[Epiploic appendagitis: an underestimated self-limiting acute abdominal condition]
A C van Breda Vriesman1, J C de Mol van Otterloo, J B Puylaert
1Afd. Radiologie, Medisch Centrum Haaglanden, locatie Westeinde Ziekenhuis, Postbus 432, 2501 CK Den Haag.
Objective:
To describe the clinical findings in patients with epiploic appendagitis and to evaluate its natural course.
Design:
Retrospective.
Method:
A review of the medical records was carried out for all patients who were diagnosed with epiploic appendagitis using ultrasonography and computed tomography (CT), during the period June 1988-October 2001, at the Haaglanden Medical Centre (Westeinde site), The Hague, the Netherlands.
Results:
The study group consisted of 49 patients, 38 men and 11 women, with a median age of 41 years. The main symptom was focal abdominal pain, with a median diagnostic delay in the patients of 2 days, located in the left lower quadrant (n = 34), right lower quadrant (n = 8), right upper quadrant (n = 6) or left upper quadrant (n = 1) of the abdomen. No other complaints were present with the exception of nausea and vomiting in two patients. Leucocytosis was found in 21% of patients, the erythrocyte sedimentation rate was elevated in 26% of the patients, and signs of peritoneal irritation were found in 53% of the patients. Epiploic appendagitis was correctly included in the clinical differential diagnosis of 2 patients. All of the patients made a complete and uncomplicated recovery under conservative treatment; the majority were symptom-free within 9 days.
Conclusion:
Due to the increased use of diagnostic imaging in patients with acute abdominal symptoms, epiploic appendagitis is much more frequently diagnosed than before. Presenting symptoms of epiploic appendagitis are non-specific, leading to misdiagnosis in most cases. Epiploic appendagitis has a benign natural course and if patients are correctly diagnosed using ultrasonography and CT, unnecessary surgery and medical treatment may be avoided.
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