Clinical Study of Primary Epiploic Appendagitis Diagnosed in an Emergency Department

ABSTRACT

PURPOSE: Primary epiploic appendagitis (PEA) is a rare cause of focal abdominal pain and diagnosis is very infrequent, due in part to low or absent awareness among emergency physicians. The study evaluated clinical findings, laboratory data, and computed tomography (CT) findings of PEA to aid in early diagnosis. METHODS: All patients diagnosed with PEA between December 2005 and July 2010 at an emergency department were retrospectively reviewed. The diagnosis of PEA was made by two radiologists. Clinical findings, laboratory data, and CT findings of each patient were analyzed. A p value <0.014 was considered to indicate statistical significance. RESULTS: Fourteen patients (10 men and four women; average age: 38.2 years; range: 15~65 years) were diagnosed with PEA. Abdominal pain was localized in the left side (64%) and the initial impression was diverticulitis (11 patients, 79%). Except in one patient, all patients were afebrile and had no nausea or vomiting. Mean C-reactive protein level was slightly increased (0.90 mg/dL), and mean white blood cell count was 9,855/microL. CT findings in 12 patients consisted of an oval lesion with attenuation equivalent to that of fat and with surrounding inflammatory changes. The other two patients presented with only an oval lesion without surrounding inflammatory changes. All patients were treated conservatively. CONCLUSION: In patients with localized, acute abdominal pain not associated with other symptoms or signs such as nausea, vomiting, fever, or atypical laboratory values, PEA should be suspected.