Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence

Area of Science:

• Gastroenterology
• Abdominal Imaging
• Surgical Pathology

Background:

• Limited comparative data exists for left-sided primary epiploic appendagitis (PEA) versus left-sided acute colonic diverticulitis (ACD).
• Similarly, data comparing right-sided PEA and right-sided ACD is scarce.

Purpose of the Study:

• To compare the clinical characteristics and recurrence rates of left-sided PEA versus left-sided ACD.
• To compare the clinical characteristics and recurrence rates of right-sided PEA versus right-sided ACD.

Main Methods:

• Retrospective review of medical records and CT scans for patients with acute abdominal pain.
• Inclusion criteria: radiological signs of PEA or ACD on CT scan between January 2004 and December 2014.
• Comparison of clinical features between left PEA vs. left ACD and right PEA vs. right ACD.

Main Results:

• 56 patients diagnosed with PEA (27 left-sided, 29 right-sided) and 308 with ACD (24 left-sided, 284 right-sided).
• Left-sided PEA patients were significantly younger (50.2 vs. 62.1 years), more obese (BMI 26.3 vs. 22.3 kg/m2), and had lower hsCRP levels (1.2 vs. 8.4 mg/dL) compared to left-sided ACD.
• Discriminative functions: age ≤ 59 years (0.71), BMI > 24.5 kg/m2 (0.83), and CRP < 1.8 mg/dL (0.80) for differentiating left-sided PEA from ACD.

Conclusions:

• Clinicians should suspect PEA over ACD in patients with left lower quadrant pain who are under 60 years old.
• Obesity (BMI > 24.5 kg/m2) and normal to mildly elevated CRP levels (CRP < 1.8 mg/dL) further support a PEA diagnosis.
• These clinical factors can aid in differentiating PEA from ACD, potentially improving diagnostic accuracy.