Primary epiploic appendagitis: evaluation of computed tomography findings in the differential diagnosis of patients that presented with acute abdominal pain

A.N. Doğan, B. Çakıroğlu, A.H. Akça, S.H. Aksoy, T. Akar

Department of Internal Medicine, Hisar Intercontinental Hospital, Istanbul, Turkey. drbasri@gmail.com

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• Gastroenterology

OBJECTIVE: Primary epiploic appendagitis (PEA) is a rare cause of abdominal pain revealed by torsion of colonic structures called epiploic appendices. In this paper, we present our clinical data and experience regarding this rare condition that may be confused with many diseases, such as acute appendicitis, diverticulitis, salphingitis, renal colic that may require emergency surgery.

MATERIALS AND METHODS: A total of 39 consecutive patients diagnosed as PEA confirmed by abdominal computed tomography with a clinical course. Basic demographic data, abdominal pain characteristics, physical examination findings, laboratory results, treatment methods, and clinical course of the patients were retrospectively evaluated. Statistical analysis was performed using SPSS (18.0; Chicago, IL, USA), using the χ2-test and Fisher’s exact test.

RESULTS: Of the 39 patients diagnosed with PEA, 35 were male and 4 were female; the mean age of the patients was 36.0 ± 10.3. The main complaints were 69.2% abdominal pain, 12.8% groin pain, 5.1% flank pain with nausea and vomiting (2.6%), and abdominal swelling and dysuria. The average time of symptom was 5.3 days (1-15 days). In the computed tomography scan images, PEA was located in the sigmoid colon (21, 53.8%), descending colon (10, 25.6%), ascending colon (5, 12.8%), cecum (2, 5.1%), and hepatic flexure (1, 2.6%). No patient underwent surgical treatment. However, 9 of 39 patients were hospitalized for medical treatments, such as antibiotics and analgesic drugs intravenously. All patients were followed-up for a period of 1-year and there were no recurrence symptoms.

CONCLUSIONS: When patients with localized lower abdominal pain and tenderness do not have associated symptoms or laboratory abnormalities, a high index of suspicion for PEA and early radiologic examinations are required.

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