12/18/2022] Open
Abstract
Epiploic appendagitis is a rare cause of acute abdominal pain, determined by a benign self-limiting inflammation of the epiploic appendages. It may manifest with heterogeneous clinical presentations, mimicking other more severe entities responsible of acute abdominal pain, such as acute diverticulitis or appendicitis. Given its importance as clinical mimicker, imaging plays a crucial role to avoid inaccurate diagnosis that may lead to unnecessary hospitalization, antibiotic therapy, and surgery. CT represents the gold standard technique for the evaluation of patients with indeterminate acute abdominal pain. Imaging findings include the presence of an oval lesion with fat-attenuation surrounded by a thin hyperdense rim on CT (“hyperattenuating ring sign”) abutting anteriorly the large bowel, usually associated with inflammation of the adjacent mesentery. A central high-attenuation focus within the fatty lesion (“central dot sign”) can sometimes be observed and is indicative of a central thrombosed vein within the inflamed epiploic appendage. Rarely, epiploic appendagitis may be located within a hernia sac or attached to the vermiform appendix. Chronically infarcted epiploic appendage may detach, appearing as an intraperitoneal loose calcified body in the abdominal cavity. In this review, we aim to provide an overview of the clinical presentation and key imaging features that may help the radiologist to make an accurate diagnosis and guide the clinical management of those patients.
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Affiliation(s)
- Dario Giambelluca
- Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Roberto Cannella
- Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giovanni Caruana
- Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Leonardo Salvaggio
- Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Emanuele Grassedonio
- Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Galia
- Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giuseppe Salvaggio
- Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.
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Nugent JP, Ouellette HA, O'Leary DP, Khosa F, Nicolaou S, McLaughlin PD. Epiploic appendagitis: 7-year experience and relationship with visceral obesity. Abdom Radiol (NY) 2018; 43:1552-1557. [PMID: 29043404 DOI: 10.1007/s00261-017-1355-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Location, size, and local inflammatory findings in primary epiploic appendagitis (EA) have not been reported outside of small studies. The association between EA and increased adiposity is controversial. The goals of this project are to compare demographics and imaging-based measurements of adiposity between patients with EA and patients with acute abdomen without EA, and to identify CT features of EA. METHODS A consecutive sample of acute, primary EA (n = 100), and control (acute abdomen; n = 100) was selected retrospectively. Cases of suspected EA were included if they had the characteristic ovoid fatty mass and hyperattenuated ring sign on CT. Abdominal adipose volume (AAV), visceral adipose area (VAA), and subcutaneous adipose area (SAA) were quantified by CT. Location, size, and frequency of coexisting local inflammatory findings in EA patients were recorded. RESULTS EA had 60% greater AAV, 117% greater VAA, and 35% greater SAA than control subjects (p < 0.0001). Males composed a great proportion of the EA group (67%) than the control group (41%) (p = 0.0002). Inflamed appendage was found in sigmoid colon in 49% of cases, descending colon in 23%, and right colon in 19%. Peritoneal thickening was frequent (76%) and bowel wall thickening was common (47%). Diverticulosis coexisted incidentally in 28%. CONCLUSION EA is associated with increased abdominal adipose tissue. EA can occur in both sexes at any age, but occurs at age 50 on average and more frequently in males. Patient with EA exhibited central hyperdense dot (79%), peritoneal thickening (76%), and bowel wall thickening (47%).
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Affiliation(s)
- James P Nugent
- Radiology Department, Vancouver General Hospital, 889 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Hugue A Ouellette
- Radiology Department, Vancouver General Hospital, 889 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - D Peter O'Leary
- Department of Surgery, Cork University Hospital, Cork, Ireland
| | - Faisal Khosa
- Radiology Department, Vancouver General Hospital, 889 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Savvas Nicolaou
- Radiology Department, Vancouver General Hospital, 889 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Patrick D McLaughlin
- Radiology Department, Vancouver General Hospital, 889 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
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15
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Charfi M, Hedfi M, Ben Salah Y, El Fourti S, Chouchen A, Bouhaouala MH. [Acute epiploic appendagitis imaging: Reporting of 3 cases and literature review]. Presse Med 2016; 45:1061-1065. [PMID: 27597304 DOI: 10.1016/j.lpm.2016.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/13/2016] [Accepted: 07/18/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mehdi Charfi
- Hôpital des FSI, service d'imagerie médicale, La Marsa, Tunisie
| | - Mohamed Hedfi
- Hôpital des FSI, service de chirurgie générale, La Marsa, Tunisie.
