Ultrasound Diagnosis of Primary Epiploic Appendagitis: A Case Report

A rare differential diagnosis for severe abdominal pain is acute epiploic appendagitis. Its symptoms resemble those of acute diverticulitis, acute appendicitis, or omental infarction quite a bit. The primary imaging method used for diagnosis is computed tomography (CT). We are describing the case of a 27-year-old guy who underwent an abdominal ultrasonography after complaining of severe left lower quadrant abdominal pain. It identified an oval and non-compressible hyperechoic mass in the left iliac fossa. The mass was surrounded by a hypoechoic rim and there was no color Doppler signal. In the absence of CT, radiologists must be able to diagnose acute epiploic appendagitis on ultrasound in order to avoid unnecessary hospital admission, pricey laboratory tests, antibiotic treatment, and unnecessary surgery. In this instance, the patient was spared from ionization exposure from a potential CT scan and other invasive treatments including surgery with associated costs because of the reliable ultrasound diagnosis of epiploic appendagitis. After receiving conservative medical treatment, the patient was placed under surveillance and then discharged.

Acute epiploic appendagitis at the tip of the appendix mimicking acute appendicitis: A rare case report with literature review

BACKGROUND Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation of acute appendicitis (AA). To date, very few cases of AEAA have been reported. We report a case of a 52-year old man with the clinical suspicion of AA, but post-operative specimen examination confirmed AEAA as the final diagnosis. CASE SUMMARY A 52-year-old morbidly obese man presented to the emergency department with a 1-d history of the right lower quadrant (RLQ) abdominal pain. Physical examination revealed localized RLQ tenderness mimicking AA. The computed tomography abdomen was inconclusive, and a decision was made to perform laparoscopic appendectomy (LA). During the LA, an infarcted epiploic appendage at the tip of appendix and adherent to the abdominal wall was found, which was entirely excised. Final pathology showed congested and hemorrhagic epiploic appendage without any accompanied acute inflammatory changes in the wall of the appendix. Postoperative course was uneventful and he was doing well at seven months follow-up. CONCLUSION The possibility of AEAA should be considered in patients clinically suspected of having AA. Surgery is considered for those refractory to conservative management, with inconclusive diagnosis or develop complications at presentation.

Epiploic appendagitis as an uncommon cause of lower abdominal pain

Epiploic appendagitis should be considered to be an uncommon cause of lower abdominal pain. To diagnose accurately, typical CT findings are needed, and total colonoscopy should be done later to rule out the possibility of diverticulosis.

Is Outpatient Follow-Up of Epiploic Appendagitis with NSAIDs Alone and Noantibiotics Possible?

Purpose: To assess the clinical course of patients diagnosed as having “epiploic appendagitis” who are given only NSAIDs without antibiotic treatment. Materials and Methods: Between December 2010 and November 2013, twelve patients were presented to the Emergency Surgery Department, Istanbul Medical Faculty, Istanbul University with abdominal pain and were diagnosed having “epiploic appendagitis”. The diagnoses were made using the information gathered from patients’ complaints, physical examination, biochemical results, and radiologic images (Abdominal X-Ray, Abdominal Ultrasonography [USG], and Contrast-Enhanced Computerized Tomography [CT]). We evaluated and recorded the patients’ age distribution, sex difference, laboratory results, radiologic images, length of hospital stay, and control exams after discharge. Results: Twelve out of 35,574 (0.033%) patients who were presented to our Emergency Surgery Department with abdominal pain and were hospitalized as “epiploic appendagitis”. Of these 12 patients, 7 were male (58.3%), and 5 were female (41.7%). The mean age of the patients was 43.5 (range: 22 to 60). The mean time passed between the beginning of the symptoms and presentation to the hospital was 1 day. The length of hospital stay was 1 to 2 days with a mean of 1.3 days. All patients were followed-up non-invasively under NSAID treatment without antibiotherapy. No complications were observed throughout the hospitalization period. The follow-up period of the patients was between 2 to 31 months with a mean of 16 months. Conclusion: Epiploic appendagitis is a self-limiting, benign disease, but differential diagnosis should be done carefully. Patients who are diagnosed with epiploic appendagitis may be followed-up with NSAIDs alone without hospitalization or antibiotherapy.