Abstract
BackgroundEpiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal pathology. It can mimick diverticulitis or appendicitis on clinical exam. The diagnosis of EA is very infrequent, due in part to low or absent awareness among general surgeons. The objective of this work was to review the authors' experience and describe the clinical presentation of EA.MethodsAll patients diagnosed with EA between January 2004 and December 2006 at an urban surgical emergency room were retrospectively reviewed by two authors in order to share the authors' experience with this rare diagnosis. The operations were performed by two surgeons. Pathological examinations of specimens were performed by a single pathologist. A review of clinical presentation is additionally undertaken.ResultsTen patients (3 females and 7 males, average age: 44.6 years, range: 27–76 years) were diagnosed with symptomatic EA. Abdominal pain was the leading symptom, the pain being localized in the left (8 patients, 80 %) and right (2 patients, 20%) lower quadrant. All patients were afebrile, and with the exception of one patient, nausea, vomiting, and diarrhea were not present. CRP was slightly increased (mean: 1.2 mg/DL) in three patients (33%). Computed tomography findings specific for EA were present in five patients. Treatment was laparoscopic excision (n = 8), excision via conventional laparotomy (n = 1) and conservative therapy (n = 1).ConclusionIn patients with localized, sharp, acute abdominal pain not associated with other symptoms such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of EA should be considered. Although infrequent up to date, with the increase of primary abdominal CT scans and ultrasound EA may well be diagnosed more frequently in the future.
Highlights
Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal pathology
Besides torsion, which is most likely the main pathophysiological mechanism, spontaneous venous thrombosis of an appendageal draining vein is another uncommon cause of primary epiploic appendagitis [5,6]
All patients diagnosed with epiploic appendagitis, either at the surgical emergency room or at discharge from the hospital, were identified by a review of the visit logs by means of an electronic patient medical record system (Care Center, V 14.0.100 Siemens Medical Solutions Health Services GmbH, Erlangen, Germany)
Summary
Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal pathology. It can mimick diverticulitis or appendicitis on clinical exam. Torsion of the epiploic appendages is rare, but can result in ischemia presenting as an acute clinical condition which can mimic diverticulitis, appendicitis, or other more serious causes of acute abdominal pain [4]. Due to the lack of pathognomic clinical features the diagnosis of epiploic appendagitis is difficult It is very infrequent, causing awareness among general surgeons for this clinical condition to be missing sometimes
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