Primary epiploic appendagitis

Abstract

Primary epiploic appendagitis (PEA) is a seldom reported disease caused by spontaneous torsion of one or more epiploic appendices. The aim of this study is to describe two cases of PEA reviewing the main aspects of the diagnosis and treatment of disease. Case report: Case 1) Male patient, 55 years old, obese, with abdominal right iliac fossa (RIF) pain for two days. Abdominal examination showed pain on palpation in the RIF with rebound tenderness. Abdominal computed tomography identified lobulated lesion in the cecum, measuring 4.5 cm in diameter, which was suggestive of PEA or early neoplasm of the colon wall. The laparoscopic assessment confirmed the diagnosis of PEA and the appendix was removed. The patient had a satisfactory outcome, being discharged on the second postoperative day. Case 2) Female patient, obese, 47 years old, with abdominal pain for six days, with sudden RIF onset. She had pain at palpation with rebound tenderness. Acute diverticulitis was suspected and patient underwent abdominal CT that identified PEA in the sigmoid colon. After expectant management, the patient showed progressive improvement resuming her activities in seven days. PEA is a rarely recalled condition during the investigation of inflammatory acute abdomen which can be easily recognized by modern imaging methods of assessment.

Clinical, diagnostic and therapeutic aspects of the epiploic appendagitis

“…However, they are more frequently found in the sigmoid (57%), followed by cecum (26%), ascending colon (9%), transverse colon (6%) and descending colon (2%). 3,11 They are not commonly found in reto. 4 Its length varies from 0.5-5cm and its wall thickness is 1-2cm.…”

“…4 Each appendages receives blood supply from one or two branches of terminal arteries formed in the straight vasa of the colon, being drained by a single tortuous vein which passes through its narrow pedicle. 11,12 The ischemic symptoms of EA are initially caused by the venous component. 4 Thus, this blood supply, associated with the pedunculated form, excessive mobility transforms the appendages into structures prone to torsion, ischemia or even hemorrhagic infarction and spontaneous venous thrombosis of a drainage vein.…”

“…10 The predicted risk factors include: hernia, obesity, rapid weight loss, and strenuous exercise. 4,10 In the research developed by Martinez et al 11 the majority of patients with EA was obese or lost weight sharply in a short period of time. In this same research was also cited a study in which the patients with EA had a body mass index (BMI) >25.9 with deviation of ±3.5kg/m 2 , significantly higher when compared to patients with acute diverticulitis.…”

“…This pathology has a higher incidence around 40 years, a younger age when compared to patients with Acute Diverticulitis in sigmoid. 11 In addition, reports of EA in children are very rare. 8 There is evidence in the literature which reveals that men are affected almost five times more than women (82%x18% respectively).…”

“…It is preferably located in the lower left quadrant (73%-93%) when compared to the right (7% -21%) or in epigastric region (2% to 5%). 11,14 This is probably due to a higher incidence of EA in the sigmoid. 11 Freitas et al reported that the time of evolution of abdominal pain before the definitive diagnosis ranged from one to five days, with a median duration of three days.…”