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1
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Ramzan NUH, Asif T, Tauqeer M, Hashmat MB, Anwer MU. A False Alarm of Acute Abdomen: Epiploic Appendagitis Case Report and Literature Review. Cureus 2024; 16:e65529. [PMID: 39188448 PMCID: PMC11346586 DOI: 10.7759/cureus.65529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
An acute abdomen that is tender to palpation often represents a life-threatening emergency requiring immediate surgical or medical management. We present a case of acute abdomen with peritoneal signs and symptoms due to epiploic appendagitis (EA) that resolved with a single dose of ibuprofen. EA often mimics appendicitis, diverticulitis, and rarely cholecystitis based on its location. It arises due to ischemic infarction of an epiploic appendage, typically caused by torsion or spontaneous thrombosis of the central draining vein. Despite its rarity, clinicians need to recognize the characteristic imaging findings of EA on CT and ultrasound to avoid unnecessary surgical interventions and to manage the condition conservatively.
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Affiliation(s)
| | - Talha Asif
- Internal Medicine, Allied Hospital, Faisalabad, PAK
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2
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El-Menyar A, Naqvi SGA, Al-Yahri O, Abusal AM, Al-Shaikhli A, Sajid S, Abdelrahman H, Kloub AG, Ibnas M, Latifi R, Toble YMR, Al-Thani H. Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases. World J Surg 2024; 48:1363-1372. [PMID: 38558004 DOI: 10.1002/wjs.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. METHODS An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. RESULTS There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. CONCLUSION This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Syed G A Naqvi
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Omer Al-Yahri
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Sadia Sajid
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad G Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Muhamed Ibnas
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Latifi
- Kosova College of Surgeons, Prishtina, Kosova, and University of Arizona, Tucson, Arizona, USA
| | - Yasser M R Toble
- Department of Anesthesiology and Pain Management, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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3
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Alhazmi A, de Carvalho Fischer C, Schaafs LA, Seifarth C. [Epiploic appendagitis: an uncommon and nonsurgical cause of abdominal pain]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:954-958. [PMID: 37698617 DOI: 10.1007/s00104-023-01960-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Epiploic appendagitis (AE) is a rare cause of acute abdomen and is often misdiagnosed as other common causes of acute abdomen, such as acute appendicitis, cholecystitis or diverticulitis due to its low incidence and its nonspecific clinical picture. This study presents the clinical course of AE and typical radiological features for an early and correct diagnosis in order to emphasize the importance of an early and correct diagnosis of AE. METHODS This is a retrospective review of 43 patients diagnosed with AE between June 2010 and September 2022 at the Charité - University Hospital Berlin, Campus Benjamin Franklin. The medical records were reviewed regarding clinical und radiological features, anatomical location of the AE und treatment methods. RESULTS A total of 43 patients (29 male, 11 female) were diagnosed with AE and almost all patients presented with abdominal pain, except in 8 cases (18.6%). Specific findings in computer tomography (CT) with a typical picture of AE were found in 33 patients (76.7%). AE was mostly localized in the left colon: 12 were found in the sigmoid colon (27.9%), 16 in the descending colon (37.2%) and 5 at the junction of the descending colon and the sigmoid colon (11.6%). Of the patients 28 (65.1%) were admitted for conservative treatment and the rest of the patients were treated as outpatients. No patient underwent surgery, all were treated with analgesics (NSAID) and 17 patients received antibiotics in addition. CONCLUSION AE is a self-limiting disease and a common mimic of other serious causes of abdominal pain. Due to the emergence of the widespread use of imaging modalities, an early diagnosis of AE and a conservative approach as first choice of treatment in patients with AE could be established.
