Clinical aspects of Primary Epiploic Appendagitis

Choo, Sung Wook; Lee, Jae Wook; Lee, Jang Kyu; Kim, Sung Jun; Lee, Duck Young; Park, Gyeng Hyen; Hur, Chung; Lee, JinKwan

Abstract

BACKGROUND: Primary epiploic appendagitis is rarely diagnosed preoperatively and usually results from torsion with subsequent infarction epiploic appendage. Until recent years no diagnostic procedures or clinical symptoms were pathognomic for this disease and the most common preoperative diagnosis were acute diverticulitis and appendicitis. Rapid advance of imaging technique, especially ultrasound, makes it possible to get image of diseased epiploic appandage. Also primary epiploic appendagitis occurs more frequently than it has been suggested in the literature. Therefore authors analyzed and reviewed clinical features and radiological findings of 15 cases with primary epiploic appendagitis to give attention to the acute epiploic appendagitis as one of the ways for diagnosing the acute abdominal pain that has unclear diagnosis, thinking that the rapid diagnosis will helpful to escaping the unnecessary operations.
METHODS
This study included twelve men and three women(aged 20-60years). Surgery was done in two patients, one misdiagnosed for acute appendicitis and another for acute diverticulitis with abscess. Follow up examinations were performed with US and CT(n=3), with US, CT and MRI(n=2) and with clinical course (n=13).
RESULTS
All patients had localized abdominal pain and tenderness, mostly in the left lower quadrants (n=12). Duration of pain was 3.3 days (1-15days). Two patients had mild fever and two patients had nausea. Leukocytosis was found in four patients. In all cases US revealed a solid hyperechoic(n=13) or isoechoic(n=2) non-compressible ovoid mass with hypoechoic rim. The masses were located under the site of maximum tenderness. CT and MRI finding were compatible with US.
CONCLUSION
Primary epiploic appendagitis can be diagnosed pre-operatively using recent imaging technique, and US finding is fairly characteristic. This disorder is not so rare entity as previously known and must be included in the differential diagnosis of acute unexplained abdominal pain in adults.