Diagnosis Of Primary Epiploic Appendagitis Research Articles

Rare causes of acute abdomen and review of literature: Primary/secondary omental torsion, isolated segmental omental necrosis, and epiploic appendagitis.

Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain. The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature. The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings. POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient's clinical condition.

Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker

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.

Primary epiploic appendagitis as an unusual cause of acute abdominal pain in a middle-aged male

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.

An Uncommon Cause of Acute Abdominal Pain: Primary Epiploic Appendagitis in the Emergency Setting

In the emergency setting, the diagnosis of benign causes of acute abdominal pain can prevent unnecessary medical interventions. To illustrate this point, we report the case of a 28-year-old man who presented to the emer- gency department with symptoms suggestive of acute diverticulitis. Abdominal computed tomography (CT) established, instead, a diagnosis of primary epiploic appendagitis (PEA), which was managed expectantly. The patient’s symptoms resolved within one week of hospital discharge and he remained free of pain at a five-month phone follow-up. Increased awareness of PEA and its self-limited course can help the emergency physician avoid unnecessary imaging studies and expectantly manage this cause of acute abdominal pain.

Primary epiploic appendagitis: reconciling CT and clinical challenges.

Our aim was to explain the spectrum of clinical and CT findings in 18 patients with acute epiploic appendagitis. We reviewed the clinical records and CT pictures of 18 consecutive patients seen in Nejran Armed Forces Hospital, Nejran, Kingdom of Saudi Arabia and Sohag University Hospital, Sohag, Egypt between July 2006 and June 2013 with a diagnosis of primary epiploic appendagitis. The age ranged between 22 and 64 years old with a mean of 44.3. Males were affected in 72 % of cases. Eleven patients had acute pain in left lower quadrant. Nausea and vomiting were encountered in four patients. No fever was recorded in all cases. Leukocytosis was found in four patients and C-reactive protein (CRP) was high in five. CT scan diagnosed primary epiploic appendagitis (PEA) in 15 patients, while 3 patients were diagnosed intraoperatively. The left colon was affected in 11 patients. All patients except one had a central fatty core surrounded by inflammation with size ranging between 1.5 and 3.5 cm in length. Fifteen patients were treated conservatively, and three cases underwent surgical exploration. Ten patients (55.5 %) completed the follow up schedule. Complete resolution was noted in three patients at 2 weeks, in six patients at 3 months, and only one patient had residual changes at 6 months. PEA is a challenging clinical diagnosis, and CT scan is extremely necessary in diagnosing this disease accurately. The awareness of the surgeons concerning this rare occasion will avoid unnecessary hospital admission and operative treatment.

Contrast-enhanced ultrasound appearance of primary epiploic appendagitis

Primary epiploic appendagitis (PEA) is a rare, benign self-limiting condition more often secondary to torsion or spontaneous venous thrombosis of a draining vein of the epiploic appendages; symptoms can mimic an acute abdomen [1]. The diagnosis is based on abdominal computed tomography or ultrasound [2–5]. More recently, a fairly characteristic contrast-enhanced ultrasound (CEUS) feature was described as a central area of no enhancement [6]. A 38-year-old man with a body mass index of 27 and without any significant clinical history was admitted to our hospital for the abrupt onset of acute localised pain in the left lower quadrant of the abdomen. The patient was afebrile and had no intestinal symptoms. The blood tests showed no abnormalities. Grey-scale ultrasound examination focused on the point of maximal tenderness revealed a well-delineated, oval, and homogeneously hyperechoic intra-abdominal mass, with a maximum diameter of 30 mm. The mass was adjacent to the abdominal wall and located anteromedial and adherent to the left colon. It was uncompressible and no thickening of the left colon wall was identified (Fig. 1). Fig. 1 Grey-scale ultrasound focused on the point of maximal tenderness. An oval hyperechoic mass is adherent to the left colon wall (arrow). Arrowheads mark the boundary of the mass The mass was evaluated with CEUS: a blood pool second-generation contrast agent (SonoVue®, Bracco, Milan, Italy) and a Philips iU22 ultrasound machine (Philips Healthcare, Best, The Netherlands) with a contrast harmonic imaging technology and a 3–9 MHz linear probe were used. The real-time images were displayed on a split screen: the left side displayed the contrast harmonic imaging, allowing the visualisation of the microvascularisation without the fundamental grey-scale echoes; the right side of the screen displayed the grey-scale images. The contrast harmonic imaging revealed a thick rim of arterial enhancement and a wide hypoechoic central area (Fig. 2). The CEUS appearance of the mass was unvaried in the venous phase; in particular, the wide central area remained hypoechoic. A computed tomography scan revealed the typical features of PEA (Fig. 3) [7]. Fig. 2 Contrast-enhanced ultrasound (arterial phase). The left image shows a thick rim of enhancement and a hypoechoic central area of the mass. On the right side is displayed the grey-scale image. Arrowheads mark the boundary of the mass Fig. 3 Computed tomography. An oval lesion (arrow), 2 cm in diameter, with attenuation similar to that of fat and with surrounding inflammatory changes, is localised next to the anterior left colon wall The patient was managed conservatively and the symptoms were completely resolved after 6 days. The follow-up grey-scale ultrasound, 4 and 19 days from the first examination, revealed progressive shrinkage of the mass. The patient gave informed written consent for the grey-scale sonography, the CEUS, and the computed tomography. Specific clinical features and grey-scale sonography findings of PEA are lacking; furthermore, there is the absence of flow in colour Doppler imaging [8, 9]. In this single patient, CEUS has confirmed that a thick rim of enhancement and a hypoechoic central area of the mass are characteristic features of PEA, as was previously reported by Gorg [6]. Therefore, in the adequate clinical context, the use of CEUS can give an immediate answer, thus allowing the diagnosis of PEA at the bedside.