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Affiliation(s)
- Ahmad Alhazmi
- Klinik für Allgemein- und Viszeralchirurgie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - Cynthia de Carvalho Fischer
- Klinik für Allgemein- und Viszeralchirurgie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Lars-Arne Schaafs
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Claudia Seifarth
- Klinik für Allgemein- und Viszeralchirurgie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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4
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Patel M, Haider I, Cheung A. Primary Epiploic Appendagitis: A Mimicker of Abdominal Pain. Clin Med Res 2023; 21:159-162. [PMID: 37985168 PMCID: PMC10659129 DOI: 10.3121/cmr.2023.1837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 11/22/2023]
Abstract
Epiploic appendagitis is a rare cause of acute lower abdominal pain. Epiploic appendices are fat-filled serosal outpouchings of the cecum and sigmoid colon. Primary epiploic appendagitis (PEA) is characterized by epiploic inflammation caused by torsion of the appendage leading to ischemia or thrombosis of the appendage draining vein. Secondary epiploic appendagitis occurs in association with other inflammatory conditions of the abdomen or pelvis, most commonly diverticulitis. PEA is an important clinical mimicker of more severe causes of acute abdominal pain, such as diverticulitis, appendicitis, or gynaecological causes. The ease of access to computed tomography (CT), the diagnostic test of choice, has resulted in increased recognition of PEA. The classic CT findings of PEA are an ovoid mass measuring between 1.5 and 3.5 cm surrounded by a hyperattenuating/hyperdense ring with a centrally located hyperdense area. It is important to diagnose PEA as it is self-limiting and the correct diagnosis can prevent unnecessary hospital admission, antibiotic use, or even surgical intervention. We present a case of a 65-year-old male with a history of diverticulitis, presenting with left lower quadrant abdominal pain who was diagnosed with PEA based on CT and successfully managed with conservative treatment.
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Affiliation(s)
- Matthew Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Imran Haider
- Medical Student, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew Cheung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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5
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Ekladious A, Bhandari R. Epiploic appendagitis: a commonly undiagnosed non-surgical acute abdominal emergency. Intern Med J 2023; 53:1265-1268. [PMID: 37474462 DOI: 10.1111/imj.16157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/15/2023] [Indexed: 07/22/2023]
Abstract
Epiploic appendagitis is a rare cause of acute abdomen and is diagnostically challenging as it mimics common causes of acute abdomen. However, advancements in computerised tomography/Ultrasound imaging have improved the frequency and confidence of diagnosing epiploic appendagitis, preventing unnecessary surgeries. We present a case of an acute abdomen who had to undergo laparoscopy before being diagnosed with epiploic appendagitis, underscoring the difficulty in diagnosis.
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Affiliation(s)
- Adel Ekladious
- Department of General Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of General Medicine and Acute Assessment Unit, Canberra Hospital, Canberra, ACT, Australia
| | - Ritesh Bhandari
- Department of General Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
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6
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Khafaji RA, Ghandourah HS, Altamimi SK, Alwarthan AA, Alhabib RA, Alaiyar MN, Alomar IA, Alayshan MI, Almasoudi MS, Jaml Allil HA, Munshi SZ, Aljamri SK, Bagadeem BS, Attar MS, Al-Hawaj F. Epiploic Appendagitis Clinically Masquerading as an Acute Diverticulitis. Cureus 2021; 13:e20188. [PMID: 35004011 PMCID: PMC8727498 DOI: 10.7759/cureus.20188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/22/2022] Open
Abstract
Acute diverticulitis is a prevalent surgical condition that typically presents with lower abdominal pain and tenderness. However, the clinical and laboratory findings of diverticulitis are non-specific and other conditions may give similar manifestations. We present the case of a middle-aged woman with a left lower quadrant abdominal pain and fever of three days duration. On examination, she had tachycardia and localized tenderness in the left iliac fossa with rebound tenderness. There were no signs of peritonitis, including the rigid abdomen and decreased bowel sounds. The laboratory findings were suggestive of an inflammatory or infectious process. A computed tomography scan of the abdomen demonstrated a fat-density lesion anterior to the descending colon representing epiploic appendagitis. The patient was managed conservatively with non-steroidal anti-inflammatory drugs (lornoxicam 8 mg). The patient experienced gradual improvement and was discharged after four days of hospitalization. No surgical intervention was needed. The case highlighted the importance of considering epiploic appendagitis in the differential diagnosis of acute diverticulitis. An accurate diagnosis will prevent the patient from having unnecessary surgeries as conservative management is often sufficient in patients with epiploic appendagitis.
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Affiliation(s)
| | | | | | - Afnan A Alwarthan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | | | | | - Hashem A Jaml Allil
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | | | - Sarah K Aljamri
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Basil S Bagadeem
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Motaz S Attar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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7
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Shelton J, Terry S. CT Imaging Findings of Porcelain Gallbladder and Epiploic Appendagitis: Two Rare Abdominal Pathologies in an Asymptomatic Patient. Cureus 2021; 13:e15578. [PMID: 34277200 PMCID: PMC8272651 DOI: 10.7759/cureus.15578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Porcelain gallbladder (PG) and epiploic appendagitis (EA) are rare imaging findings in an asymptomatic patient. The clinical presentation of PG and EA can vary; however, a common presenting complaint is abdominal discomfort. We describe the case of a 54-year-old male with computerized tomography findings consistent with PG and EA. We also performed a review of the literature to understand the etiology, clinical presentation, and diagnosis and treatment options of both PG and EA.