| | - Yosr Ben Salah
- Hôpital des FSI, service d'imagerie médicale, La Marsa, Tunisie
| | - Slim El Fourti
- Hôpital des FSI, service d'imagerie médicale, La Marsa, Tunisie
| | - Adnene Chouchen
- Hôpital des FSI, service de chirurgie générale, La Marsa, Tunisie
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16
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Eberhardt SC, Strickland CD, Epstein KN. Radiology of epiploic appendages: acute appendagitis, post-infarcted appendages, and imaging natural history. Abdom Radiol (NY) 2016; 41:1653-65. [PMID: 27142382 DOI: 10.1007/s00261-016-0757-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Our aim was to demonstrate the imaging characteristics of epiploic appendages in native, acute inflamed/ischemic and post-infarcted states through retrospective imaging analysis, with clinical and pathologic correlation, and to discuss clinical implications. Cases were gathered mostly retrospectively and reviewed for inclusion based on established diagnostic criteria. Radiology report text search was used to find cases, using terms "epiploic," "appendage," "appendagitis," and "peritoneal body." Data records included patient demographics, relevant clinical data, lesion size, location and apparent imaging composition, and the presence of change or stability in features over multiple studies. Pathologic and clinical data were sought and assessed for correlation. Imaging studies of 198 individuals were included (mean age 50, range 9-95), with a total of 228 lesions: 63 acute and 165 non-acute presentations. All included subjects had CT imaging and some had lesions visible on radiographs, MRI, PET/CT, and sonography. 23 subjects had more than one studied lesion. In addition to classic acute appendagitis, more frequently encountered are post-infarcted appendages either in situ along the colon, adhered to peritoneal or serosal surfaces, or freely mobile in the peritoneum as loose bodies. The majority of the non-acute varieties are recognizable due to peripheral calcification that develops over time following ischemic insult. Multiple cases demonstrated the imaging natural history and confirmed pathologic basis for imaging findings. In summary, acute and post-infarcted epiploic appendages have characteristic imaging appearances and natural history which should provide correct diagnosis in most cases. Incidental post-infarcted epiploica are more commonly encountered than acute presentations.
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17
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Hwang JA, Kim SM, Song HJ, Lee YM, Moon KM, Moon CG, Koo HS, Song KH, Kim YS, Lee TH, Huh KC, Choi YW, Kang YW, Chung WS. Differential diagnosis of left-sided abdominal pain: Primary epiploic appendagitis vs colonic diverticulitis. World J Gastroenterol 2013; 19:6842-6848. [PMID: 24187459 PMCID: PMC3812483 DOI: 10.3748/wjg.v19.i40.6842] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/16/2013] [Accepted: 09/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical characteristics of left primary epiploic appendagitis and to compare them with those of left colonic diverticulitis.
METHODS: We retrospectively reviewed the clinical records and radiologic images of the patients who presented with left-sided acute abdominal pain and had computer tomography (CT) performed at the time of presentation showing radiological signs of left primary epiploic appendagitis (PEA) or left acute colonic diverticulitis (ACD) between January 2001 and December 2011. A total of 53 consecutive patients were enrolled and evaluated. We also compared the clinical characteristics, laboratory findings, treatments, and clinical results of left PEA with those of left ACD.
