Primary Epiploic Appendagitis

Abstract

Primary epiploic appendagitis is an inflammation of the epiploic appendages occurring due to ischemic infarction as a result of appendage torsion or spontaneous thrombosis usually affecting patients from second to fifth decades, being more common in women and obese patients. It is a self-limiting entity with clinical features similar to other inflammatory abdominal processes and sometimes not remembered at clinical examinations. The awareness of this entity and its correct identification on imaging examinations could prevent unnecessary surgery. The authors present a clinical case complemented with ultrasound and CT images of this entity.

An Acute Abdomen Dilemma: Epiploic Appendagitis

“…The pain was reported to be more frequent in the left lower quadrant in the literature. 3,4,5 However, it was more frequent in the right lower quadrant in our study. Routine laboratory tests are within normal limits, except for mild leukocyte count and CRP increase.…”

“…Male or female dominance is not certain in the literature. 1,3 It may be confused with acute appendicitis, acute cholecystitis or diverticulitis, depending on localization. The patients with a definite diagnosis based on imaging should be initially treated medically.…”

Epiploic appendagitis with acute pyelonephritis: a case report

“…Secondary epiploic appendagitis is due to diverticulitis, appendicitis, or pancreatitis. 6 Clinical presentation is abdominal pain and localized tenderness.…”

“…7 Epiploic appendage is seen as an ovoid hypodense pericolic lesion due to the fat composition with a hyperdense halo representing the inflamed visceral peritoneal covering of the appendage. 6 Standard treatment is with anti-inflammatory drugs; antibiotics are generally not indicated, except in rare cases in which colonic bacteria infiltrate and cause localized abscess formation or generalized peritonitis. 8 Laparoscopy is done for complications such as adhesions, intestinal obstruction, doubtful cases or recurrence of symptoms after conservative management.…”

Mast cell deposition and activation may be a new explanation for epiploic appendagitis

“…Epiploic appendages are rows of adipose structures found on the surfaces of the small and large intestine and are composed of fat and have a central vein and artery and a peritoneal covering. 1 Epiploic appendagitis (EA) can be caused by an idiopathic inflammatory disease and/or disease caused by torsion of the appendage. 1 The classic presentation is sudden onset of dull or sharp abdominal pain which is referred directly from the inflamed peritoneal surface of the appendage which usually is located in the right or left lower quadrant.…”