ABSTRACT
Epiploic appendagitis (EA) is an uncommon condition caused by infarction of epiploic appendages "small fat outpouchings present on the outside of the colon wall" because of torsion or thrombosis of the main draining vein. It is sometimes misdiagnosed as diverticulitis or appendicitis. Lab tests usually are normal, and the diagnosis is mainly by computerized tomography (CT) scan. Treatment is conservative as it is a self-limited condition, and the symptoms will resolve spontaneously within 2 weeks. However, surgical appendage removal could be necessary if symptoms increase or continue. Here, we report our experience with a 21-year-old male patient, who presented with a 1-day duration of localized right lower quadrant (RLQ) abdominal pain within 18*10 cm incisional hernia, imaging revealed signs of epiploic appendages infarction within the huge incisional hernia. This case describes an atypical scenario for EA, which was successfully managed with surgery. The final pathology report confirms the diagnosis.
ABSTRACT
A man in his mid-50s presented with heaviness in the right lower abdomen for the last three months. Ultrasonography (USG) showed an intra-abdominal mass in the right iliac fossa. Contrast-enhanced CT (CECT) revealed a well-defined circumscribed mass near the ileocaecal junction, with a hypodense center, surrounded by a hyperdense periphery and well-defined capsule. A lower midline laparotomy was performed. Intraoperatively, a white, firm, smooth ball-like mass was found, lying freely in the abdomen. Histopathology revealed fatty tissues surrounded by a calcified shell, which was further surrounded by proteinaceous material. Such peritoneal loose bodies (PLBs) are free masses in the abdomen, with variable sizes. These are asymptomatic, unless they compress any nearby viscera, as was in our case. The objective of this case report is to make surgeons and radiologists aware of this rare entity, which can be a source of confusion in a case of mass in the abdomen.
ABSTRACT
In children, epiploic appendagitis has been seldom reported. We describe two children with clinical presentations mimicking appendicitis. A correct diagnosis was eventually achieved by magnetic resonance imaging (MRI) and confirmed at laparoscopy in the initial case. Our preliminary experience suggests that MRI is a valid and non-invasive alternative to computed tomography for characterization of unusual causes of pediatric abdominal pain in the acute hospital care setting.
Subject(s)
Abdominal Pain/diagnosis , Appendicitis/diagnosis , Magnetic Resonance Imaging/methods , Abdominal Pain/etiology , Appendectomy/methods , Appendicitis/complications , Appendicitis/surgery , Child , Child, Preschool , Diagnosis, Differential , Humans , Laparoscopy/methods , Male , Tomography, X-Ray ComputedABSTRACT
Primary epiploic appendagitis is an inflammation of the epiploic appendages occurring due to ischemic infarction as a result of appendage torsion or spontaneous thrombosis usually affecting patients from second to fifth decades, being more common in women and obese patients. It is a self-limiting entity with clinical features similar to other inflammatory abdominal processes and sometimes not remembered at clinical examinations. The awareness of this entity and its correct identification on imaging examinations could prevent unnecessary surgery. The authors present a clinical case complemented with ultrasound and CT images of this entity.
ABSTRACT
A peritoneal loose body is reported to develop because of torsion and separation of the epiploic appendages. The condition is usually symptomless and may be incidentally during abdominal surgery or autopsy. It usually occurs in middle-aged and elderly adults and is very rare in children. In this paper, we report a case of a peritoneal loose body in the pelvic cavity of a 10-year old-girl who presented with urinary frequency and left lower abdominal discomfort. A second plain X-ray film of the abdomen, obtained before surgery, in a different view than the first, revealed that the calcified mass had migrated to a lower position. The mass was laparoscopically resected, and histological examination revealed it to be a fibrotic nodule with central liquefaction and calcification.