RESULTS: Twenty-eight patients and twenty-five patients were diagnosed with symptomatic left PEA and ACD, respectively. The patients with left PEA had focal abdominal tenderness on the left lower quadrant (82.1%). On CT examination, most (89.3%) of the patients with left PEA were found to have an oval fatty mass with a hyperattenuated ring sign. In cases of left ACD, the patients presented with a more diffuse abdominal tenderness throughout the left side (52.0% vs 14.3%; P = 0.003). The patients with left ACD had fever and rebound tenderness more often than those with left PEA (40.0% vs 7.1%, P = 0.004; 52.0% vs 14.3%, P = 0.003, respectively). Laboratory abnormalities such as leukocytosis were also more frequently observed in left ACD (52.0% vs 15.4%, P = 0.006).
CONCLUSION: If patients have left-sided localized abdominal pain without associated symptoms or laboratory abnormalities, clinicians should suspect the diagnosis of PEA and consider a CT scan.
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18
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Alves GRT, Silva RVDA, Corrêa JRM, Haygert CJP, Gössling PAM. Epiploic Appendagitis: A challenging imaging diagnosis. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2012. [DOI: 10.29333/ejgm/82448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Hasbahceci M, Erol C, Seker M. Epiploic Appendagitis: Is There Need for Surgery to Confirm Diagnosis in Spite of Clinical and Radiological Findings? Reply. World J Surg 2012; 36:1451-1452. [DOI: 10.1007/s00268-012-1543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mustafa Hasbahceci
- Department of General Surgery Umraniye Education and Research Hospital Hirka‐i Serif M Kececi Cesmesi S Doktorlar S B Bl 6/7 34291 Fatih Istanbul Turkey
| | - Cengiz Erol
- Department of Radiology, Selcuklu Faculty of Medicine Selcuk University Konya Turkey
| | - Mehmet Seker
- Department of Radiology Istanbul May 29 Hospital Fatih Istanbul Turkey
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20
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Kani KK, Moshiri M, Bhargava P, Kolokythas O. Extrahepatic, Nonneoplastic, Fat-Containing Lesions of the Abdominopelvic Cavity: Spectrum of Lesions, Significance, and Typical Appearance on Multidetector Computed Tomography. Curr Probl Diagn Radiol 2012; 41:56-72. [DOI: 10.1067/j.cpradiol.2011.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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21
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Hasbahceci M, Erol C, Seker M. Epiploic appendagitis: is there need for surgery to confirm diagnosis in spite of clinical and radiological findings? World J Surg 2012; 36:441-446. [PMID: 22167263 DOI: 10.1007/s00268-011-1382-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The present retrospective study was conducted to review the authors' experience and describe clinical and radiologic features of epiploic appendagitis (EA), which is an uncommon, self-limiting clinical entity mimicking acute appendicitis and diverticulitis. Awareness of the features of EA would allow a correct diagnosis and avoid unnecessary surgical interventions. METHODS Patients diagnosed as EA in one regional medical center between June 2006 and June 2010 were included. Clinical, laboratory, and imaging features of EA were studied, with particular attention to its unique radiologic appearances. RESULTS Twenty patients (13 men and 7 women; average age 43.2 years) diagnosed with EA were included in the study. Localized abdominal pain without nausea, vomiting, and fever were the major presenting symptoms for all patients. Laboratory blood tests were normal, except in one patient with leukocytosis and two patients with increased serum C-reactive protein (CRP) levels. A noncompressible hyperechoic ovoid mass with hypoechoic border and without central blood flow on Doppler ultrasound (US) was detected in five of six patients. In all patients, the computed tomography (CT) scans revealed an ovoid fatty mass with hyperattenuating rim and disproportionate adjacent fat stranding. Central dot sign, concomitant old infarct, and lobulation were present in 75%, 20%, and 10% of the patients, respectively. All of the patients were treated conservatively. No recurrences occurred during the follow-up period (average: 24.8 months) in 18 (90%) of the patients. CONCLUSIONS In patients with localized abdominal pain without other symptoms, diagnosis of EA should be considered. Recognizing the US and CT features of EA may allow an accurate diagnosis and avoid unnecessary surgery.
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Affiliation(s)
- Mustafa Hasbahceci
- Department of General Surgery, Umraniye Education and Research Hospital, Hirka-i Serif M Kececi Cesmesi S Doktorlar S B Bl 6/7, Fatih, 34291, Istanbul, Turkey.
