Primary epiploic appendagitis- the great imitator

Monica Laniado, MD, Ibrahim Matar, MD, Simona Croitero, MD, Gideon Sroka, MD, MSc. Bnai-Zion Medical Center

Background: Primary epiploic appendigitis (PEA) is considered a rare cause of abdominal pain. With the increasing use of CT scan, the diagnosis of PEA is increasing, although its true prevalence is not known. Torsion of epiploic appendages resulting in local inflammation can mimic other acute conditions, such as acute appendicitis and diverticulitis. In contrast to these conditions, PEA is a self-limiting disorder. Our purpose was to describe the clinical features and natural history of this disorder.

Methods: A retrospective search of patients admitted to our department between 2009 and 2014 was made. Diagnosis of PEA was made either by CT or during operation. Patients' demographics, clinical presentation, and treatment were assessed.

Results: 41 patients were identified. In 40 of them (98%) the diagnosis was made by CT scan, which revealed a characteristic lesion. One patient (2%) was operated due to suspected appendicitis and the diagnosis of PEA was made during operation. Male predominance (63%) was observed and median age was 49 years. The incidence of PEA in left colon was slightly higher than in the right colon (56% vs. 44%, respectively). 88% of patients had localized abdominal pain, while only in 31% of them it was accompanied by gastrointestinal symptoms, such as nausea or anorexia. In most patients (61%) rebound tenderness (RT) was absent. Symptoms included fever in 2 patients (5%). Leukocytosis was observed in 24% and mild elevation in CRP was observed in 78%. 9 patients (22%) were initially treated with antibiotics and median hospitalization duration was 2 days.

Conclusions: PEA is not a negligible disorder. It is characterized by localized pain and usually is not accompanied by fever or GI symptoms. Mild elevation in inflammatory markers may be observed. The diagnosis is made by abdominal CT scan, which reveals a characteristic para-colic, oval-shaped lesion. A correct diagnosis enables conservative treatment with symptoms relief in few days.

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