Acute Epiploic Appendagitis: A Nonsurgical Abdominal Pain (original) (raw)
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Polish Journal of Radiology
Purpose: Acute epiploic appendagitis (EA) is a relatively rare, benign and local inflammatory disease involving the epiploic appendices. Unlike its mimics, EA is generally a self-limiting inflammatory disease and can be treated conservatively. Case presentation: A 33-year-old Caucasian man presented to our emergency department with a sever and sharp left iliac fossa pain. He underwent abdominal X-ray, ultrasound (US) and computed tomography (CT) evaluations. Conclusion: We illustrate US and CT findings to increase the radiologists' awareness of this condition and to avoid diagnostic delay and unnecessary use of antibiotics, hospitalization and surgery.
Epiploic Appendagitis: A Commonly Overlooked Differential of Acute Abdominal Pain
Cureus, 2021
Epiploic appendagitis is an unusual and very commonly overlooked source of acute abdominal pain. Its incidence is highest in middle-aged obese males. It presents clinically as a focal lower quadrant abdominal pain, usually in the absence of pyrexia, nausea, vomiting or change in bowel habit, and unremarkable laboratory markers. Due to its vague presentation, epiploic appendagitis may be mistaken for other more severe causes of acute abdominal pain like diverticulitis and appendicitis, thereby causing patients to undergo unwarranted management interventions and hospital stay. Epiploic appendagitis is usually diagnosed through imaging, most commonly computed tomography (CT). This condition is largely self-resolving and can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). Operative intervention is usually employed when symptoms persist or when complications arise. We present a case of epiploic appendagitis in a patient who presented with right lower quadrant pain initially misdiagnosed as acute appendicitis.
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...
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-...
Acute epiploic appendagitis: A rare cause of acute abdomen and a diagnostic dilemma
Journal of Family and Community Medicine, 2016
Acute epiploic appendagitis is a relatively rare cause of lower abdominal pain that clinically mimics other acute abdomen conditions that require surgery such as acute diverticulitis or appendicitis. Here, we report a case of a 50-year-old lady who presented with an unusual lower abdominal pain. Awareness of such a clinical condition with its characteristic imaging findings is important to avoid costly hospitalization, unnecessary antibiotic courses, and the morbidity and mortality associated with surgical procedures.
Puerto Rico health sciences journal, 2015
Epiploic appendagitis (EA) is a rare entity caused by the inflammation of the appendix epiploica. It is a benign and self-limited condition presenting as acute onset abdominal pain. The inaccurate diagnosis of EA can lead to unnecessary hospitalization, antibiotic therapy, and surgery. Our aim is to describe the common clinical features of patients who were diagnosed with EA over a 2-year period at the San Juan Veterans Administration Hospital. A retrospective descriptive review of the records of all patients diagnosed with EA from 2007 to 2009. The clinical data was obtained through record review. Diagnoses were confirmed by 2 radiologists reviewing imaging studies. Eight patients were included in the study. All were male with a mean age of 58 years. Seven patients were overweight as per body mass index (BMI) scale. All had localized focal, non-migratory abdominal pain, most (75%) in the left lower quadrant. Nausea (37.5%), anorexia (12.5%), constipation (12.5%), and diarrhea (25%)...
Primary Epiploic Appendagitis: Solving the Puzzle of a Benign Acute Abdomen
Open Access Journal of Surgery, 2018
Background: Acute Epiploic Appendagitis is a self limiting disease due to ischemic infarction of an epiploic appendix. Diagnosis is difficult clinically due to the lack of pathognomonic clinical features, a sudden onset of sharp localized pain either in the left or right iliac fossa with minimal gastrointestinal symptoms, which can simulate a surgical clinical picture. Awareness of imaging findings of this entity is important to arrive at a correct diagnosis and to avoid unnecessary hospitalization and surgery. Methods: 25 patients diagnosed with EA were evaluated and analyzed for demographic factors clinical presentation and diagnostic radiological features. Comparison was also done with data in patients of earlier reported series.
Ultrasound Diagnosis of Primary Epiploic Appendagitis: A Case Report
Open Journal of Medical Imaging
A rare differential diagnosis for severe abdominal pain is acute epiploic appendagitis. Its symptoms resemble those of acute diverticulitis, acute appendicitis, or omental infarction quite a bit. The primary imaging method used for diagnosis is computed tomography (CT). We are describing the case of a 27-year-old guy who underwent an abdominal ultrasonography after complaining of severe left lower quadrant abdominal pain. It identified an oval and non-compressible hyperechoic mass in the left iliac fossa. The mass was surrounded by a hypoechoic rim and there was no color Doppler signal. In the absence of CT, radiologists must be able to diagnose acute epiploic appendagitis on ultrasound in order to avoid unnecessary hospital admission, pricey laboratory tests, antibiotic treatment, and unnecessary surgery. In this instance, the patient was spared from ionization exposure from a potential CT scan and other invasive treatments including surgery with associated costs because of the reliable ultrasound diagnosis of epiploic appendagitis. After receiving conservative medical treatment, the patient was placed under surveillance and then discharged.
Epiploic Appendagitis: CT and MRI Features: Case Presentation
The Internet Journal of Surgery, 2014
Epiploic appendagitis is a rare self-limiting condition and results from either torsion or inflammation of an appendix epiploica of the colon. We report a case of sigmoid epiploic appendagitis diagnosed pre-operatively and treated conservatively. INTRODUCTION Epiploic appendagitis is a rare clinical entity. Depending on its location, epiploic appendagitis may mimic nearly any acute abdominal condition. We report a case of sigmoid epiploic appendagitis in a young male presented with left lower abdominal pain mimicking acute diverticulitis. We also demonstrate the CT scan and MRI features of the condition. CASE REPORT A 36-year-old male patient presented to the ER department complaining of left-side lower abdominal pain for three days duration. He described the pain as of sudden onset and severe in nature initially, but it gradually eased off after few hours and then remained constant. He had no vomiting or change of bowel habits and no urinary symptoms. On examination, the patient wa...
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.