Primary Epiploic Appendagitis Research Articles

Secondary Epiploic Appendagitis – Report of Three Cases with CT Findings

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.

Prevalence of SIRS with primary epiploic appendagitis.

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. 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. 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%). 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.

Primary epiploic appendagitis: A retrospective analysis of clinical and tomographic findings in 14 patients

Background: The aim of this study is to describe the clinical features and imaging findings of 14 patients diagnosed with primary epiploic appendagitis on computed tomography (CT). Methods: Between January 2019 and August 2022, the hospital records of 14 patients were retrospectively reviewed. We recorded patients' age, gender, fever presence, blood leukocyte count (WBC), C-reactive Protein (CRP) level, localization of abdominal pain, the presence of nausea or vomiting, the involved part of the colon on CT, whether they received treatment or not, and whether they underwent surgery. Results: This study included 14 patients, 8 male and 6 female. Their ages ranged from 27 to 63 years. All patients presented with acute abdominal pain in most cases, with no elevation in body temperature or significant increase in inflammation markers. CT scan images showed a fat oval lesion corresponding to the inflamed Appendix epiploica, with a peripheral hyper-attenuated frame and a central "dot" in some cases referring to the thrombosed vessel. The patients were successfully treated with conservative methods. Conclusions: Epiploic appendagitis can mimic surgical diseases such as appendicitis and diverticulitis due to its non-specific clinical presentation. CT scan is essential in diagnosing this disease, which can be managed with more conservative treatment methods.

Primary Epiploic Appendagitis: Not Rare But Rarely Diagnosed Pathology.

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. 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. 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. 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.

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.

Acute Localized Abdominal Pain From Primary Epiploic Appendagitis

This report describes primary epiploic appendagitis in a 40-year-old man. He had the classic physical finding of highly localized abdominal pain and the classic computed tomography findings of a hyperattenuating ring sign and a central dot sign.

Primary epiploic appendagitis: evaluation of computed tomography findings in the differential diagnosis of patients that presented with acute abdominal pain.

Primary epiploic appendagitis (PEA) is a rare cause of abdominal pain revealed by torsion of colonic structures called epiploic appendices. In this paper, we present our clinical data and experience regarding this rare condition that may be confused with many diseases, such as acute appendicitis, diverticulitis, salphingitis, renal colic that may require emergency surgery. A total of 39 consecutive patients diagnosed as PEA confirmed by abdominal computed tomography with a clinical course. Basic demographic data, abdominal pain characteristics, physical examination findings, laboratory results, treatment methods, and clinical course of the patients were retrospectively evaluated. Statistical analysis was performed using SPSS (18.0; Chicago, IL, USA), using the χ2-test and Fisher's exact test. Of the 39 patients diagnosed with PEA, 35 were male and 4 were female; the mean age of the patients was 36.0 ± 10.3. The main complaints were 69.2% abdominal pain, 12.8% groin pain, 5.1% flank pain with nausea and vomiting (2.6%), and abdominal swelling and dysuria. The average time of symptom was 5.3 days (1-15 days). In the computed tomography scan images, PEA was located in the sigmoid colon (21, 53.8%), descending colon (10, 25.6%), ascending colon (5, 12.8%), cecum (2, 5.1%), and hepatic flexure (1, 2.6%). No patient underwent surgical treatment. However, 9 of 39 patients were hospitalized for medical treatments, such as antibiotics and analgesic drugs intravenously. All patients were followed-up for a period of 1-year and there were no recurrence symptoms. When patients with 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.

Three cases of primary epiploic appendagitis cured only with oral analgesics

Three cases of primary epiploic appendagitis cured only with oral analgesics

Incidentally Diagnosed Colon Cancer by Ultrasound due to Acute Abdomen Caused by Primary Epiploic Appendagitis

Incidentally Diagnosed Colon Cancer by Ultrasound due to Acute Abdomen Caused by Primary Epiploic Appendagitis

Food intolerance/malabsorption may occur in rare diseases.

Sugars including lactose and fructose, or proteins (gluten), or biogenic amines (histamine), and combinations thereof may cause food intolerance/malabsorption. However, in usually asymptomatic patients with rare diseases, who present with functional, non-specific, non-allergic gastrointestinal (GI) complaints the etiologic factors of food intolerance/malabsorption need to be evaluated. We summarize patients with rare diseases, such as primary epiploic appendagitis, beta-thalassemias minor, Gullo syndrome and anomaly of the inferior vena cava, who presented functional, non-specific, non-allergic GI complaints. As conclusion, these GI symptoms in patients with otherwise asymptomatic, rare diseases were due to fructose malabsorption, histamine-, lactose intolerance and Helicobacter pylori (H.p.) infection. A registered and experienced dietician was employed to design an individually-tailored diet which ensured effective treatments and H.p. infection was accordingly eradicated.