CT features of primary epiploic appendagitis

Objective The aim of this study is to describe the computed tomography (CT) findings of primary epiploic appendagitis (PEA). Methods We reviewed the clinical records and CT images of 14 consecutive patients in Singapore who presented with acute abdominal pain from July 2000 to April 2004 and had radiological signs of PEA. Results Hyperattenuated ring with adjacent fat stranding was present in all the patients. The central high attenuation dot was seen in 42.9% (6/14) of the patients. We observed a lobulated fatty mass in 21.4% (3/14) of our patients. All patients recovered during clinical follow-up. Conclusions We believe the lobulated appearance of PEA is due to two or more, contiguous infarcted epiploic appendages lying in close proximity. This appearance further aids in the diagnosis of PEA and helps differentiates the condition from omental infarction. Recognizing the CT signs of PEA should allow a confident diagnosis and avoid unnecessary surgery.

Clinical diagnosis of primary epiploic appendagitis: differentiation from acute diverticulitis.

Primary epiploic appendagitis (PEA) is an uncommon cause of abdominal pain that occurs either from appendageal torsion or spontaneous thrombosis of an appendageal draining vein. Primary epiploic appendagitis is frequently misdiagnosed as either appendicitis or diverticulitis, depending on its location. Clinical and radiologic characteristics of 8 patients with PEA were retrospectively reviewed and compared with 18 patients with acute diverticulitis. Patients with PEA presented with lower abdominal pain of recent onset that was localized to the left (seven cases) and right (one case) lower quadrants. Well-localized tenderness without peritoneal irritation sign was usually the only physical finding. Blood tests were not significant. In acute diverticulitis, the pain was more evenly distributed throughout the lower abdomen and findings like nausea, fever, and leukocytosis were more frequently associated than in PEA. Computed tomography findings, such as pedunculated oval fatty mass with streaky densities connected to the serosal surface of the adjacent colon, can lead to the diagnosis of PEA. Symptoms of PEA were resolved within 1 week (mean, 4.7 days) without surgery. When patients with very localized lower abdominal pain and tenderness do not have associated symptoms or laboratory abnormalities, a high index of suspicion for PEA and early radiologic examinations are required.

Primary epiploic appendagitis: an unusual and often misdiagnosed cause of abdominal pain

The aim of this study is to describe the computed tomography (CT) findings of primary epiploic appendagitis (PEA).We reviewed the clinical records and CT images of 14 consecutive patients in Singapore who presented with acute abdominal pain from July 2000 to April 2004 and had radiological signs of PEA.Hyperattenuated ring with adjacent fat stranding was present in all the patients. The central high attenuation dot was seen in 42.9% (6/14) of the patients. We observed a lobulated fatty mass in 21.4% (3/14) of our patients. All patients recovered during clinical follow-up.We believe the lobulated appearance of PEA is due to two or more, contiguous infarcted epiploic appendages lying in close proximity. This appearance further aids in the diagnosis of PEA and helps differentiates the condition from omental infarction. Recognizing the CT signs of PEA should allow a confident diagnosis and avoid unnecessary surgery.