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      Acute Appendagitis Presenting with Features of Appendicitis: Value of Abdominal CT Evaluation

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          Abstract

          We report a case of acute appendagitis in a patient who presented initially with typical features of acute appendicitis. The diagnosis of acute appendagitis was made on pathognomonic signs on computed tomography (CT) scan. Abdominal pain is a common surgical emergency. CT is not always done if there are clear features of acute appendicitis. The rare but important differential diagnosis of acute appendagitis must be borne in mind when dealing with patients with suspected acute appendicitis. A CT scan of the abdomen may avoid unnecessary surgery in these patients.

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          Most cited references 12

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          Acute epiploic appendagitis and its mimics.

          Acute epiploic appendagitis most commonly manifests with acute lower quadrant pain. Its clinical features are similar to those of acute diverticulitis or, less commonly, acute appendicitis. The conditions that may mimic acute epiploic appendagitis at computed tomography (CT) include acute omental infarction, mesenteric panniculitis, fat-containing tumor, and primary and secondary acute inflammatory processes in the large bowel (eg, diverticulitis and appendicitis). Whereas the location of acute epiploic appendagitis is most commonly adjacent to the sigmoid colon, acute omental infarction is typically located in the right lower quadrant and often is mistaken for acute appendicitis. It is important to correctly diagnose acute epiploic appendagitis and acute omental infarction on CT images because these conditions may be mistaken for acute abdomen, and the mistake may lead to unnecessary surgery. The CT features of acute epiploic appendagitis include an oval lesion 1.5-3.5 cm in diameter, with attenuation similar to that of fat and with surrounding inflammatory changes, that abuts the anterior sigmoid colon wall. The CT features of acute omental infarction include a well-circumscribed triangular or oval heterogeneous fatty mass with a whorled pattern of concentric linear fat stranding between the anterior abdominal wall and the transverse or ascending colon. As CT increasingly is used for the evaluation of acute abdomen, radiologists are likely to see acute epiploic appendagitis and its mimics more often. Recognition of these conditions on CT images will allow appropriate management of acute abdominal pain and may help to prevent unnecessary surgery. RSNA, 2005.
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            Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis

            Background Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal pathology. It can mimick diverticulitis or appendicitis on clinical exam. The diagnosis of EA is very infrequent, due in part to low or absent awareness among general surgeons. The objective of this work was to review the authors' experience and describe the clinical presentation of EA. Methods All patients diagnosed with EA between January 2004 and December 2006 at an urban surgical emergency room were retrospectively reviewed by two authors in order to share the authors' experience with this rare diagnosis. The operations were performed by two surgeons. Pathological examinations of specimens were performed by a single pathologist. A review of clinical presentation is additionally undertaken. Results Ten patients (3 females and 7 males, average age: 44.6 years, range: 27–76 years) were diagnosed with symptomatic EA. Abdominal pain was the leading symptom, the pain being localized in the left (8 patients, 80 %) and right (2 patients, 20%) lower quadrant. All patients were afebrile, and with the exception of one patient, nausea, vomiting, and diarrhea were not present. CRP was slightly increased (mean: 1.2 mg/DL) in three patients (33%). Computed tomography findings specific for EA were present in five patients. Treatment was laparoscopic excision (n = 8), excision via conventional laparotomy (n = 1) and conservative therapy (n = 1). Conclusion In patients with localized, sharp, acute abdominal pain not associated with other symptoms such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of EA should be considered. Although infrequent up to date, with the increase of primary abdominal CT scans and ultrasound EA may well be diagnosed more frequently in the future.
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              Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases.

              To describe the appearance at ultrasonography (US) of primary epiploic appendagitis in correlation with computed tomographic (CT) findings. From January 1992 through June 1993, clinical, US, and CT findings were reviewed in 14 patients with primary epiploic appendagitis (seven men and seven women, aged 25-51 years [mean, 39 years 3 months]). Follow-up examinations were performed with US alone (n = 4), with US and CT (n = 3), and with clinical examination (n = 14). Surgery was performed in two patients. The main symptoms were right (n = 3) or left (n = 11) flank pain. US revealed an echogenic mass that was small, ovoid, and noncompressible, located anterolateral to the right colon (n = 3), anterior or anterolateral to the left colon (n = 10), and anteromedial to the left colon (n = 1). CT helped confirm the presence of a fatty lesion in each patient without other inflammatory process in the abdomen. Symptoms resolved within 7 days in 12 patients. Primary epiploic appendagitis has fairly characteristic US and CT features that enable a rapid diagnosis.
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                Author and article information

                Journal
                Case Rep Gastroenterol
                CRG
                Case Reports in Gastroenterology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1662-0631
                May-Aug 2008
                24 May 2008
                24 May 2008
                : 2
                : 2
                : 191-195
                Affiliations
                aDepartment of Gastroenterology, Ealing Hospital, London, UK
                bDepartment of Radiology, Ealing Hospital, London, UK
                Author notes
                *Prof. Jayantha Arnold, Consultant Gastroenterologist, Ealing Hospital, Uxbridge Road, Southall, Middlesex, UB1 3HW (UK), Tel. +44 208 967 5513, Fax +44 208 967 5083, E-Mail jayanthaarnold@ 123456hotmail.com
                Article
                crg0002-0191
                10.1159/000133827
                3075141
                21505556
                Copyright © 2008 by S. Karger AG, Basel

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License ( http://creativecommons.org/licenses/by-nc-nd/3.0/). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

                Page count
                Figures: 3, References: 11, Pages: 5
                Categories
                Published: May 2008

                Gastroenterology & Hepatology

                appendagitis, appendicitis, ct scan

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