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Affiliation(s)
| | - Shawn Terry
- Trauma & Critical Care Surgery, Wellspan York Hospital, York, USA
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8
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Hirose Y, Shikino K. Epiploic Appendagitis. Am J Med 2021; 134:e195-e196. [PMID: 32941844 DOI: 10.1016/j.amjmed.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Yuta Hirose
- Department of General Medicine, Funabashi Futawa Hospital, Chiba, Japan.
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Japan
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9
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Akubudike JTE, Egigba OF, Kobalava B. Epiploic Appendagitis: A Commonly Overlooked Differential of Acute Abdominal Pain. Cureus 2021; 13:e12807. [PMID: 33628675 PMCID: PMC7894223 DOI: 10.7759/cureus.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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.
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10
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Abstract
Acute epiploic appendagitis is a benign condition caused by inflammation of the epiploic appendages that are serosal lined outpouchings of the colon lying adjacent to the tenia coli. This rare condition has non-specific clinical findings and is frequently misdiagnosed as either acute diverticulitis or acute appendicitis. However, unlike other surgical causes of acute abdomen, epiploic appendagitis is a self-limited condition and resolves with conservative management. CT of the abdomen plays a vital role in diagnosing this condition and excluding other causes of acute abdomen. This case report highlights the importance of being aware of this rare condition and its consideration in the differential diagnosis of acute lower abdominal pain to avoid unnecessary hospitalization and surgery.
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Affiliation(s)
| | - David Lerner
- Department of Radiology: Abdominal Imaging, University of Washington, Seattle, USA
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11
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Elmohr MM, Elsayes KM, Pickhardt PJ. Non-neoplastic conditions mimicking peritoneal carcinomatosis at CT imaging. Br J Radiol 2020; 93:20200401. [PMID: 32516560 DOI: 10.1259/bjr.20200401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The general appearance of peritoneal carcinomatosis at abdominal CT and other cross-sectional imaging modalities consists of varying amounts of peritoneal-based soft tissue implants (mass-forming or infiltrative), peritoneal fluid, and occasionally calcification. However, a wide variety of common and uncommon neoplastic and non-neoplastic conditions can closely mimic peritoneal carcinomatosis at imaging. Neoplastic mimics of peritoneal carcinomatosis include primary peritoneal and sub peritoneal tumors, as well as peritoneal lymphomatosis and sarcomatosis.Broad categories of non-neoplastic mimics of peritoneal carcinomatosis include tumor-like conditions, systemic processes, atypical infections, and fat-based conditions. For many entities, suggestive or specific patient information and/or CT imaging findings exist that may allow the radiologist to narrow the differential diagnosis. In this article, we review the salient clinical and cross-sectional imaging features of non-neoplastic mimics of peritoneal carcinomatosis and malignancy, with emphasis on the CT findings and the additional clues that may suggest the correct benign diagnosis.
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Affiliation(s)
- Mohab M Elmohr
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Khaled M Elsayes
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
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12
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Trovato P, Simonetti I, Verde F, Lomoro P, Vinci G, Tarotto L, Corvino F, Corvino A. Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques. Pol J Radiol 2020; 85:e178-e182. [PMID: 32419882 PMCID: PMC7218446 DOI: 10.5114/pjr.2020.94335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/02/2020] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Piero Trovato
- Department of Advanced Biomedical Sciences, University of Naples ”Federico II”, Naples, Italy
| | - Igino Simonetti
- Department of Advanced Biomedical Sciences, University of Naples ”Federico II”, Naples, Italy
| | - Francesco Verde
- Department of Advanced Biomedical Sciences, University of Naples ”Federico II”, Naples, Italy
| | - Pascal Lomoro
- Department of Radiology, Valduce Hospital, Como, Italy
| | - Giorgia Vinci
- Department of Nephrology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luca Tarotto
- Department of Advanced Biomedical Sciences, University of Naples ”Federico II”, Naples, Italy
| | - Fabio Corvino
- Department of Interventional Radiology, AORN “A. Cardarelli”, Naples, Italy
| | - Antonio Corvino
- Department of Motor Science and Wellness, University of Naples “Parthenope”, Naples, Italy
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13
