Epiploic Appendagitis: A Riddle for Right Lower Quadrant Pain! (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...
Acute Epiploic Appendagitis: A Nonsurgical Abdominal Pain
Case Reports in Emergency Medicine
Epiploic appendagitis is a relatively rare disease characterized by an inflammation of fat-filled serosal outpouchings of the large intestine, called epiploic appendices. Diagnosis of epiploic appendagitis is made challenging by the lack of pathognomonic clinical features and should therefore be considered as a potential diagnosis by exclusion first of all with appendicitis or diverticulitis which are the most important causes of lower abdominal pain. Currently, with the increasing use of ultrasound and computed tomography in the evaluation of acute abdominal pain, epiploic appendagitis can be diagnosed by characteristic diagnostic imaging features. We present a case of epiploic appendagitis with objective of increasing knowledge of this disease and its diagnostic imaging findings, in order to reduce harmful and unnecessary surgical interventions.
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.
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.
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...
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.
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-...