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22
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Choi YU, Choi PW, Park YH, Kim JI, Heo TG, Park JH, Lee MS, Kim CN, Chang SH, Seo JW. Clinical characteristics of primary epiploic appendagitis. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:114-21. [PMID: 21829765 PMCID: PMC3145881 DOI: 10.3393/jksc.2011.27.3.114] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 05/31/2011] [Indexed: 01/10/2023]
Abstract
Purpose Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis. Methods We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications. Results In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 ± 11.9 vs. 69.7 ± 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 ± 2.9 vs. 22.6 ± 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001). Conclusion In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.
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Affiliation(s)
- Young Un Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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23
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Epiploic appendagitis: an entity frequently unknown to clinicians--diagnostic imaging, pitfalls, and look-alikes. AJR Am J Roentgenol 2009; 193:1243-51. [PMID: 19843737 DOI: 10.2214/ajr.08.2071] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Epiploic appendagitis is an ischemic infarction of an epiploic appendage caused by torsion or spontaneous thrombosis of the epiploic appendage central draining vein. When it occurs on the right side of the abdomen, it can mimic appendicitis and right-sided diverticulitis; whereas when it occurs on the left side of the abdomen, it is often mistaken for sigmoid diverticulitis. The purpose of this article is to review the diagnostic imaging of this entity. CONCLUSION Epiploic appendagitis is self-limited and spontaneously resolves without surgery within 5-7 days. Therefore, it is imperative for radiologists to be familiar with this entity.
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24
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Fraser JD, Aguayo P, Leys CM, St Peter SD, Ostlie DJ. Infarction of an epiploic appendage in a pediatric patient. J Pediatr Surg 2009; 44:1659-61. [PMID: 19635325 DOI: 10.1016/j.jpedsurg.2009.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/12/2009] [Accepted: 04/14/2009] [Indexed: 12/19/2022]
Abstract
Epiploic appendagitis or infarction of an epiploic appendage is an uncommon cause of abdominal pain in pediatric patients. Few cases have been reported. Diagnosis based on clinical examination alone is nearly impossible, and therefore, adjunctive radiographic measures are necessary to aid in the diagnosis, including ultrasound and computed tomography. We present the case of an 8-year-old boy whose diagnosis of epiploic infarction was suggested by computed tomography and was confirmed and treated via laparoscopy.
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Affiliation(s)
- Jason D Fraser
- Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA
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25
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Ba-Ssalamah A, Uffmann M, Bastati N, Schima W. [Diseases of the peritoneum and mesenterium]. Radiologe 2009; 49:637-51; quiz 652-4. [PMID: 19224192 DOI: 10.1007/s00117-008-1766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peritoneal diseases can be seen in the different imaging modalities either as fluid collections or solid tumors along the ligaments, mesenteries, and spaces of the peritoneal cavity. The broad spectrum of different abnormalities includes inflammatory, infectious, traumatic, and neoplastic diseases. In this article, a large variety of peritoneal abnormalities such as ascites, peritonitis, intraperitoneal hemorrhage, and both primary and secondary peritoneal tumors are discussed. The different imaging modalities, characteristic radiological features, and typical pathways of anatomic spread are explained.
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Affiliation(s)
- A Ba-Ssalamah
- Universitätsklinik für Radiodiagnostik, Medizinische Universität, A-1090 Wien, Osterreich.
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26
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Abstract
While omental infarction (OI) and acute epiploic appendagitis (AEA) often clinically mimic surgical abdomen, their management is distinct. As such, accurate and timely diagnosis is essential to follow medical management. Computed tomography and ultrasound imaging, utilized routinely in the evaluation of acute abdominal pain in the emergent setting, facilitate diagnosis and appropriate management of OI and AEA. The awareness of the clinical manifestations and imaging features of OI, AEA, and their mimics allow the radiologist to play a decisive role in triaging patients into surgical and medical management groups.
