Clinical surgery-International
Torsion of the primary epiploic appendagitis: a case series and review of the literature

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Abstract

Background

Differential diagnosis and appropriate treatment of epiploic appendagitis (EA) is a dilemma for general surgeons because of nonspecific signs and symptoms.

Methods

Twelve patients (3 women and 9 men, average age 40 years, range 18–82 years) who were diagnosed as having EA upon presenting to the emergency department or at the time of discharge between April 2002 and September 2008 were included.

Results

The major presenting symptom was abdominal pain. Physical examination revealed well-localized tenderness in all cases (n = 12); in addition, rebound tenderness and distention were also observed. Laboratory blood tests were normal except for 4 patients who had leukocytosis. Seven cases were diagnosed by an abdominal computed tomography scan. Five patients required surgical intervention, whereas the remaining did not.

Conclusions

Surgeons should be aware of this self-limiting disease that mimics many other intra-abdominal acute conditions. An abdominal computed tomography scan has a significant role in accurate diagnosis of EA before surgery to avoid unnecessary surgical interventions.

Section snippets

Patients and Methods

Data for the presented cases were collected from Ufuk University Faculty of Medicine Department of Surgery (n = 2) and Ankara Guven Hospital Emergency Service (n = 10) between April 2002 and September 2008. Among 2,500 visits annually in each hospital, 12 patients (3 women and 9 men) were diagnosed with symptomatic EA, and the mean age was 40 years (range 18–82 years). All patients were evaluated by the same clinician (first author) and diagnosed as EA either in the emergency room or at final

Results

Patients presented at the hospital between 1 and 10 days after the initial symptoms had arisen. Most patients (n = 10) had dull, constant pain either in the right (n = 3 patients, 30%) or left lower quadrant (n = 7 patients, 70%). Most of them (n = 10) denied complaints such as anorexia, nausea, vomiting, diarrhea, hematochezia, melena, fever, chills, and sweats. In addition, 1 patient had recurrent urinary tract symptoms. Two patients had general abdominal pain with nausea and vomiting and

Comments

EA was first anatomically described by Vesalius in 1543, but their surgical significance was not realized until 1843 when Virchow suggested that their detachment might be a source of free intraperitoneal loose body.5, 6 EA is typically .5 to 5-cm long and 1 cm to 2 cm thick and has no known function. The total number is approximately 100 and generally located along the sigmoid colon (57%) and ileocecum (26%).7, 8, 9 Our study at this point showed that the sigmoid colon appears to be the most

Conclusions

Diagnosis and treatment of EA is still a challenge for surgeons because of its nonspecific signs and symptoms. However, the increasing use of abdominal CT scans in the diagnosis of abdominal pain is leading clinicians to become more familiar with this disease. Finally, we suggest that when combined with appropriate imaging techniques, EA patients with a consistent clinical history and physical examination have the opportunity to be managed conservatively.

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