scholarly journals Epiploic Appendagitis: An Often Misdiagnosed Cause of Acute Abdomen

2019 ◽  
Vol 13 (3) ◽  
pp. 364-368
Author(s):  
Vishnu Charan Suresh Kumar ◽  
Kishore Kumar Mani ◽  
Hisham Alwakkaa ◽  
James Shina
Keyword(s):  
Abdominal Pain ◽  
Bowel Wall ◽  
Acute Diverticulitis ◽  
Lower Abdominal Pain ◽  
Wall Thickening ◽  
Antibiotic Administration ◽  
Epiploic Appendagitis ◽  
High Attenuation ◽  
History Of ◽  
Bowel Wall Thickening

Epiploic appendages are peritoneal structures that arise from the outer serosal surface of the bowel wall towards the peritoneal pouch. They are filled with adipose tissue and contain a vascular stalk. Epiploic appendagitis is a rare cause of acute lower abdominal pain. It most commonly results from torsion and inflammation of the epiploic appendages, and its clinical features mimic acute diverticulitis or acute appendicitis resulting in being often misdiagnosed as diverticulitis or appendicitis. This frequently leads to unnecessary hospitalization, antibiotic administration, and unwarranted surgeries. Epiploic appendagitis is usually diagnosed with CT imaging, and the classic CT findings include: (i) fat-density ovoid lesion (hyperattenuating ring sign), (ii) mild bowel wall thickening, and (iii) a central high-attenuation focus within the fatty lesion (central dot sign). It is treated conservatively, and symptoms typically resolve in a few days. Therefore, epiploic appendagitis should be considered as one of the differential diagnosis for acute lower abdominal pain and prompt diagnosis of epiploic appendagitis can avoid unnecessary hospitalization and surgical intervention. In this case report, we discuss a 72-year-old woman who presented with a 2-day history of acute left lower abdominal pain.

scholarly journals CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Dario Giambelluca ◽  
Roberto Cannella ◽  
Giovanni Caruana ◽  
Leonardo Salvaggio ◽  
Emanuele Grassedonio ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Acute Diverticulitis ◽  
Abdominal Cavity ◽  
Imaging Features ◽  
Imaging Findings ◽  
Hernia Sac ◽  
Epiploic Appendagitis ◽  
High Attenuation ◽  
Epiploic Appendage

AbstractEpiploic appendagitis is a rare cause of acute abdominal pain, determined by a benign self-limiting inflammation of the epiploic appendages. It may manifest with heterogeneous clinical presentations, mimicking other more severe entities responsible of acute abdominal pain, such as acute diverticulitis or appendicitis. Given its importance as clinical mimicker, imaging plays a crucial role to avoid inaccurate diagnosis that may lead to unnecessary hospitalization, antibiotic therapy, and surgery. CT represents the gold standard technique for the evaluation of patients with indeterminate acute abdominal pain. Imaging findings include the presence of an oval lesion with fat-attenuation surrounded by a thin hyperdense rim on CT (“hyperattenuating ring sign”) abutting anteriorly the large bowel, usually associated with inflammation of the adjacent mesentery. A central high-attenuation focus within the fatty lesion (“central dot sign”) can sometimes be observed and is indicative of a central thrombosed vein within the inflamed epiploic appendage. Rarely, epiploic appendagitis may be located within a hernia sac or attached to the vermiform appendix. Chronically infarcted epiploic appendage may detach, appearing as an intraperitoneal loose calcified body in the abdominal cavity. In this review, we aim to provide an overview of the clinical presentation and key imaging features that may help the radiologist to make an accurate diagnosis and guide the clinical management of those patients.

scholarly journals Caecal Epiploic Appendagitis Masquerading Clinically as an Acute Appendicitis: A Case Report and Brief Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Tallat Ejaz ◽  
Eltaib Saad ◽  
Andik Nabil ◽  
James Slattery
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Good Health ◽  
Final Diagnosis ◽  
Epiploic Appendagitis ◽  
Rebound Tenderness ◽  
History Of ◽  
The Right

A 46-year-old female presented to our emergency department (ED) with a 2-day history of right lower abdominal pain which was associated with nausea and anorexia. Abdominal examination revealed tenderness in the right iliac fossa (RIF) with rebound tenderness and a localized guarding. Urine dipstick was normal, and the pregnancy test was negative. Her laboratory investigations were significant only for a CRP of 16.6. A presumptive clinical diagnosis of acute appendicitis was suggested based on the given history and relevant physical signs. However, an abdominal computed tomography (CT) scan revealed an epiploic appendagitis of the caecum with a normal-looking appendix. She was managed conservatively and responded well and was discharged after 2 days in good health. Though being a relatively rare case of acute localized right-sided lower abdominal pain, caecal epiploic appendagitis should be considered as one of the differential diagnoses with the final diagnosis reached usually by the radiological findings due to the nonspecific nature of clinical and laboratory features.

scholarly journals Intestinal Bowel Wall Thickening Analysis on MDCT: A Retrospective Study

2020 ◽  
Vol 8 (1) ◽  
pp. 106-109
Author(s):  
Jefrin Roy Mathew ◽  
A Parthasarathi ◽  
BT Deepthi ◽  
U Harsha
Keyword(s):  
Computed Tomography ◽  
Inflammatory Bowel Disease ◽  
Bowel Wall ◽  
Correct Diagnosis ◽  
Wall Thickening ◽  
Common Causes ◽  
History Of ◽  
Bowel Wall Thickening ◽  
Inflammatory Bowel ◽  
Operative Findings

