Differential diagnosis of left-sided abdominal pain: Primary epiploic appendagitis vs colonic diverticulitis

Table 1 Clinical characteristics of patients with left primary epiploic appendagitis and left acute colonic diverticulitis

	Lt. PEA (n = 28)	Lt. ACD (n = 25)	P-value
Mean age (yr)	45.0 ± 11.6	58.8 ± 16.3	0.001
Sex (male/female)	16/12	15/10	0.833
Body mass index (kg/m2)	24.8 ± 3.3	24.9 ± 3.0	0.921
Underlying disease (+)	6 (21.4)	10 (40.0)	0.142
Alcohol (+)	14 (50.0)	13 (52.0)	0.884
Smoking (+)	11 (39.3)	8 (32.0)	0.581
Sudden onset of abdominal pain (+)	28 (100.0)	25 (100.0)	NA
Duration of pain (d)	3.8 ± 5.3	4.6 ± 4.1	0.537
Nausea (+)	2 (7.1)	2 (8.0)	1.00
Vomiting (+)	2 (7.1)	2 (8.0)	1.00
Diarrhea (+)	0 (0.0)	3 (12.0)	0.098
Fever (+)	2 (7.1)	10 (40.0)	0.004
Location of abdominal tenderness			0.003
Focal	24 (85.7)	12 (48.0)
Lt. lower quadrant	23 (82.1)	11 (44.0)
Lt. upper quadrant	1 (3.6)	1 (4.0)
Diffuse	4 (14.3)	13 (52.0)
Rebound tenderness (+)	4 (14.3)	13 (52.0)	0.003
Palpable mass (+)	1 (3.6)	0 (0.0)	1.00

Values are presented as mean ± SD or n (%). PEA: Primary epiploic appendagitis; ACD: Acute colonic diverticulitis; NA: Not available.

Table 2 Presumptive diagnoses prior to imaging studies n (%)

Impression	Lt. PEA (n = 28)	Lt. ACD (n = 25)
PEA	7 (25.0)	0 (0.0)
ACD	16 (57.1)	15 (60.0)
Pelvic inflammatory disease	0 (0.0)	1 (4.0)
Ureter stone	1 (3.6)	0 (0.0)
Gastritis	2 (7.1)	0 (0.0)
Constipation	1 (3.6)	1 (4.0)
Appendicitis	1 (3.6)	1 (4.0)
Ischemic colitis	0 (0.0)	1 (4.0)
Cancer	0 (0.0)	1 (4.0)
Peritonitis	0 (0.0)	2 (8.0)
Enteritis (colitis)	0 (0.0)	3 (12.0)

PEA: Primary epiploic appendagitis; ACD: Acute colonic diverticulitis.

Table 3 Computer tomography features of left primary epiploic appendagitis

Features	Value
Location
Descending colon	18 (64.3)
Sigmoid-descending junction	3 (10.7)
Sigmoid colon	7 (25.0)
Size (mm)	2.3 ± 0.6
Shape
Oval	22 (78.6)
Semicircular	4 (14.3)
Triangular	2 (7.1)
Computer tomography
features
Ovoid fatty mass	28 (100.0)
Hyperattenuated ring sign	25 (89.3)
Disproportionate fat stranding	4 (14.3)
Bowel wall thickening±compression	6 (21.4)
Central hyperdense dot/line	5 (17.9)
Lobulated appearance	0 (0.0)

Values are presented as mean ± SD or n (%).

Table 4 Treatments and clinical results of patients with left primary epiploic appendagitis and left acute colonic diverticulitis

	Lt. PEA (n = 28)	Lt. ACD (n = 25)	P-value
Hospitalization	22 (78.6)	25 (100.0)	0.014
Treatment			0.474
Antibiotics	22 (78.6)	22 (88.0)
Conservative management	6 (21.4)	3 (12.0)
Duration of hospital stay (d)	5.4 ± 5.0	10.2 ± 4.0	< 0.001
Duration of abdominal pain (d)	3.3 ± 2.9	5.6 ± 3.6	0.012
Duration of abdominal tenderness (d)	3.3 ± 1.9	7.2 ± 3.8	< 0.001
Duration of antibiotic therapy (d)	10.5 ± 8.4	16.5 ± 12.6	0.045

Values are presented as mean ± SD or n (%). PEA: Primary epiploic appendagitis; ACD: Acute colonic diverticulitis.