The combined application of low and high frequency ultrasound in the diagnosis of 130 cases of acute primary epiploic appendagitis / 天津医药

@#Objective To summarize the experience of combined application of low and high frequency ultrasound in the diagnosis of acute primary epiploic appendagitis. Methods The clinical data of 130 patients with acute primary epiploic appendagitis confirmed by operation or other clinical examinations were retrospectively analyzed. Results All the 130 patients were found homogenous or heterogeneous solid block in the area of the abdominal pressure point. Four patients were treated by operation and 126 patients were cured by symptomatic supportive treatment. There were no serious complications in all patients. Conclusion Ultrasonography plays an important role in the diagnosis and differential diagnosis of acute primary epiploic appendagitis.

MSCT findings and clinical diagnostic value of acute primary epiploic appendagitis / 实用放射学杂志

Objective To analyze the MSCT characteristics in patients with acute primary epiploic appendagitis(PEA)and to explore the clinical diagnostic value.Methods The complete MSCT examination data,surgical pathology and follow-up results of 1 2 patients with acute PEA in our hospital were analyzed retrospectively.Results In 1 2 cases of acute PEA,the locations of lesion were:beside the sigmoid colon in 5 cases,beside the descending colon in 4 cases,beside the ascending colon in 2 cases and beside the cecum in 1 case;the lesion morphologies were:round or oval in 9 cases,lobulated changes in 3 cases;the lesions were all lipid density;1 2 cases showed a ring-shaped high-density shadow on the edge;1 1 cases of lesions showed high-density shadow in the center,1 case of lesion showed no high density shadow in the center;in 8 cases,there were stripe-shaped high-density exudation shadow around the fat space;only 2 lesions showed thickening of the adjacent colon wall;and in two cases,the edges of lesions in the enhanced scanning showed annular enhancement.Conclusion Acute PEA has characteristic features in the examination of MSCT (oval or ring-like fat density mass,central punctate high-density shadow,high-density marginal ring sign with or without peripheral inflammatory exudation changes). Combining the multiplanar reconstruction(MPR),it can clarify the diagnosis and show conditions of the surrounding tissue,providing important value for clinical treatment.

Apendagitis epiploica primaria: Clínica y evolución de 73 casos

La apendagitis epiploica primaria es una enfermedad relativamente infrecuente dentro de los diagnósticos diferenciales del abdomen agudo. Describimos las características clínicas y evolución de una serie de 73 casos de apendagitis epiploica primaria. Se realizó una búsqueda de imágenes ecográficas y tomográficas con diagnóstico de apendagitis en el sistema de información hospitalario electrónico del Hospital Alemán entre abril del 2007 y julio del 2013 y posteriormente se revisaron sus historias clínicas. Se incluyeron 73 casos; la edad promedio fue de 45 años (± 16), 54 (74%) eran varones. El motivo de consulta fue dolor abdominal: en fosa ilíaca izquierda en 65 (el 89% de los casos); en fosa ilíaca derecha en seis (8%) y en otras localizaciones en dos (3%). Se les realizó ecografía abdominal a 44 (60%), tomografía computarizada a 21 (29%), y ambos estudios a 8 (11%). En el 49% de los casos se solicitó interconsulta con el servicio de cirugía. Recibieron tratamiento con antibióticos 15 (21%) pacientes, de los cuales el 73% fue indicado por un médico clínico. Recibieron tratamiento ambulatorio con antiinflamatorios no esteroides 67 (92%); dos requirieron cirugía laparoscópica, dos internación y dos opiáceos. La apendagitis epiploica es infrecuente dentro de los diagnósticos diferenciales de abdomen agudo, pero es una entidad que no debe ser desconocida por los médicos para prevenir intervenciones innecesarias y el uso excesivo de antibióticos.

Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74%) were men. Abdominal pain (left lower quadrant in 89% of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60%) of patients, computed tomography on 21 (29%), and both studies on 8 (11%) of cases in this series. In 49% of cases surgery consultation was requested. Fifteen patients (21%) were treated with antibiotics, 73% of them were prescribed by a clinician. Sixty seven patients (92%) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.

Primary Epiploic Appendagitis in Children: Report of Two Cases

Primary epiploic appendagitis (PEA) is a condition that results from spontaneous torsion, ischemia, or inflammation of an epiploic appendage. This condition is manifested by localized abdominal pain and tenderness, which is often mistaken for diverticulitis or appendicitis in the adult population. PEA is a self-limiting disease, and differential diagnosis with surgical condition is important in order to prevent unnecessary surgery. Although it is commonly reported in adults, it is rarely reported in the pediatric population. We report on the radiologic findings of two cases of PEA in a 12- and a 17-year-old boy, focusing on sonographic findings.

A Case of Primary Epiploic Appendagitis

Primary epiploic appendagitis (PEA) is an uncommon cause of acute abdominal pain that occurs either from appendageal torsion or spontaneous thrombosis of an appendageal vein. It is a benign condition that may present with peritoneal findings. Thus, it is rarely considered in the differential diagnosis of intra-abdominal disease. Until recently, an accurate diagnosis could not be made preoperatively. With the aid of contemporary imaging modalities, however, the diagnosis of PEA need no longer hinge on the pathologic specimen, but may be established by the emergency physician. Common findings include left lower quadrant pain and guarding. Nonmigratory symptoms should also prompt the clinician to consider a CT scan in patients with similar signs and symptoms. Knowledge of this uncommonly diagnosed entity and its usual benign course may allow the emergency physician to order the appropriate studies to help avoid unnecessary surgical treatment. The anatomy, the clinical presentation, the radiologic evaluation, and the emergency management of epiploic appendagitis are reviewed with the literature.