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Affiliation(s)
- Alpa G Garg
- Division of Abdominal Imaging, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
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27
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Multidetector computed tomography diagnosis of primary and secondary epiploic appendagitis. ACTA ACUST UNITED AC 2009; 26:582-6. [DOI: 10.1007/s11604-008-0278-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
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28
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Bastidas JG, Danzy LE, Blackwell L, Hayden R, Bostick PJ. Epiploic appendagitis in a 24-year-old woman. Am J Emerg Med 2008; 26:838.e1-2. [DOI: 10.1016/j.ajem.2008.01.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 01/02/2008] [Indexed: 11/15/2022] Open
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Computed Tomographic Appearance of Prolene Hernia System and Polypropylene Mesh Plug Inguinal Hernia Repair. J Comput Assist Tomogr 2008; 32:529-32. [DOI: 10.1097/rct.0b013e31815145c8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Macari M, Laks S, Hajdu C, Babb J. Caecal epiploic appendagitis: an unlikely occurrence. Clin Radiol 2008; 63:895-900. [PMID: 18625354 DOI: 10.1016/j.crad.2007.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 12/01/2007] [Accepted: 12/20/2007] [Indexed: 10/22/2022]
Abstract
AIM To determine whether epiploic appendagitis occurs in the caecum. METHODS From 2000-2006, 58 cases with classic computed tomography (CT) features of acute epiploic appendagitis (focal round or oval fat density immediately adjacent to the colon with surrounding oedema and stranding, with or without a central area of high attenuation) were identified from a radiology information system and available for review on the picture archiving and communication system (PACS). Cases were assigned to one of six colonic segments: rectum, sigmoid, descending colon, transverse colon, ascending colon, and caecum. The Blyth-Still-Casella procedure was used to derive an exact upper bound on the likelihood of epiploic appendagitis occurring within the caecum. RESULTS Twenty-eight cases occurred in the sigmoid colon, 16 in the descending colon, four in the transverse colon, and 10 in the ascending colon. No cases of acute epiploic appendagitis were identified in the caecum. Four cases of prospectively dictated caecal epiploic appendagitis were identified from the database. Retrospective review of these cases showed two cases to be epiploic appendagitis of the ascending colon. The third case demonstrated peritoneal thickening without evidence of an inflamed epiploic appendage. The fourth case was caecal diverticulitis. Based on these findings there is 95% confidence that no more than 4.6% of patients with epiploic appendagitis will show this condition within the caecum. CONCLUSION In the authors' experience, epiploic appendagitis does not occur in the caecum. Therefore, it is an unlikely cause for an inflammatory process in this region and other conditions should be considered.
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Affiliation(s)
- M Macari
- Department of Radiology, Abdominal Imaging, NYU School of Medicine, NY 100016, USA.
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31
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de Brito P, Gomez M, Besson M, Scotto B, Huten N, Alison D. Fréquence et épidémiologiedescriptive de l’appendicite épiploïque primitive par l’exploration tomodensitométrique des douleurs abdominales de l’adulte. ACTA ACUST UNITED AC 2008; 89:235-43. [DOI: 10.1016/s0221-0363(08)70399-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Patel VG, Rao A, Williams R, Srinivasan R, Fortson JK, Weaver WL. Cecal Epiploic Appendagitis: A Diagnostic and Therapeutic Dilemma. Am Surg 2007. [DOI: 10.1177/000313480707300821] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute epiploic appendagitis (EA) is a rare and often misdiagnosed cause of acute abdominal pain. Though a benign and often self-limiting condition, EA's ability to mimic other disease processes makes it an important consideration in patients presenting with acute abdominal symptoms. Careful evaluation of abdominal CT scan findings is crucial in the accurate diagnosis of epiploic appendagitis, thus avoiding unnecessary surgical intervention. We report a case of a 29-year-old male presenting with a two day history of generalized abdominal pain. Physical exam revealed a diffusely tender abdomen with hypoactive bowel sounds. The patient had a leukocytosis of 18,000 and abdominal CT scan revealed right lower quadrant inflammatory changes suggestive of acute appendicitis. Laparoscopic exploration revealed an inflamed gangrenous structure adjacent to the ileocecal junction. Pathologic evaluation revealed tissue consistent with epiploic appendagitis. Retrospective review of the CT scan revealed a normal appearing appendiceal structure superolateral to the area of inflammation. The patient recovered uneventfully with resolving leukocytosis. We present a case of cecal epiploic appendagitis mimicking acute appendicitis and review the current literature on radiographic findings, diagnosis, and treatment of this often misdiagnosed condition. General surgeons should be aware of this self-limiting condition and consider this in the differential diagnosis.
