Clinical Characteristics of Primary Epiploic Appendagitis
Choi Young-Un, 최평화, 박용환, 김재일, 허태길, 박제훈, 이명수, 김철남, 장석효, 서정욱,
소속 상세정보
( Choi Young-Un )
Inje University College of Medicine Department of Surgery
최평화 ( Choi Pyong-Wha )
Inje University College of Medicine Department of Surgery
박용환 ( Park Yong-Hwan )
Inje University College of Medicine Department of Surgery
김재일 ( Kim Jae-Il )
Inje University College of Medicine Department of Surgery
허태길 ( Heo Tae-Gil )
Inje University College of Medicine Department of Surgery
박제훈 ( Park Je-Hoon )
Inje University College of Medicine Department of Surgery
이명수 ( Lee Myung-Soo )
Inje University College of Medicine Department of Surgery
김철남 ( Kim Chul-Nam )
Inje University College of Medicine Department of Surgery
장석효 ( Chang Surk-Hyo )
Inje University College of Medicine Department of Surgery
서정욱 ( Seo Jeong-Wook )
Inje University College of Medicine Department of Radiology
KMID : 0356720110270030114
Abstract
Purpose: Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis.
Methods: We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications.
Results: In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 ± 11.9 vs. 69.7 ± 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 ± 2.9 vs. 22.6 ± 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001).
Conclusion: In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.
키워드
Epiploic appendagitis; Diverticulitis; Acute abdomen
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