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Clinical diagnosis of primary epiploic appendagitis: differentiation from acute diverticulitis
Hee Jung Son1, Soon Jin Lee, Jun Haeng Lee
1Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Background:
Primary epiploic appendagitis (PEA) is an uncommon cause of abdominal pain that occurs either from appendageal torsion or spontaneous thrombosis of an appendageal draining vein. Primary epiploic appendagitis is frequently misdiagnosed as either appendicitis or diverticulitis, depending on its location.
Study:
Clinical and radiologic characteristics of 8 patients with PEA were retrospectively reviewed and compared with 18 patients with acute diverticulitis.
Results:
Patients with PEA presented with lower abdominal pain of recent onset that was localized to the left (seven cases) and right (one case) lower quadrants. Well-localized tenderness without peritoneal irritation sign was usually the only physical finding. Blood tests were not significant. In acute diverticulitis, the pain was more evenly distributed throughout the lower abdomen and findings like nausea, fever, and leukocytosis were more frequently associated than in PEA. Computed tomography findings, such as pedunculated oval fatty mass with streaky densities connected to the serosal surface of the adjacent colon, can lead to the diagnosis of PEA. Symptoms of PEA were resolved within 1 week (mean, 4.7 days) without surgery.
Conclusions:
When patients with very 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.
Insights
Primary epiploic appendagitis (PEA) is an uncommon cause of abdominal pain. Early imaging is key for diagnosis when localized pain lacks other symptoms, aiding differentiation from diverticulitis.
Area of Science:
- Gastroenterology
- Abdominal Imaging
- Surgical Pathology
Background:
- Primary epiploic appendagitis (PEA) is a rare cause of abdominal pain, often mistaken for appendicitis or diverticulitis.
- It arises from appendageal torsion or venous thrombosis.
Purpose of the Study:
- To compare the clinical and radiologic features of PEA with acute diverticulitis.
- To improve diagnostic accuracy for PEA.
Main Methods:
- Retrospective review of 8 patients with PEA.
- Comparison with 18 patients diagnosed with acute diverticulitis.
- Analysis of clinical presentation, physical findings, laboratory tests, and computed tomography (CT) scans.
Main Results:
- PEA patients presented with localized lower abdominal pain, typically without fever, nausea, or leukocytosis.
- Acute diverticulitis cases showed more diffuse pain and systemic symptoms.
- CT scans revealed a characteristic pedunculated fatty mass for PEA diagnosis.
- PEA resolved within a week without surgery.
Conclusions:
- Localized abdominal pain without systemic signs or lab abnormalities warrants suspicion for PEA.
- Early radiologic imaging, particularly CT, is crucial for accurate diagnosis.
- Distinguishing PEA from diverticulitis avoids unnecessary interventions.