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Affiliation(s)
| | - Arundathi Rao
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Reginald Williams
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | | | - James K. Fortson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - William L. Weaver
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
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Talukdar R, Saikia N, Mazumder S, Gupta C, Khanna S, Chaudhuri D, Bhullar SS, Kumar A. Epiploic Appendagitis: Report of Two Cases. Surg Today 2007; 37:150-3. [PMID: 17243036 DOI: 10.1007/s00595-006-3345-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 06/22/2006] [Indexed: 10/23/2022]
Abstract
Epiploic appendagitis (EA) refers to primary or secondary inflammatory disease of the epiploic appendages: peritoneal pouches of subserosal fat, which run in parallel rows beside the taenia coli of the colon. It is an uncommon but self-limiting condition, which often mimics acute appendicitis or diverticulitis. An accurate diagnosis of EA can be made by performing an abdominal computed tomography scan. Establishing a correct preoperative diagnosis is important to avoid unnecessary exploratory laparoscopy or laparotomy. We report two cases of EA, which to our knowledge represent the first documented cases from India.
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Affiliation(s)
- Rupjyoti Talukdar
- Department of Gastroenterology, Pushpawati Singhania Research Institute, Sheikh Sarai Phase II, Press Enclave Marg, New Delhi, 110017, India
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Romano S, Romano L, Grassi R. Multidetector row computed tomography findings from ischemia to infarction of the large bowel. Eur J Radiol 2006; 61:433-41. [PMID: 17157468 DOI: 10.1016/j.ejrad.2006.11.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 11/02/2006] [Indexed: 02/06/2023]
Abstract
OBJECTIVE MDCT is performed as first imaging examination for patients with acute abdomen in most Emergency Departments. Clinical suspicion of ischemic colitis and infarction is related to specific findings, however, differential diagnosis as well as the staging for a confirmed ischemic affection may be critical. The individual signs from ischemia to infarction of large bowel is a captivating topic. In this study, we report our experience of the MDCT assessment of acute colonic disease from vascular mesenteric disorders. MATERIALS AND METHODS We retrospectively reviewed the MDCT findings of 71 patients admitted to our attention for acute abdomen, with final proven diagnosis of colonic ischemia and/or infarction made by surgery and/or endoscopy. CT-scanning of the abdomen and pelvis was performed after i.v. contrast medium administration, using a multidetector row CT equipment. We correlated the presence of parietal disease, the evidence of mesenteric arterial or venous vessels occlusion, the parietal features as well as others findings, such as free fluid and/or air in peritoneal recess or in retroperitoneum, with the surgical and/or endoscopic findings. RESULTS Analysis of our data showed a segmental (84%) or complete (16%) involvement of the colon; 57 cases were related to ischemia, 14 to infarction. Inferior mesenteric vessels defect of opacification was noted in 10 cases. Various degree of wall thickening and parietal enhancement, peritoneal fluid, mural or portal-mesenteric pneumatosis were compared to evidence of mesenteric arterial or vein occlusion and to final proven diagnosis. A classification in a multi-stage grading for both decreased of arterial supply or impaired venous drainage disorders was done. CONCLUSIONS A grading scale from ischemia to infarction affecting the large bowel from arterial or venous mesenteric vessels origin has been not previously reported in a series at our knowledge. MDCT findings may support the clinical evaluation of patients affected by acute colon from vascular disorders. In particular, it seems to provide effective and valuable information's in differentiating etiology and stage of disease.
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Affiliation(s)
- Stefania Romano
- Department of Diagnostic Imaging, A. Cardarelli Hospital, Viale Cardarelli 9, 80131 Naples, Italy.
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