Background: The aim of this study was to determine the causes and establish the significance of bowel wall thickening on abdominal computed tomography. Subjects and Methods: Consecutive abdominal CT’s between January 2019 and December 2019 with findings of duodenal, jejunal, ileal and colonic ‘bowel wall thickening ‘on the formal report was reviewed retrospectively. The patients history, inpatient course & subsequent colonoscopy and /or operative findings were also reviewed. Results: Of the 88 consecutive CT abdomen’s identified, infection (26.1%) and new cancer (22.7%) were the most common causes. Bowel obstruction (12.5%) and Inflammatory Bowel Disease (10.2%) were relatively uncommon causes. Overall 40/88 (45%) & 14/88 (15%) patients underwent subsequent colonoscopy and progressed directly to surgery respectively; of these 36/40 (90%) of the former and 14/14 (100%) of the latter showed findings similar to CT. Conclusion: When thickening of the bowel is detected with CT; pattern of the thickening, accompanying findings, history of the patient and clinical features must be evaluated together to reach prompt and correct diagnosis. All cases detected with bowel wall thickening on CT abdomen should warrant a subsequent colonoscopy.

Clinical and Endoscopic Significance of Bowel-Wall Thickening Reported on Abdominal Computed Tomographies in Symptomatic Patients with No History of Gastrointestinal Disease

2014 ◽  
Vol 65 (1) ◽  
pp. 67-70 ◽  
Author(s):  
Saad S. Al-Khowaiter ◽  
Mayur Brahmania ◽  
Edward Kim ◽  
Mark Madden ◽  
Alison Harris ◽  
...  
Keyword(s):  
Bowel Wall ◽  
Gastrointestinal Disease ◽  
Primary Objective ◽  
Vancouver General Hospital ◽  
Wall Thickening ◽  
Inclusion Criteria ◽  
Infectious Colitis ◽  
Endoscopic Findings ◽  
History Of ◽  
Bowel Wall Thickening

Background Bowel-wall thickening (BWT) is a commonly reported finding on diagnostic abdominal pelvic computed tomographies (CT) in patients with no history of gastroenterologic disease. The significance of this nonspecific finding is not clear. Methods Medical records from the Vancouver General Hospital were reviewed from October 27, 1999, to October 27, 2009. The initial search yielded 5696 cases, of which 76 cases met the inclusion criteria for review. Inclusion criteria were the following: age older than 18 years, symptoms without a diagnosis of gastrointestinal disease before CT, the reported finding of terminal ileal and/or colonic BWT, colonoscopy after CT, and/or microbiologic investigations. Exclusion criteria included known gastrointestinal disease before CT. The primary objective was to determine if BWT could be associated with a significant endoscopic pathology. The secondary objective was to determine whether the pattern of abnormality on the CT was associated with a specific endoscopic finding. Results A total of 76 patients met the inclusion criteria of our study. Of those, 76% had various identifiable pathologies on colonoscopy. Only 24% had normal colonoscopic findings. Inflammatory bowel disease (IBD) and infectious colitis were the most common causes of BWT. A report of “skip lesions” on the CT (5%) was always associated with IBD. “Pancolitis” reported on the CT (11%) was associated with endoscopic findings of IBD in 25% of cases, infection in 50% of cases, and normal findings in 25% of cases. The report of “stranding” (36%) on CT in the presence of BWT was associated with many non-neoplastic endoscopic pathologic processes, including infectious colitis (22%), IBD (19%), and ischemia (15%), but also was associated with normal endoscopic findings in 26% of the cases. “Lymphadenopathy” was reported in 17% of the CTs and was associated with infectious colitis (30%), IBD (38%), or neoplastic processes (15%) but also normal endoscopic findings in 15%. Conclusion Symptomatic patients who are found to have nonspecific BWT on CT should undergo definitive endoscopic investigation because the majority will have significant gastroenterologic disease, and only a minority will have a normal colonoscopy.

An adolescent with acute abdominal pain and bowel wall thickening

2016 ◽  
Vol 103 (1) ◽  
pp. 22-24 ◽  
Author(s):  
Giorgio Cozzi ◽  
Lorenzo Calligaris ◽  
Claudio Germani ◽  
Daniela Sanabor ◽  
Egidio Barbi
Keyword(s):  
Abdominal Pain ◽  
Bowel Wall ◽  
Acute Abdominal Pain ◽  
Wall Thickening ◽  
Bowel Wall Thickening

Correlation of Bowel Wall Thickening Seen Using Computerized Tomography With Colonoscopies

2017 ◽  
Vol 27 (3) ◽  
pp. 154-157 ◽  
Author(s):  
Arda Isik ◽  
Mehmet Soyturk ◽  
Sakir Süleyman ◽  
Deniz Firat ◽  
Kemal Peker ◽  
...  
Keyword(s):  
Computerized Tomography ◽  
Bowel Wall ◽  
Wall Thickening ◽  
Bowel Wall Thickening

CT Evaluation of Target-like Bowel Wall Thickening

1997 ◽  
Vol 36 (2) ◽  
pp. 271
Author(s):  
In Young Bae ◽  
Mi Young Kim ◽  
Chang Hea Suh ◽  
Soon Gu Cho ◽  
Jin Hee Kim ◽  
...  
Keyword(s):  
Bowel Wall ◽  
Wall Thickening ◽  
Ct Evaluation ◽  
Bowel Wall Thickening

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

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