Clinical Characteristics of Primary Epiploic Appendagitis

Abstract

PurposePrimary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis.MethodsWe reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications.ResultsIn most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 ± 11.9 vs. 69.7 ± 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 ± 2.9 vs. 22.6 ± 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001).ConclusionIn patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.

Is Outpatient Follow-Up of Epiploic Appendagitis with NSAIDs Alone and Noantibiotics Possible?

“…The clinic entity defined as "epiploic appendagitis" is seen mostly between the second and fifth decades of life, and has an incidence of 8.8 per million (0.0008%). There is no gender difference in the incidence of epiploic appendagitis, although it is seen more commonly in obese people [5]. In our clinic, twelve of 35,574 cases (0.033%) who presented to the hospital between the years of 2010 and 2013 with abdominal pain were diagnosed having "epiploic appendagitis".…”

“…Leucocytosis is minimal, and sometimes high levels of CRP may be seen. Other than complicated cases, it is a self-limiting, benign disease [5]. In our physical examinations, 5 patients had tenderness in the right lower quadrant, 5 in the left lower quadrant, and 2 in the right upper quadrant.…”

“…Epiploic appendices show symptoms mostly because of its torsion, ischemia or hemoragicinfarct [4] [5]. This acute abdomen presentation, which is defined as "primary epiploicappendagitis", occurs most commonly in the fourth decade of life [5]. Patients usually present to hospital with a one-or two-day complaint of abdominal pain.…”

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

“…Their sizes are usually 1-2 cm in thickness and 0.5-5 cm in length. Approximately 50-100 appendix epiploica exist from the cecum to the rectosigmoid junction [5]. Epiploic appendagitis has primary and secondary forms.…”

“…They exist in the rectosigmoid junction (57%), ileocecal region (26%), ascending colon (9%), transverse colon (6%), and descending colon (2%) [4]. Primary epiploic appendagitis (PEA) refers to inflammation of appendix epiploica caused by either spontaneous torsion or a hemorrhagic infarct [5]. Their limited blood supply, pedinculated shapes and heavy exercise of the individual make the appendix epiploica prone to torsion and also ischemic or hemorrhagic infarct resulting in the inflamation of the surrounding tissues [2,3].…”