Primary Epiploic Appendagitis Research Articles

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

Temporary exacerbation of primary epiploic appendagitis: A case report

Temporary exacerbation of primary epiploic appendagitis: A case report

Computed tomography findings of primary epiploic appendagitis as an easily misdiagnosed entity: Case series and review of literature.

Primer epiploic appendagitis (PEA) is an uncommon condition. We retrospectively reviewed the clinical records and computed tomography (CT) findings of 45 patients with PEA. On the basis of physical examination and pain localization, presumptive clinical diagnosis was acute appendicitis (n=13), acute cholecystitis (n=2), acute diverticulitis (n=19), renal colic (n=7) and ovarian pathology (n=4). Although it has no characteristic clinical and laboratory features, CT is the best modality for accurate diagnosis of PEA.

Primary Epiploic Appendagitis Mimicking Acute Abdomen in Emergency Department

Turker Acar1, Duran Efe2, Kazim Gemici3, Serkan Guneyli4 1Department of Radiology, Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey 2Department of Radiology, Mevlana University School of Medicine, Konya, Turkey 3Department of Surgery, Mevlana University School of Medicine, Konya, Turkey 4Department of Radiology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey

A Rare Cause of Abdominal Pain: Primary Epiploic Appendagitis (PEA)

Karin Agrisi; Primer Epiploik Apendajitis; Tomografi Abstract Primary epiploic appendagitis (PEA) is a rare disease caused by torsion or spontaneous thrombosis of the central vein that drains epiploic appendages (EA). Primary Epiploic Appendagitis (PEA) is an ischemic infarction. Although PEA is a self-limiting disease and does not require surgical intervention in most cases, it may mimic diseases that require surgical intervention or aggressive medical therapy, such as appendicitis, diverticulitis, or cholecystitis. In order to avoid unnecessary surgical intervention, PEA should be kept in mind when patients present with acute abdominal pain. In this report, we present a PEA case admitted with abdominal pain.

A Rare Cause of Left Lower Quadrant Pain at a Rare Localization of Colon: Primary Acute Epiploic Appendagitis of Descendant Colon

A Rare Cause of Left Lower Quadrant Pain at a Rare Localization of Colon: Primary Acute Epiploic Appendagitis of Descendant Colon

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.

Primary Epiploic Appendagitis.

Primary epiploic appendagitis is an inflammation of the epiploic appendages occurring due to ischemic infarction as a result of appendage torsion or spontaneous thrombosis usually affecting patients from second to fifth decades, being more common in women and obese patients. It is a self-limiting entity with clinical features similar to other inflammatory abdominal processes and sometimes not remembered at clinical examinations. The awareness of this entity and its correct identification on imaging examinations could prevent unnecessary surgery. The authors present a clinical case complemented with ultrasound and CT images of this entity.

Features and clinical value of multi-slice spiral computed tomography examination of acute primary epiploic appendagitis

Objective To summarize the features of multi-slice spiral computed tomography (MSCT) examination of acute primary epiploic appendagitis, and investigate the clinical value of MSCT. Methods The clinical data of 19 patients with acute primary epiploic appendagitis who were admitted to the Yangzhou No. 1 Hospital from December 2009 to March 2014 were retrospectively analyzed. All the patients received MSCT examination, and the data were transported to the work station for multiplanar reconstruction. The location, shape, size, density, peripheral performance and peritoneal thickening were observed. Results The foci of the 19 patients were located adjacent to the colon. One focus was adjacent to the cecum, 4 were adjacent to the ascending colon, 1 was adjacent to the hepatic flexure of the colon, 6 were adjacent to the descending colon, and 7 were adjacent to the sigmoid colon. The shapes of the foci were similar to the oval or ring in 14 cases and similar to the flame in 5 cases. The diameters of the foci were 0. 8-3. 7 cm. The results of CT plain scan showed that the density of the foci was similar to that of the fat, and the CT value was –101––34 HU. The central density of the foci was lower, while the limbic density was higher. The results of CT enhanced scan showed a ring-like enhancement region in the foci, and the lesion was surrounded by slightly high-density inflammation. Point or linear slightly high-density shadows were detected at the center of the foci in 9 patients. The peritoneum was locally thickened in 14 patients. The colonic wall was locally thickened in 1 patient, and the pelvic effusion was detected in 5 patients. The results of CT reexamination of 4 patients showed that the inflammatory regions were reduced or disappeared, the mass shrank, nodulized or calcified. Conclusions MSCT examination can provide a specific features of primary epiploic appendagitis. It could accurately diagnose acute primary epiploic appendagitis when combined with multiplanar reconstruction. Key words: Epiploic appendagitis; Primary; Multiplanar reconstruction; Tomography, X-ray computed

