Torsion of the primary epiploic appendagitis: a case series and review of the literature

Am J Surg. 2010 Apr;199(4):453-8. doi: 10.1016/j.amjsurg.2009.02.004. Epub 2009 Jun 11.

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.

Publication types

  • Review

MeSH terms

  • Abdomen, Acute / diagnostic imaging
  • Abdomen, Acute / etiology*
  • Abdominal Pain / diagnostic imaging
  • Abdominal Pain / etiology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Appendicitis / diagnosis*
  • Appendicitis / diagnostic imaging
  • Appendix / abnormalities*
  • Appendix / diagnostic imaging
  • Diagnosis, Differential
  • Female
  • Gangrene / diagnosis
  • Gangrene / surgery
  • Humans
  • Laparoscopy
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed
  • Torsion Abnormality / diagnosis*
  • Torsion, Mechanical