Primary epiploic appendagitis: a diagnostic challenge, clinical spectrum and experience from a tertiary care centre

Background: Acute Epiploic Appendagitis is a self limiting disease due to ischaemic infarction of an epiploic appendix.Diagnosis is difficult clinically due to the lack of pathognomonic clinical features, a sudden onset of sharp localized pain either in the left or right iliac fossa with minimal gastrointestinal symptoms, which can simulate a surgical clinical picture. Awareness of imaging findings of this entity is important to arrive at a correct diagnosis and to avoid unnecessary hospitalization and surgery.

Methods: 15 patients diagnosed with EA were evaluated and analysed for demographic factors clinical presentation and diagnostic radiological features. Comparision was also done with data in patients of earlier reported series.

Results: 15 patients (5 females and 10 males, average age: 43.6 years, range: 24–73 years) were diagnosed with symptomatic EA. Abdominal pain was the leading symptom, the pain being localized in the left (8 patients, 53 %) and right (3 patients, 20%) lower quadrant. Except two all patients were afebrile, and with the exception of three patient, nausea, vomiting, and diarrhea were not present. CRP was slightly increased (mean: 1.4 mg/DL) in three patients (33%). Computed tomography findings specific for EA were present in five patients. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. In all cases except two, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Two patient (13%) with left PEA showed leukocytosis,

Conclusion: Epiploic appendagitis was more frequent in males. Abdominal pain was located in the lower quadrant, more predominant in the left than right. Blood tests were normal except for increased levels of C-reactive protein. Diagnosis was made mostly preoperatively due to imaging tests, avoiding unnecessary surgical intervention. In patients with localized, sharp, acute abdominal pain not associated with other symptoms such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of EA should be considered. In patients with acute abdomen & localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA necessary.