A Case of Primary Epiploic Appendagitis

ABSTRACT

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.