An unusual cause of acute abdomen – epiploic appendagitis: report of two cases

Burcu, Busra; Ekinci, Özgür; Inan, İbrahim; Ozyalvac, Ferman Tevfik; Eren, Tunç; Ali̇moğlu, Orhan

doi:10.14744/nci.2015.25338

Cited by 3 publications

(4 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A clinical profile of 21 patients of EA searched in the indexed journals shows that almost 90% have lower abdominal pain, as shown in Table 1 [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Fever and vomiting were absent in most patients, while tenderness of localized area was present in all patients.…”

Section: Discussionmentioning

confidence: 99%

Epiploic Appendagitis: A Riddle for Right Lower Quadrant Pain!

Bains

Bahadur

Lal³

et al. 2021

Case Rep Gastroenterol

View full text Add to dashboard Cite

Epiploic appendagitis (EA) is inflammation of epiploic appendages, which are pedunculated fatty structures, extend from the cecum to the rectosigmoid junction, and are covered by the peritoneum. Torsion, infarction, and inflammation of it present with acute lower abdominal pain and localized tenderness in a well-looking patient. It poses as diagnostic conundrum due to its rarity and not picked by conventional radiography. A 50-year-old male presented with pain in RLQ for past 1 day, which kept on increasing without any other symptoms. His abdomen was soft with tenderness localized to the right lower quadrant (RLQ), classically at McBurney’s point along with mild peritonism. Rest laboratory test, chest, and abdominal X-ray were normal except slight leukocytosis. Ultrasound was inconclusive. A working clinical diagnosis of appendicitis was made. Patient did not consent for surgery and was started on antibiotics with pain killers. With no significant improvement, he underwent CT scan which revealed focal area of soft-tissue attenuation along the lateral wall of ascending colon with fat stranding. He was diagnosed as EA and improved on conservative treatment. EA of RLQ of abdomen mimics acute appendicitis and can be considered as an uncommon differential diagnosis in presence of radiological findings of normal-appearing appendix. CT is the investigation of choice, and treatment is essentially conservative. Further, if appendix is found normal at exploration, surrounding epiploic appendages of the cecum and ascending colon should also be evaluated carefully for inflammation/hematoma/gangrene, besides looking for Meckel’s diverticulum.

show abstract

Section: Discussionmentioning

confidence: 99%

Epiploic Appendagitis: A Riddle for Right Lower Quadrant Pain!

Bains

Bahadur

Lal³

et al. 2021

Case Rep Gastroenterol

View full text Add to dashboard Cite

show abstract

“…PEA being a self-limiting disease is managed conservatively with a better understanding of the disease, and conservative management is established as the treatment of choice [ 4 , 5 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Primary Epiploic Appendagitis: A Case Report

Mert¹,

Mırcık²

2021

Cureus

View full text Add to dashboard Cite

Primary epiploic appendagitis (PEA) is a rather uncommon and self-limiting cause of acute abdomen managed conservatively. Overlapping clinical features with other common causes of acute abdomen usually requiring surgical intervention, and rare occurrences have led to misdiagnosis of the condition and unnecessary surgical intervention. However, with identification of definite characteristic features on imaging (computed tomography [CT] scan) has led to easier diagnosis and avoidance of exploratory laparotomy. Here we present a case of PEA in a 34-year-old otherwise healthy Caucasian male with a chief complaint of acute left-sided abdominal, flank and inguinal pain with diarrhea. Laboratory investigation reports were more or less within normal limits; CT scan confirmed the diagnosis of PEA. The patient was managed successfully with an oral antibiotic and a non-steroidal anti-inflammatory drug. CT scan should be done in cases of acute abdomen (if not absolutely contraindicated) for confirmation of diagnosis, as in our case CT scan helped in confirmation of diagnosis of PEA and thus avoided unnecessary surgical intervention. However, with the current advances in radiological tools, correct diagnosis of acute abdomen has become a lot easier, leading to timely surgical intervention and also at the same time avoidance of unnecessary exploratory laparotomy. Again, with documentation of specific characteristic radiological features of PEA, diagnosis of PEA has become much easier. After careful correlation among clinical, radiological, and laboratory findings, diagnosis of PEA was confirmed. The patient was managed conservatively at home with the advice of plenty of fluid intake and bed rest. Furthermore, he was prescribed an oral antibiotic (ciprofloxacin) and a non-steroidal anti-inflammatory drug (ibuprofen) empirically for seven days to prevent further complications like adhesions, bowel obstruction, intussusception, peritonitis, and local abscess formation. The patient recovered completely (the symptoms and signs resolved clinically) after one week. To conclude, it can be said, although rare in occurrence and lacking in specific presenting features, diagnosis of PEA has become easier with imaging techniques like CT scan and magnetic resonance imaging (MRI); thus, with prior awareness regarding this disease among physicians, unnecessary surgical interventions can be avoided.

show abstract

“…The right lower PEA is often confused with acute appendicitis; while left sided PEA is often misdiagnosed as sigmoid diverticulitis in clinic. Therefore, diagnosis of PEA was often the result of an unexpected finding during an exploratory laparotomy in the past [14] . Today, however, this condition is usually accurately diagnosed by Color Doppler ultrasound (CDUS) or CT pre-operatively.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the past, the regular therapy for PEA was surgical excision because most cases were discovered during exploratory operation. Some researchers have reported that pain recurred or persisted until the epiploic appendagitis was removed in a part of their cases, so they strongly recommended excision of PEA when it was diagnosed [14] . Later, with the further understanding of this disease, more and more researchers proposed nonsurgical management of PEA.…”

Section: Discussionmentioning

confidence: 99%

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

2019

View full text Add to dashboard Cite

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.

show abstract

An unusual cause of acute abdomen – epiploic appendagitis: report of two cases

Cited by 3 publications

References 7 publications

Epiploic Appendagitis: A Riddle for Right Lower Quadrant Pain!

Epiploic Appendagitis: A Riddle for Right Lower Quadrant Pain!

Primary Epiploic Appendagitis: A Case Report

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

Contact Info

Product

Resources

About