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: compared with diverticulitis and focused on obesity and recurrence.

Background/AimsThere 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.MethodsWe 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.ResultsFifty-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%).ConclusionsIf 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.

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.

Epiploik Apendiks Enflamasyonu: Primer Epiploik Apandajit

Epiploic appendices are extensions of omentum which covers most of the colon. Most of the pathologic changes are related with spontaneous torsion or venous thrombosis culminating with inflammation and is referred as primary epiploic appendagitis (PEA). There is no pathognomonic symptom, finding or laboratory test for this relatively rare intra-abdominal inflammation. A non-toxic patient with acute onset localized abdominal pain in the right or left lower quadrant is the typical presentation. Imaging studies such as ultrasound and tomography with the awareness of PEA in differential diagnoses of intra-abdominal pathologies are the key to correct diagnosis. Since the conservative treatment is sufficient in most of cases, accurate and timely diagnosis can ensure the appropriate patient management and can prevent unnecessary hospitalizations and interventions.

Primary Epiploic Appendagitis: Solving the Puzzle of a Benign Acute Abdomen

Primary Epiploic Appendagitis: Solving the Puzzle of a Benign Acute Abdomen

Epiploic appendagitis: A self-limiting cause of abdominal pain

Epiploic appendagitis (EA) is a rare cause of acute to subacute lower quadrant abdominal pain. It has two subtypes: primary and secondary EA. Primary EA is characterized by inflammation of the epiploic appendages caused by torsion or thrombosis of the draining vein of the appendage whereas secondary EA often occurs in association with other inflammatory processes in the abdomen and pelvis. Due to its similarity to other causes of acute abdomen, patients with primary EA often undergo unnecessary treatment with antibiotics and surgical intervention. We present a case of a middle-aged female who was diagnosed with primary EA based on imaging studies and was successfully managed with conservative treatment.

Primary Epiploic Appendagitis with Adjacent Colonic Wall Thickening

원발성 복막수염은 ê¸°ì €ì§ˆí™˜ 없이 복막수의 ì—¼ì „ê³¼ 주행하는 혈관의 í˜ˆì „ì— 의해 발생하며 대부분 특별한 치료 없이 수일 이내에 í˜¸ì „ëœë‹¤. 발생 빈도가 ë“œë¬¼ê³ ë¹„íŠ¹ì´ì  임상 증상을 가지므로 급성 복통의 다른 원인으로 오인되기도 한다. ë¶€ì •í™•í•œ 진단은 환자에게 불필요한 ë‚´ê³¼ì  또는 ìˆ˜ìˆ ì  치료를 받게 한다. 이를 피하기 위해 임상 의사는 이 질환을 잘 ì•Œê³ ìžˆì–´ì•¼ 하며 급성 하복부 통증으로 내원한 환자에서 ë¹„êµì  흔한 질환인 급성 게실염, 충수염과 함께 이 질환의 가능성을 염두에 ë‘ì–´ì•¼ê² ë‹¤. 과거에는 진단이 ì–´ë ¤ì› ìœ¼ë‚˜ 요즘은 복부 초음파나 ì „ì‚°í™”ë‹¨ì¸µì´¬ì˜ 등의 ì˜ìƒí•™ì  검사를 통해 진단을 내릴 수 있다. 비록 복막수는 대장벽에 ë‹¬ë ¤ 있지만 복막수염에 동반되는 대장벽 자체의 변화는 ë¹„êµì  드물다. 이에 ì €ìžëŠ” ì¸ì ‘í•œ 대장벽의 비후를 동반한 원발성 복막수염 증례를 경험하여 ë³´ê³ í•˜ëŠ” 바이다. 중심 단어: 원발성 복막수염; 대장벽의 비후; 급성 복통

Epiploic appendagitis: 7-year experience and relationship with visceral obesity.

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. 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. 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%. 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%).

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.

A Case of Primary Epiploic Appendagitis of the Ascending Colon Diagnosed by Abdominal Enhanced Computed Tomography

A Case of Primary Epiploic Appendagitis of the Ascending Colon Diagnosed by Abdominal Enhanced Computed Tomography