Intest Res.  2019 Oct;17(4):554-560. 10.5217/ir.2018.00148.

Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence

• Choi YI
• Woo HS
• Chung JW
• Shim YS
• Kwon KA
• Kim KO
• Kim YJ
• Park DK

• KMID: 2465821
• DOI: http://doi.org/10.5217/ir.2018.00148

Abstract

BACKGROUND/AIMS
There is limited data to compare the clinical characteristics and recurrence rates between left-sided primary epiploic appendagitis (PEA) versus left-sided acute colonic diverticulitis (ACD), and right-sided PEA versus right-sided ACD, respectively.
METHODS
We retrospectively reviewed the medical records and radiologic images of the patients who presented with left-sided or right-sided acute abdominal pain and had computer tomography performed at the time of presentation showing radiological signs of PEA or ACD between January 2004 and December 2014. We compared the clinical characteristics of left PEA versus left ACD and right PEA versus right ACD, respectively.
RESULTS
Fifty-six patients (left:right = 27:29) and 308 patients (left:right = 24:284) were diagnosed with symptomatic PEA and ACD, respectively. Left-sided PEA were statistically significantly younger (50.2 ± 15.4 years vs. 62.1 ± 15.8 years, P= 0.009), more obese (body mass index [BMI]: 26.3 ± 2.9 kg/m² vs. 22.3 ± 3.1 kg/m² , P< 0.001), and had more tendencies with normal or mildly elevated high-sensitivity C-reactive protein (hsCRP) (1.2 ± 1.3 mg/dL vs. 8.4 ± 7.9 mg/dL, P< 0.001) than patients with left-sided ACD. The discriminative function of age, BMI and CRP between left-sided PEA versus left-sided ACD was 0.71 (cutoff: age ≤ 59 years, sensitivity of 66.7%, specificity of 77.8%), 0.84 (cutoff: BMI > 24.5 kg/m² , sensitivity of 80.0%, specificity of 80.0%) and 0.80 (cutoff: CRP < 1.8 mg/dL, sensitivity of 72.2%, specificity of 85.7%).
CONCLUSIONS
If patients with left lower quadrant abdominal pain are less than 60 years, obese (BMI > 24.5 kg/m² ) with or without normal to mild elevated CRP levels (CRP < 1.8 mg/dL), it might be necessary for clinicians to suspect the diagnosis of PEA rather than ACD.

Keyword

Appendage; Diverticulitis, colonic; Recurrence; Obesity

MeSH Terms

Abdominal Pain
C-Reactive Protein
Diagnosis
Diverticulitis*
Diverticulitis, Colonic
Humans
Medical Records
Obesity*
Peas
Recurrence*
Retrospective Studies
Sensitivity and Specificity
C-Reactive Protein

Figure

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  Fig. 1. Flowchart. ACD, acute colonic diverticulitis; PEA, primary epiploic appendagitis.

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  Fig. 2. Recurrence-free survivals of all PEA and ACD patients. PEA, primary epiploic appendagitis; ACD, acute colonic diverticulitis.

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  Fig. 3. Recurrence-free survivals of left-sided PEA and ACD patients. PEA, primary epiploic appendagitis; ACD, acute colonic diverticulitis.

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  Fig. 4. Recurrence-free survivals of right-sided PEA and ACD patients. PEA, primary epiploic appendagitis; ACD, acute colonic diverticulitis.

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