Epiploic Appendagitis: An Entity Frequently Unknown to Clinicians—Diagnostic Imaging, Pitfalls, and Look-Alikes (original) (raw)
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Insights into epiploic appendagitis
Nature reviews. Gastroenterology & hepatology, 2011
Epiploic appendagitis is a rare cause of abdominal pain. Diagnosis of epiploic appendagitis, although infrequent, is easily made with CT or ultrasonography in experienced hands. As reported in the literature, most patients with primary epiploic appendagitis are treated conservatively without surgery, with or without anti-inflammatory drugs. A small number of patients are treated with antibiotics and some patients require surgical intervention to ensure therapeutic success. Symptoms of primary epiploic appendagitis usually resolve with or without treatment within a few days. A correct diagnosis of epiploic appendagitis with imaging procedures enables conservative and successful outpatient management of the condition and avoids unnecessary surgical intervention and associated additional health-care costs. Gastroenterologists and all medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions, such as diverticulitis, cho...
Journal of Coloproctology, 2013
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...
A Rare Pathology Mimicing Acute Appendicitis; Epiploic Appendagitis
Sakarya Medical Journal, 2014
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.
Can elongation of the ileum by epiploic appendagitis result in acute abdomen?
The Turkish Journal of Gastroenterology
Epiploic appendagitis mimics acute abdomen or is a condition associated with acute abdomen, although it is usually not treated by emergent surgical intervention and has characteristic findings on computed tomography (1). Mechanical intestinal obstruction is not a real manifestation of the disease because those small appendages (inflamed or not) cannot easily obstruct the small or large intestines because of their small sizes. Epiploic or omental appendages are in fact visceral peritoneal pouches that arise from the serosal and antimesenteric surface of the large intestine. They may act as defending mechanisms, similar to the omentum (2). They can even be helpful in spontaneous healing of small perforations in the hollow viscera, and they can also be used as a patch during surgical interventions, such as in appendectomy, by the surgeon. Because of their roles in defending mechanisms, they can also be speculatively interpreted as dwarf omental structures. Consisting of fat tissue and vessels, they have a length of 0.5-5 cm. While epiploic appendages located near the sigmoid colon are the biggest, >100 such appendages may also occur. None of them are found at the rectal wall. Unfortunately, epiploic appendages are detected on computed tomography only when they are inflamed or surrounded by fluid accumulation. Torsion of epiploic appendages results in vascular occlusion that might lead to ischemia (3). Although there are rare reports about acute epiploic appendagitis, a condition resulting in mechanical obstruction of the ileum elongated like a horse by inflamed and fused epiploic appendagitis has not been reported previously. An 87-year-old female and obese patient with hypertension, diabetes mellitus, and Alzheimer disease was admitted to emergency service because of abdominal distention, nausea, vomiting, and subfebrile fever lasting
Digestive Diseases and Sciences, 2004
Epiploic appendices are small lobular masses of fat emanating from the serosal surface of the colon, normally identifiable by CT only when surrounded by peritoneal fluid. However, an inflamed appendage, which can result from appendageal torsion or thrombosis of an appendageal draining vein, has a characteristic appearance on CT. With the increasing use of CT in the diagnosis of abdominal pain, primary epiploic appendagitis (PEA), a relatively uncommon and benign condition, can now be identified by pathognomonic radiological findings, thus obviating the need for hospitalization, further studies, or surgical exploration. Based upon patient series, PEA is the correct diagnosis in 2-7% of presumed diverticulitis cases and 1% of presumed appendicitis cases (1, 2). Appropriate radiological diagnosis in the otherwise non-toxic-appearing patient allows the clinician to pursue conservative management, avoiding unnecessary intervention and cost. We report three recent cases of PEA presenting to our institution, describing their clinical symptoms, laboratory and CT findings, and follow-up examinations. CASE SERIES Patient 1. A 37-year-old otherwise healthy man presented to his local emergency department with severe right lower quadrant abdominal pain. He had no associated fever, nausea, vomiting, diarrhea, or hematuria. An abdominal CT was obtained and reported to demonstrate inflammation surrounding the right colon.
Torsion of epiploic appendage mimic acute appendicitis
Collegium antropologicum, 2011
Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong right iliac fossa tenderness and guarding. The white cell count was 12.82 x 10(9)/L, and C reactive protein count was 15.13MG/DL. She underwent emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration of the abdominal cavity showed vermiform, no inflamed, appendix and necrotic appendix epiploica of the caecum. The treatment consisted of typical laparoscopic appendectomy and laparoscopic resection of the necrotic appendix epiploica. The patient made rapid recovery and was discharged from the hospital on second day after the operation. Histological investigation of the appendix epiploica revealed gangrenous epiploic appendage.
Primary epiploic appendagitis is a very rare condition that results from acute inflammation of an epiploic appendix. Clinical presentation is non-specific, and many times can mimic acute abdomen. When the diagnosis of epiploic appendagitis is made, conservative treatment must be initiated to avoid unnecessary surgery. We report three cases of acute epiploic appendagitis which were diagnosed by imaging and were managed conservatively with good clinical outcome.
Epiploic appendagitis: a non-surgical cause of acute abdomen
Annals of Gastroenterology : Quarterly Publication of the Hellenic Society of Gastroenterology, 2015
Two patients, a 53-year-old man and a 27-year-old woman, presented at the Emergency Department of our hospital with symptoms of acute abdomen without concomitant fever. Th ey both complained of severe acute abdominal pain localized at the right and left lower quadrants respectively, worsening during the last couple of hours, accompanied by moderate nausea. Rebound tenderness was present in the right and left lower abdominal quadrants respectively, with absence of other pathological fi ndings on physical examination. In this setting our diagnostic thought was guided to the possibility of acute appendicitis in the fi rst patient and acute diverticulitis, pelvic infl ammatory disease or ruptured ovarian cyst in the second one. Laboratory tests were unremarkable. Both patients underwent contrast-enhanced abdominal computed tomography (CT) scan (Fig. 1A-D), which established the diagnosis of primary epiploic appendagitis (EA). Patients were administered a single dose of non-steroid anti-...
Primary Epiploic Appendagitis: A Case Report
Cureus, 2021
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.