A Rare Pathology Mimicing Acute Appendicitis; Epiploic Appendagitis

Aim: Primary epiploic appendagitis (PEA) is an inflammatory disease occurs due to the torsion or spontaneous venous thrombosis of colonic epiploic appendages. Frequency of PEA is greater in the sigmoid colon, which is the place where appendix epiploica most commonly observed. Cecal PEA is seen rarely. PEA is actually a disease that can be cured by conservative treatment. However, cecal epiploic appendagitis is sometimes managed by surgical treatment because it mimics acute abdomen.Case Reports: Two epiploic appendagitis cases were reported in this article. These patients were presented to our emergency department with sign and symptoms of acute appendicitis. Surgical treatment was performed in both two patients, since epiploic appendagitis was not radiologically identified in either case preoperatively. Conclusion: Surgery is not necessary in the treatment of epiploic appendagitis. A careful radiological examination, especially a computed tomography, would increase the correct diagnosis of epiploic appendagitis cases and provide an opportunity for conservative treatment. On the other hand, if cecal epiploic appendagitis can not be diagnosed preoperatively by the radiologist, surgery will be inevitable because it mimics acute appendicitis.

EPIPLOIC APPENDAGITIS;

Acute epiploic appendagitis is an uncommon cause of abdominal pain that has only recently been recognized. Thediagnosis of this condition primarily relies on cross-sectional imaging and is made most often on CT, although occasionally sonography1 2- has been used . Epiploic appendages are fat- and blood vessel-containing outpouchings protruding from the serosal surface of the colon4. They appear in the fifth month of fetal life and in an adult human, the average number of epiploic appendages is approximately 50-2,3,5 100.They measure from 2-5 cm in length . Epiploic appendagitis is the inflammatory process of the epiploic appendage and hasprimary and secondary types. Primary epiploic appendagitis (PEA) is the infarction and inflammation of an appendage because of torsionor spontaneous venous thrombosis. PEA mimics acute abdominal diseases; thus, it must be distinguished from the secondary epiploic2,3 appendagitis, which is caused by neighborhood inflammatory processes such as diverticulitis, appendicitis or cholecystitis . The mostcommon computed tomographic (CT) appearance of acute epiploic appendagitis is the presence of 1.5- to 3.5-cm-diameter fat-density1 lesion with surrounding inflammatory changes abutting the anterior wall of the sigmoid colon .

Primary epiploic appendagitis

Primary epiploic appendagitis

Differential diagnosis of left-sided abdominal pain: Primary epiploic appendagitisvscolonic diverticulitis

To investigate the clinical characteristics of left primary epiploic appendagitis and to compare them with those of left colonic diverticulitis. 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. 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). 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.

Primary epiploic appendagitis

Primary epiploic appendagitis

Management of Primary Epiploic Appendagitis in the Laparoscopic Era

Management of Primary Epiploic Appendagitis in the Laparoscopic Era

Primary epiploic appendagitis and successful outpatient management

SummaryBackgroundPrimary epiploic appendagitis (PEA) is a rare cause of abdominal acute or subacute complaints. Diagnosis of PEA is made with ultrasonography (US) or when computed tomography (CT) reveals a characteristic lesion.Case ReportWe report on two patients with PEA. In one patient PEA was first seen with US and confirmed with contrast enhanced CT, and in the second patient CT without contrast enhancement demonstrated PEA. In both patients an outpatient recovery with conservative non-surgical treatment is described.ConclusionsMedical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions. A correct diagnosis of PEA with imaging procedures enables conservative and successful outpatient management avoiding unnecessary surgical intervention and additional costs.

Primary Epiploic Appendagitis As a Rare Cause of Localized Abdominal Pain: Imaging Findings

Epiploik apendiksin hastaliklari nadir olup genellikle orta yas grubunu etkilemektedir. Pirimer epiploik apendijit, yuzlerce epiploik apendiksten birinin torsiyonu, spontan venoz trombozu veya inflamasyonu sonucu olusan inflamatuar ve iskemik bir durumdur. Bu yazida, ultrasonografi ve bilgisayarli tomografi ile tanisi konulan primer epiploik apendijitli bir hastayi, bu hastaligin onemli klinik ve radyolojik bulgulari esiliginde sunuyoruz.

A case of primary epiploic appendagitis of the sigmoid colon diagnosed by abdominal CT and managed conservatively

A case of primary epiploic appendagitis of the sigmoid colon diagnosed by abdominal CT and managed conservatively