Clinical aspects of Primary Epiploic Appendagitis / 대한내과학회지

BACKGROUND: Primary epiploic appendagitis is rarely diagnosed preoperatively and usually results from torsion with subsequent infarction epiploic appendage. Until recent years no diagnostic procedures or clinical symptoms were pathognomic for this disease and the most common preoperative diagnosis were acute diverticulitis and appendicitis. Rapid advance of imaging technique, especially ultrasound, makes it possible to get image of diseased epiploic appandage. Also primary epiploic appendagitis occurs more frequently than it has been suggested in the literature. Therefore authors analyzed and reviewed clinical features and radiological findings of 15 cases with primary epiploic appendagitis to give attention to the acute epiploic appendagitis as one of the ways for diagnosing the acute abdominal pain that has unclear diagnosis, thinking that the rapid diagnosis will helpful to escaping the unnecessary operations. METHODS: This study included twelve men and three women(aged 20-60years). Surgery was done in two patients, one misdiagnosed for acute appendicitis and another for acute diverticulitis with abscess. Follow up examinations were performed with US and CT(n=3), with US, CT and MRI(n=2) and with clinical course (n=13). RESULTS: All patients had localized abdominal pain and tenderness, mostly in the left lower quadrants (n=12). Duration of pain was 3.3 days (1-15days). Two patients had mild fever and two patients had nausea. Leukocytosis was found in four patients. In all cases US revealed a solid hyperechoic(n=13) or isoechoic(n=2) non-compressible ovoid mass with hypoechoic rim. The masses were located under the site of maximum tenderness. CT and MRI finding were compatible with US. CONCLUSION: Primary epiploic appendagitis can be diagnosed pre-operatively using recent imaging technique, and US finding is fairly characteristic. This disorder is not so rare entity as previously known and must be included in the differential diagnosis of acute unexplained abdominal pain in adults.

A Case of Gastric Actinomycosia after Gastrectomy for Early Gastric Cancer / 대한소화기내시경학회지

Primary gastric actinomycosis is an extremely rare disease and less than 20 cases are reported in literature. We experienced a case of gastric actinomycosis in the 63-year-old woman who had subtotal gastrectomy for early gastric cancer(type IIc) 7 month ago. Endoscopic biopsy from elevated lesion on stoma was found to show the neutrophilic infiltration and sulfur granule. She placed on tetracycline for 30 days. Follow up endoscopy showed no abnormality. We report this case with literature review. (Koresn J Gastrointest Endosc 18: 757~ 760, 1996)