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Suresh Kumar VC, Mani KK, Alwakkaa H, Shina J. Epiploic Appendagitis: An Often Misdiagnosed Cause of Acute Abdomen. Case Rep Gastroenterol 2019; 13:364-368. [PMID: 31607837 PMCID: PMC6787410 DOI: 10.1159/000502683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/09/2019] [Indexed: 12/31/2022] Open
Abstract
Epiploic appendages are peritoneal structures that arise from the outer serosal surface of the bowel wall towards the peritoneal pouch. They are filled with adipose tissue and contain a vascular stalk. Epiploic appendagitis is a rare cause of acute lower abdominal pain. It most commonly results from torsion and inflammation of the epiploic appendages, and its clinical features mimic acute diverticulitis or acute appendicitis resulting in being often misdiagnosed as diverticulitis or appendicitis. This frequently leads to unnecessary hospitalization, antibiotic administration, and unwarranted surgeries. Epiploic appendagitis is usually diagnosed with CT imaging, and the classic CT findings include: (i) fat-density ovoid lesion (hyperattenuating ring sign), (ii) mild bowel wall thickening, and (iii) a central high-attenuation focus within the fatty lesion (central dot sign). It is treated conservatively, and symptoms typically resolve in a few days. Therefore, epiploic appendagitis should be considered as one of the differential diagnosis for acute lower abdominal pain and prompt diagnosis of epiploic appendagitis can avoid unnecessary hospitalization and surgical intervention. In this case report, we discuss a 72-year-old woman who presented with a 2-day history of acute left lower abdominal pain.
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Affiliation(s)
- Vishnu Charan Suresh Kumar
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York, USA
- Department of Medicine, Western Reserve Health Education/ NEOMED, Warren, Ohio, USA
| | - Kishore Kumar Mani
- S.R.M. Medical College Hospital and Research Centre, Kattankulathur, India
| | - Hisham Alwakkaa
- Department of Medicine, Western Reserve Health Education/ NEOMED, Warren, Ohio, USA
| | - James Shina
- Department of Medicine, Western Reserve Health Education/ NEOMED, Warren, Ohio, USA
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14
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Huang K, Waheed A, Juan W, Misra S, Alpendre C, Jones S. Acute epiploic appendagitis at the tip of the appendix mimicking acute appendicitis: A rare case report with literature review. World J Gastrointest Surg 2019; 11:342-347. [PMID: 31523384 PMCID: PMC6715586 DOI: 10.4240/wjgs.v11.i8.342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/04/2019] [Accepted: 07/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation of acute appendicitis (AA). To date, very few cases of AEAA have been reported. We report a case of a 52-year old man with the clinical suspicion of AA, but post-operative specimen examination confirmed AEAA as the final diagnosis.
CASE SUMMARY A 52-year-old morbidly obese man presented to the emergency department with a 1-d history of the right lower quadrant (RLQ) abdominal pain. Physical examination revealed localized RLQ tenderness mimicking AA. The computed tomography abdomen was inconclusive, and a decision was made to perform laparoscopic appendectomy (LA). During the LA, an infarcted epiploic appendage at the tip of appendix and adherent to the abdominal wall was found, which was entirely excised. Final pathology showed congested and hemorrhagic epiploic appendage without any accompanied acute inflammatory changes in the wall of the appendix. Postoperative course was uneventful and he was doing well at seven months follow-up.
CONCLUSION The possibility of AEAA should be considered in patients clinically suspected of having AA. Surgery is considered for those refractory to conservative management, with inconclusive diagnosis or develop complications at presentation.
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Affiliation(s)
- Kai Huang
- Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
| | - Abdul Waheed
- Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
| | - William Juan
- Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
| | - Subhasis Misra
- Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
| | - Cristiano Alpendre
- Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
| | - Stephen Jones
- Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
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15
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Di Serafino M, Iacobellis F, Trovato P, Stavolo C, Brillantino A, Pinto A, Romano L. Acute Epiploic Appendagitis: A Nonsurgical Abdominal Pain. Case Rep Emerg Med 2019; 2019:7160247. [PMID: 31380126 PMCID: PMC6662477 DOI: 10.1155/2019/7160247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Naples, Italy
| | - Piero Trovato
- Department of Advanced Biomedical Sciences, “Federico II” University Hospital, Naples, Italy
| | - Ciro Stavolo
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Naples, Italy
| | - Antonio Brillantino
- Department of Emergency Surgery, “Antonio Cardarelli” Hospital, Naples, Italy
| | - Antonio Pinto
- Department of Radiology, Traumatology Centre “CTO-Dei Colli” Hospital, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Naples, Italy
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